L5/S1 DISCECTOMY

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

Author

Posts
noomienoo
Member

July 7, 2011 at 6:17 am

Post count: 2

#4692

I am a 40 year old gentleman from the UK. I have had sciatica and weakness in my right leg and foot for 2 months. I have had an MRI which confirms l5/s1 disc pressing on spinal column. My right ankle reflex is absent.

I have seen the orthopaedic consultant today who says I need a discectomy. I forgot to ask questions, and am anxious for answers to the following:

1. How long is the operation, and how long is the expected time needed off work to recover?
2. What is the percentge chance of being partially paralysed if I have the operation?
3. If I don’t have the operation, I understand I will experience foot drop, is this reversible?
4. Will I be able to walk okay without the l5/s1 disc?
5. Will the operation be likely to cure the back/leg pain, and associated weakness?

I would be extremely grateful for a reply as soon as possible. I am waiting approximately a month for my next referral to a spinal orthopaedic surgeon. I do a sit down job at a desk. Will I be able to return to work before the operation?

Thanks very much for your help.

Donald Corenman, MD, DC
Moderator

July 7, 2011 at 8:40 am

Post count: 8660

#4693

The microdiscectomy procedure typically lasts about 40-60 minutes but the set up for the procedure can take as long as 40-60 minutes (anesthesia, positioning, X-ray marking and preparation).

Time off work depends upon your job demands and how you recover personally. For a sedentary job (desk job) – you could normally be back to work part time to full time in 7-10 days. For a professional athlete, it might take as long as 8 weeks.

The chance of paralysis after the operation is very- very rare. I have never seen it with myself or any of my colleagues but I have read about it in case reports. I know this is the most feared complication to the general public but is so very unusual that in good hands, you should not worry about this.

You state that without the operation, you will experience foot drop. Do you have foot drop now? (Foot drop is weakness of the tibialis anterior muscle that allows the foot to drop and catch the toes on the ground when walking). If you do not have foot drop now, it is unlikely you will get it in the future unless something significantly changes. If you do have foot drop now caused by a disc herniation, it is my opinion to have surgery as soon as possible to allow the greatest chance for the nerve to heal. If someone comes into my office with significant leg weakness from a herniated disc, I try to get them into surgery within a couple of days.

Will you be able to walk okay without the L5-S1 disc? The disc is not going away after surgery. Some of the jelly that acts as a shock absorber has been lost but the annulus, cartilaginous endplates and some of the nucleus contents are still going to be present.

There are two problems that can occur to a disc that has herniated regardless if surgery was or was not done. One is a recurrent disc herniation. This can occur about 10% of the time in an active population. The other is disc pain from lack of shock absorption or instability which can occur about 10% of the time.

The microdiscectomy is designed to take pressure off the nerve root which reduces or eliminates leg pain. It is not designed to reduce back pain although this surgery can on occasion reduce back pain.

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.

noomienoo
Member

July 8, 2011 at 7:39 am

Post count: 2

#4694

Dear Dr Corenman.

Thank you for your reply. I forgot to mention I have hydrocephalus which is controlled by a VP shunt (3 bouts of neonatal bacterial meningitis caused this at 5 months old). I have had 4 shunt operations. Would the fact I have a shunt cause a problem with the csf when the spinal operation is performed, or does it have absolutely no bearing on it? I forgot to ask the orthopaedic surgeon this yesterday.

Thanks a lot. I would appreciate an early reply.

Donald Corenman, MD, DC
Moderator

July 11, 2011 at 3:45 am

Post count: 8660

#4695

The shunt should have no bearing on the surgery as long as the shunt is functioning properly and the anesthesiologist is aware of the shunt and takes typical precautions.

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.
Author

Posts

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

You must be logged in to reply to this topic.

Donald Corenman, MD, DC

Average rating:

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel