Back injury herniated disc

Tagged: MRI and what does it mean

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

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dransberge
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December 10, 2019 at 9:35 am

Post count: 2

#31668

Hello I was a CNA and at my last job on 3/6/19 I hurt my lower back. I have had 1 epidural shot, physical therapy, 4 facet joint injections and even saw a chiropractor with the permission from my pain management doctor who is handling my issues through Workers comp. He has me on muscle relaxers and Naproxen. The first MRI showed disc bulges and facet joint arthritis. We requested a Stand up MRI flexion where I sat in a chair this MRI came back L2/L3 a disk herniation 4mm extending into the right sided neuroforamen and Anterior vertebral spurring..My question is could this require surgery he doesnt seem to think so and has said no surgery. L3/4 2mm anterior vertabral offset Posterior bulging w/ Bilateral foraminal encroachment , anterior vertebral suprring and reactive sclerosis in the facet joint. L4/5 left sided foraminal encroachment anterior vertebral spurring is noted with reactive sclerosis in the facet joints. This doctor gave me a 3 percent MMI rating, and has went on record no surgery needed. Now I am at the mercy of losing my income and insurance, if I dont qualify for disability. My attorney said a 4mm herniation is not that big? My symptoms are as follows.
1. Lower back above tail bone center swells at times almost like their is fluid build up or bursitis

2. Pain stems from that area into the hips and burns both left and right

3. When Darlene lays back flat or tries to straighten up in proper posture she has sharp extreme pain that shoots up and down her legs , up from the swelled area.

4. Feet tingle all the time.

5. Legs feel real heavy and hard to move a lot of the time

6. Afraid to fall , because legs are so week and feet feel funny.

7. Anytime I try and straighten my spine , I set myself back a few days

8. Most times when I try to do moderate walking or exercising I set myself back a few days, few days meaning 1 thru 7.

I even tried to lift 9 lbs on my legs with weight machine did it 3 to 5 x and it hurt me and set me back again.

Extended walks hurt me and set me back , that means just walking around the yard or walking slowly a half a mile

I have to sleep in recliner because Its impossible for me to lay flat in the bed, I struggle almost every morning getting out of my chair and have to use a walker.

9. I lock up my back locks up and I have muscle spasms that shoot up and down frequently

10. The muscle relaxers are not helping neither is the Naproxen.

11. I cant raise my arms over my head while standing most times.
I need help asap!! My attorney is going to try and get the pain management doctor to sign some things to declare that I can not work in this condition but I have little faith in that. Also Comp sent me back to work. I lasted 2 hours before the nursing home nurses and director of nursing sent me back home, they said I was worse off then some of the patients they have and I was a liability.
Thanks Darlene Ransberger

Donald Corenman, MD, DC
Moderator

December 14, 2019 at 11:44 pm

Post count: 8660

#31691

You note: “L2/L3 a disk herniation 4mm extending into the right sided neuroforamen
L3/4 2mm anterior vertebral offset Posterior bulging w/ Bilateral foraminal encroachment , anterior vertebral spurring and reactive sclerosis in the facet joint
L4/5 left sided foraminal encroachment anterior vertebral spurring is noted with reactive sclerosis in the facet joints”. you note nothing of L5-S1 which can be a problem too but I will assume that the MRI report is negative.

When I boil down your complaints, it sounds like lower back pain is the predominant complaint. I hear no localizing pain into one thigh or buttocks which would then lead me away from that disc herniation causing any symptoms. You do have degenerative spondylolisthesis at the level L3-4 and even maybe L4-5. This does not mean surgery necessarily but a good rehab program and possibly injections to reduce pain and inflammation.

See https://neckandback.com/conditions/degenerative-spondylolisthesis-or-spondlylolysthesis/ and
https://neckandback.com/treatments/conservative-treatment-mechanical-lower-back-disorders/

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.

dransberge
Participant

December 16, 2019 at 8:58 am

Post count: 2

#31707

Thank you Dr. Corenman for those links they were helpful. L5 /S1, disc space maintained , disc well hydrated. Posterior bulging of the disc is seen, the neuroforamina are patent. So I dont think that one is too bad. What I dont understand is I have had a epidural it did not help. I had 4 facet joint injections it did not help. I went through a month of therapy it seemed to help a bit, but then I had a set back and it started all over like when I first got hurt I was using a walker again. I try to stay active at home walking around the yard when I have better days, but it always comes back and last 3 or more days to where I cant do much of anything. My Pain management doctor did not think therapy would help anymore…He gave me a MMI rating after only seeing me since May. I did get hurt on 3/6/19 but workmens comp too a while to get me into see the pain management doctor before then I was seeing MD’s . As I said they tried to send me back to work but work sent me right back home and said I was worse off then some of the patients in the nursing home. I will lose my income shortly….because of workmens comp only paying for the 3 percent rating my workers comp pain management doctor gave me. Because he said it was just muscles. So I dont know if disability is even a option for me. To be honest I am scared because anytime I do something lightly moderate to moderate I always get set back in a lot of pain. Even on better days I cant lay flat or straighten my spine without pain. It seems workers comp and my doctor has given up on me. Scared about my future. I do have a attorney but he doesnt answer many of my emails and I have a deposition coming up in January. I do not feel its right to settle for a little bit of money until I can work or get some kind of financial help like disability. Any other suggestions would be most helpful

Donald Corenman, MD, DC
Moderator

December 22, 2019 at 2:22 am

Post count: 8660

#31778

You note “I have had a epidural it did not help. I had 4 facet joint injections it did not help”. I assume that you mean these injections did not help long term. Commonly, the diagnostic window is ignored which is a shame as the results with relief of pain in the first three hours is the key to knowing if these injected structures are the pain generators.

See
https://neckandback.com/treatments/diagnostic-vs-therapeutic-injections/
https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic/
https://neckandback.com/treatments/facet-blocks-and-rhizotomies/ and
https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections/

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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