Injury to L5 Nerve

Tagged: L5 nerve

Viewing 4 posts - 1 through 4 (of 4 total)

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sunny4lady
Participant

September 28, 2019 at 2:47 pm

Post count: 2

#31205

Hi Dr. Corenman.

I would like to ask you a question, but first of all, I wanted to say that I loved your article reg. L5 injury. I found it very helpful. But I still have some questions.

The case is as such: Last year april 2018 I fell 2 stories and landed on both my heals and buttocks. This crushed both my calcaneus and 2 lumbar vertebrae – L4 + L5 (I had other injuries such as 6 broken ribs and there was also prevertabrae bleeding retroperitoneal). I was lucky I did not become paralysed. They had to do 3 surgeries on my back – 2 on the backside and 1 from in front to stabilise the cage implant that was inserted due to my L4 + L5 being completely crushed – during these operations I also bled a lot.

I was recently diagnosed with L5 nerve damage, and they did some tests that show that the nerve damage does not stem from the periphery nerves but from the L5 nerve. BUT when I asked if the L5 nerve could be compressed, they said that that was not passible, since they made sure that there is enough space between the L5 nerve and the CAGE implant.But I am in doubt since there is no MRI scan to prove this. I asked if they could do an MRI scan, but they refused due to the fact that they say that they made enough space for the nerves during surgery of my back.

My symptoms since the accident are as follows:

I can not dorsal flex right foot very much (I can to some extent), can not extend big toe of right foot, can not supinate right foot, can not invert right foot very much, I can pronate a bit my right foot, I can plantar flex my right foot and there is some eversion of my right foot (much more in comparison to how little I can invert my right foot). Also, I have decreased sensation of the lower leg on the anterior-lateral side and the top part of my foot close to my toes. BUT, since the injury there has been SOME improvement to the sensation of my lower leg and foot, and there is also some improvement in the dorsal flexion of my foot. I do however still get nerve pain OCASIONALLY on my right foot in the form of ”electric shock” sensations.
Also, the pain that I have in my lumbar region has improved a lot since the accident, it was only a few months ago that I couldn’t even sneeze while laying down as it would cause jabbing pains in my lumbar region. I still have pain if I sit for too long or carry heavy things.

So, my questions are as follows:

1. Is it possible that during surgery the CAGE implant was somehow placed so that my L5 nerve is compressed?

2. I understand from my nursing career that if the nerve is cut of peripherally, there is a chance that the nerve can grow out again 1 mm a day if the Schwansk cells did not get damaged, which would mean that my nerve could self repair. But where does one draw the line on peripheral nerves? Does it mean that the nerves that continue RIGHT after the root of the spinal cord are also considered peripheral nerves and that there is a possibility that these nerves can then regenerate?

Hope you can answer my questions.

Thank you.

Donald Corenman, MD, DC
Moderator

September 29, 2019 at 6:25 am

Post count: 8660

#31206

It does sound like you have an L5 root disorder. You are now 1 1/2 years out from your injury so it is unlikely that nerve Wallerian regeneration is going to allow the root to heal.

Even if they made plenty of room for the L5 root, bone spur formation can occur that compresses the root. I would find someone who would consider both a new MRI and a new CT scan of the lumbar spine. You have very little to lose and much possibly to gain from this imaging series.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

sunny4lady
Participant

September 29, 2019 at 10:49 am

Post count: 2

#31211

Thank you for your answer! I have an appointment with another foot surgeon in 2 weeks for a second opinion. I will def. mention the bone formation and ask again for an MRI and CT scan.

Here is some additional information:
I have a slappage gait on my right foot, and I also have weakness on my right leg (the posterior thigh muscles are weak) and have to hold on to the stair railing when walking up the stairs to get extra support.

I don’t know how to add photos here, so I created a facebook page with an album of three photos. There is a photo of the CAGE implant in my back. Then there is a photo of my right foot after surgery of my back, and this photo was taken right after they removed the plaster cast on my feet (they were put because I had a lot of edema on the feet) and if you look carefully, you can see that the big toe is straight and not under the other toes. Then there is a photo I took today, and in this photo, you can see that my big toe is under the other toes as there is no mobility in that big toe. But I noticed today that I have some edema on the top part of my foot, where I am pressing my finger in the photo. There hasn’t been any edema for over a year so this is something new that just happened out of nowhere. Do you have an idea of why this is?

Donald Corenman, MD, DC
Moderator

December 5, 2019 at 6:33 am

Post count: 8660

#31636

You might have a Trendelenberg gait, a disorder of weakness of the gluteus medius muscle due to an L5 nerve injury. (“I also have weakness on my right leg (the posterior thigh muscles are weak) and have to hold on to the stair railing when walking up the stairs to get extra support”).

The foot doctor can order the CT and MRI of your lumbar spine but don’t expect an expert opinion of the cause of your nerve root disorder.

Sorry but I had to remove your hyperlink as this is an anonymous site and I can’t have identifying information here.

Edema of the foot can be caused by may different disorders like DVT, CRPS or local injury so I cannot differentiate as to why you have local edema.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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