L5 S1 herniated disc

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tamtamr
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June 10, 2011 at 1:57 am

Post count: 2

#4627

Hi Doc,
My MRI two months ago showed L5-S1 herniated disc (medium to large) extrusion. Initially I had lots of pain in my left feet toes specially two toes next to big toe. After resting, I got better and my pain in feet was gone. I am mostly pain free if I don’t sit for whole day (which is my job. I am a computer professional). Two days ago, after having whole morning without any pain, all of sudden my back started hearting really bad.I have pain my buttock area and now I feel some pain going on right leg as well. Is this something normal or should I be going for second MRI to make sure herniation is not growing? Also my bladder is feeling so much pressure now a days is that because of muscle got all tight around that area or something else.I am doing stretches suggested by physical therapist and taking Aleve when the pain is too much.
Should I wait some more time or its time to look for surgical option. Most of the time I have full strength in my legs and my calf muscles rarely hurts but pressure on bladder is something new. Please advice.

Donald Corenman, MD, DC
Moderator

June 13, 2011 at 1:52 am

Post count: 8660

#4629

The disc herniation you describe initially (first two months) was improving without surgery like 70% of disc herniations will. There is a 10% rate of recurrent herniation however. This includes patients who have had and HAVE NOT HAD surgery. It is a possibility that you have extruded another fragment. None the less, you could have stretched the nerve somewhat over the existing herniation and re-aggravated the nerve.

As long as there is no motor weakness or bowel/bladder involvement, then you could continue conservative treatment. You do however mention bladder involvement. It is very unusual that the herniation is so large that it would compress the entire canal which is what it would take to cause cauda equina syndrome (see web site) and bladder involvement. I see this condition about once per year and see at least 400 patients with disc herniations.

If you do have cauda equina syndrome, you should have numbness around your rear and back of the thighs and significant pain around the “saddle region”. This condition is an emergency and you would need to see a specialist “yesterday”.

In my opinion, you should see a reasonable specialist for a surgical opinion. This would develop a relationship with that physician and the information would be helpful. You have to remember that a spine surgeon is there to help you understand what your options are to make a surgical decision and not to force you into surgery.

Let me know how you do.

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.

tamtamr
Member

June 16, 2011 at 12:34 am

Post count: 2

#4632

Thanks for the prompt reply doctor. I guess bladder symptoms which I mentioned before was false alarm as I thought I was having issues but after seeing my doc, he said you will be wet without your knowledge will be the alarm. I have nothing like that at all.
I am waiting for my recent MRI results. But I am feeling pain now in my right leg for sure. I do feel fine in the morning and full strength but at the end of day, I get really tiered and my back hurts. My doc said I should take Aleve morning and evening as it gets rid of my pain and wait one more month to see any improvements.
Should I see a chiropractor or message therapist? Will that help at all? My doc do not want me to go Physical therapy because it made me worst few months back when the problem started. Is the back pain is normal as long as I don’t have pain in my legs?

Donald Corenman, MD, DC
Moderator

June 16, 2011 at 5:14 am

Post count: 8660

#4633

Your physician recommended against physical therapy because of a bad response the first time you sought care so it makes sense that further care from the same therapist might still aggravate the radiculopathy. Therapists are not always similar and some are more talented than others. A different therapist may improve the outcome. Discuss this with your doctor.

Chiropractors are the same. In the face of nerve irritation from a disc herniation, some chiropractors can improve symptoms and some can aggravate them. It really depends upon the chiropractor. Some chiropractors incorporate massage in their treatment programs and massage typically will not aggravate nerve compression.

Back pain can occur from a disc herniation which presses onto the posterior annulus but this is not typical. (See the section on back pain in neckandback.com). Back pain normally occurs from discal instability. The typical treatment is a good therapy program. In addition, an epidural steroid injection can be helpful for the back pain and the radiculopathy.

Hope this helps.

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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