constant low back pain advice appreciated

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kevin
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July 16, 2011 at 2:58 am

Post count: 4

#4702

Hi i was hoping you maybe able to offer me some advice-

Background information is that ihave had back pain on and off for the last few years , normally it would last for a few days and then go away and i wouldd be ok again for a few months until it happens again. it would happen all of a sudden eg by sneezing or just moving the wrong way.
unfortuneately for the past year its been constant pain, i think this is from when my disc actually hermiated. i have outlined the findings of my mri below, i dont have leg pain so iam just wondering would you think surgery is the best solution to my problem. i have tried physio,acupuncture, chiro etc but no luck

Mri findings
at l5-s1 there is a large focal right posterolateral disc protrusion displacing the left s1 nerve root and narrowing the right l5-s1 disc lateral foramen

at l2-3 l3-4 and l4-5 there are moderate sized broad based chiefly central posterior protrusions . there is posterior disc bulging at l1-2

no bone destruction is shown.-
considerable chronic degenerative changes at all lumbar levels- minor degenerative changes in corresponding lumbar facet joints
Also what do you think of non surgical;any advice appreciated as i really dont know what to do-

also what do you think of non surgical spinal decompression? could it work for me? do you have any faith in it?
thanks in advance for taking the time to respond

Donald Corenman, MD, DC
Moderator

July 16, 2011 at 6:24 am

Post count: 8660

#4703

Lower back pain can be caused by degenerative disc disease (most common cause), degenerative facet disease (about 5-10% of the time) and even a disc herniation or spinal stenosis (narrowing of the spinal canal) but these are not as common causes. The pain from degenerative disc disease can originate from the annulus (see degenerative disc disease on the website) or from the bony endplates of the vertebra (isolated disc resorption). Even though a disc herniation does not commonly cause back pain (it normally causes leg pain by nerve compression), it can stretch the annulus enough to create back pain.

Does the pain occur with standing, bending and lifting or does it occur with sitting? Standing/ lifting pain is generally more associated with degenerative disc disease and sitting is associated more commonly with the herniation. Is the pain in the center of the back or is it more to one side (the sacroiliac joint)? Central pain is generally associated with degenerative disc disease and pain to the side can be associated with either the disc or the herniation.

Your MRI notes multilevel degenerative changes in the lumbar spine. If your pain originates from the disc, any of the levels can generate pain but normally the bottom two levels (L4-5 and L5-S1) are more commonly pain generators.

The “spinal decompression” machine is essentially spinal traction with a fancy name. I have no typical objection to it except for the cost and the number of visits normally “required” to sign up to gain access to the machine. The only two conditions I think are contraindicated are a spondylolysthesis or instability of the lumbar spine (see website for more details). Will it work- not very likely but there is still a chance of it being effective.

I am a big fan of Pilates for spinal rehabilitation. You would need a physical therapist or chiropractor who is well trained in Pilates rehabitiation.

Only if noting else is effective and you cannot tolerate the pain is surgery an option. You would need a surgical workup to determine if you are a candidate for surgery.

Good Luck!

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.

kevin
Member

July 16, 2011 at 6:47 am

Post count: 4

#4704

hi thanks for getting back to me so soon.

the pain occurs when bending and also when lifting. i try to avoid lifting anything much these days. i am tsking lyrica(pregbalin ) tablets daily. these have helped me out a fair bit but i dont want to have to take them for the rest of my life. before i was prescribed then i would struggle at times to get back up off a chair if i sat down for a good while. Also it got to the stage where i would have to walk with small steps as i simply wssnt able to walk normally. occasionally when sitting i get a pain in my back also. best way i could describe it is that its like there is pressure been put down on my back , the tablets seem to have alleviated this in the main. i can also get a sharp shooting pain in to my back every now and again which lasts just for a second. its like something has touched a nerve

Donald Corenman, MD, DC
Moderator

July 16, 2011 at 7:42 pm

Post count: 8660

#4705

Bt your report, your pain could be discogenic from degenerative disc disease. Lyrica is a membrane stabilizer and a reasonable medication if it works for you. Make sure you are on the correct dosage by asking your physician.

Have you tried a pilates stabilization program administered by a well trained therapist? To see results, this could take at least three months. You could try using the Med-X machine which stabilizes and strengthens back muscles.

Finally, you could get a consult with a spine surgeon to have an appropriate diagnosis made and look to see if you are a potential surgical candidate.

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.

kevin
Member

July 18, 2011 at 3:10 am

Post count: 4

#4706

cheers. i have tried various exercises for my bak alright, struggling to even get into the bridge position so pilates would be hard work., never heard of the med x machine,will look it up, is it expensive..
have been to see a couple of surgeons, one said operation wouldnt be suitable , the other said he thinks it would work, thats why i dont know what to do

Donald Corenman, MD, DC
Moderator

July 18, 2011 at 1:12 pm

Post count: 8660

#4707

The Med-X machine was popular in the 1980s and there are still some that should be around today. This machine is really an exerciser machine designed to strengthen the multifidi and rotator muscles of the lower back. I can be effective but not all the time.

The surgeon who thinks he can help you- is he suggesting discograms to determine if surgery can help you? Please review discograms in the website for more information. Based upon blinded discograms, you may or may not be a candidate for surgery.

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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