severe back pain at l5/S1... No Surgery?

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manage31
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September 6, 2011 at 6:10 pm

Post count: 2

#4861

Hello,
I am new to this message board but I am enjoying all the information. My problem according to the MRI is:
There is a left paracentral disc extrusion measuring 10mm with severe narrowing of the left lateral recess and impingement of the left S1 nerve root in the lateral recess. Exiting L5 nerve root is spared. no central canal stenosis or right neural foraminal is identified. Right lateral recess is normal.
I am 37 male, 5’10” 210 and I have been experiencing terrible back pain for about a year. I have an 8 month old which doesn’t help, but to make a long story short. I have had 2 epidurals (no relief at all), months of nsaids (mostly celebrex) and I’ve done physical therapy. My Doctor who comes with a very good reputation says “no need for surgery because there is no neurological symptoms and you have no leg pain”
Thank you so much for your time.

Donald Corenman, MD, DC
Moderator

September 6, 2011 at 9:24 pm

Post count: 8660

#4864

You note a rather large herniation at L5-S1 left causing left lateral recess stenosis and impingment of the left S1 nerve. You have had what sounds to be good rehabilitation care and have failed that care. The fact that you have no leg pain and no neurological symptoms is generally reason not to perform a microdiscectomy but there are some exceptions and you need to supply some missing information.

You note that you had no relief with epidural steroid injections. Was that long term relief only? Many times, patients who undergo epidural injections are not asked to keep a pain diary or pain log for the first three hours. This period is crucial for diagnostic information. The injection contains both a corticosteroid and an anesthetic like Novocain. The injected anesthetic temporarily “numbs” the structures in the canal and if you noted relief for only three hours, that piece of information would be important to know.

You don’t specifically describe your back pain. Is the pain in the center of your back or does the pain radiate to your buttocks or sacroiliac joint on one side? If it is central back pain, what makes the pain worse? Sitting vs standing vs lifting vs????

If your pain is central back pain, the disc herniation may still be causing your pain as it could be tenting the annular fibers which could cause the symptoms (see website). The pain could also be coming from the disc itself and the herniation is a red herring. You may be a candidate for discograms (see website).

Some surgeons do not consider surgery for lower back pain and if there are no neurological signs or symptoms and no leg pain, you would not be a surgical candidate in their eyes. Other surgeons do have surgical solutions for lower back pain. You may need another set of eyes to help you.

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.

manage31
Member

September 7, 2011 at 12:24 pm

Post count: 2

#4868

Thank you Dr. Corenman,
I don’t think I received any pain relief from the shot. I don’t recall pain immediately after the epidurals but it was back within a few hours. That could have been soreness, but I really think it was just the same back pain I had been getting. I wish they had asked me to keep a journal. Darn.
As far as pain. Hip pain is just as terrible as the back pain. The actual hip bone. It does travel to the buttocks at times but not all the time. Sometimes I get a feeling in my left leg that reminds me of what I have heard when people describe restless leg syndrome. I don’t know that I would describe it the way I would explain the almost toothache like pain in my central back and hips.
Thanks again

Donald Corenman, MD, DC
Moderator

September 7, 2011 at 9:05 pm

Post count: 8660

#4869

When you note “hip” pain- where exactly is this hip pain. Is it where your back pocket would be when wearing jeans, where a holster would hang if you wore a gunbelt or in the groin area in front of the thigh? There are occasions that hip disorders can refer pain into these regions. Did you also have a hip work-up?

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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severe back pain at l5/S1… No Surgery?