antalgic scoliosis, can it become permanent?

Tagged: Antalgic (pain-driven) scoliosis

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nikolaus
Member

January 6, 2012 at 9:53 am

Post count: 11

#5312

Damn, my heart aches as much as the back. Terrible thing we can go to the moon but can’t fix ones back. Usually people write long messages, I will try mine to be short.

33 years old, thin body, sports all my life. I have a big left para-central disc herniation at L4L5 and a small left para-central bulge at L5S1. No motor weakness, no neurological signs. Pain on left leg and to lower back. To cut a long story short, last set of physical therapy was a complete disaster. Within a weekend my body responded with severe antalgic scoliosis. I could not walk at all for 3 months. No pain killers would help. Now I am 7 months with antalgic scoliosis but the pain has subsided a lot. However, my spine is out of position.

I am asking for your help because doctors seem to disagree.

I do not have any muscular weakness nor any neurological damage although I was in a lot of pain for approx 3 months. So doctors keep saying it is my choice whether to go for an operation or not.

My questions are the following:

Can generally antalgic scoliosis because of disc herniation become permanent if operation is delayed? Can it cause damage to the neck?

Two of my discs are black (L4L5 and L5S1). Will microdiskectomy lead inevitably to instability and need for fusion later on? Since I am 34, what are my **real** chances that the microdiskectomy will become a permanent life time solution?

Donald Corenman, MD, DC
Moderator

January 6, 2012 at 1:14 pm

Post count: 8660

#5314

I can’t fix heartaches but I can fix backaches!

Your pain apparently caused an antalgic scoliosis. This is an unconscious maneuver to relieve the pressure on the nerve root by leaning to one side or the other. Interesting enough, this scoliosis can last quite a long time even if the disc herniation is surgically removed. Many patients will align back to normal after the surgery but a small percentage maintain the curve for 3-6 months.

You report no neurological signs but I think that the physical examination was not complete. With the significant pain you demonstrated, I have no doubts that there were signs of root compromise that were not documented.

A microdiscectomy will not cause significant increased degenerative changes if the surgery is performed for significant leg pain. The disc has already torn through and through and some of the nucleus has extruded out. The surgery only removes the protruding portion of the disc and any loose fragments within the disc space through the present hole in the disc.

If you have leg pain that interferes with your life and have failed conservative care, a microdiscectomy needs to be considered. You have a 90-95% chance of being happy with your choice.

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.

nikolaus
Member

January 6, 2012 at 9:25 pm

Post count: 11

#5316

Thank you very much for your fast response. Your help values a lot to me.

As far as I can understand, the antalgic scoliosis thus cannot become permanent. Some claimed that the brain may get used to sending incorrect signals to the body and the scoliosis become permanent even after surgery.

Maybe I wrote something wrong though. I am not sure I used the medical term correctly. I do have neurological pain (positive lasek, in fact during the 3 months I couldn’t raise my left leg more than 5 degrees,even the slightest movement caused huge pain). By writing “I do not have neurological signs” I was expressing that I do not have weakness or absence of reflexes. I guess that’s a mistake so I wanted to fix this.

You write: “If you have leg pain that interferes with your life and have failed conservative care, a microdiscectomy needs to be considered. “

Well, the “conservative care” is what brought the scoliosis into my life, so I wish I could say that conservative care was a success to me :( I have tried mckenzie, pilates, swimming, physical therapy, strengthening exercises, all before of this mess. nothing stopped the progress of this condition ..:(

Anyway, I’d like to ask something else. Again, thank you once again for spending time to answer my messages. So…

Would persistent (chronic = almost 8 months) antalgic scoliosis (but NO huge leg pain anymore) be a good reason enough for microdiscectomy?

I mean, I did have a LOT of leg pain. But either I am healing or the nerve has adapted to the pain because I do not feel a lot of leg pain anymore. I feel dull spread burning pain in my lower back which scares the shit out of me because according to what I read in the net I may not be a good candidate for microdiscectomy. I think this pain is caused by inflamation near the injured area.

Also, will microdiscectomy (if it is successful) stop the inflamation in the lower back? It is possible? Or that burning feeling and sensitivity in the lower back will stay for life?

Donald Corenman, MD, DC
Moderator

January 7, 2012 at 1:43 pm

Post count: 8660

#5320

Continued antalgic scoliosis by itself with not much in the way of symptoms would not be an indication for surgery in my opinion. There is a caveat however. Practice holding yourself in a normal balanced posture in a mirror and learn to hold this position. Correct yourself whenever you find yourself out of balanced posture. If you develop more leg pain with this new correct posture, you would be a candidate for surgery as the antalgic position was protecting your nerve root.

Dull burning pain in your central lower back may not originate from a disc herniation. However, if the nerve is still irritable and the pain is not central but off to the side somewhat, this might still be nerve root pain. A selective nerve root block that temporarily relieves this pain might indicate that a microdiscectomy may help relieve your symptoms.

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.

nikolaus
Member

January 7, 2012 at 8:10 pm

Post count: 11

#5322

K,

Thank you very much.

Your answers were clear and helpful.

brandon8
Member

October 3, 2012 at 11:35 am

Post count: 2

#7096

Hi Dr Corenman,

About a year and half ago I tweaked my back by lifting a light box and tossing it to my left. I had severe back spasms which eventually went away. I was ok but still noticed a tilt that resulted from this injury. I would do stretches to try to straighten it out but tilt never went away. I’m tilted to right, left hip higher. I started feeling really tight pull from my left QL muscle and decided to see a sports therapist to help with my tilt and tight QL. He told me my tilt was due to muscle imbalance and he attempted to re-lengthen my quads, hamstrings, and psoas. It was pretty painful.

I was seeing the sports therapist for about a month then one day I came home after walking and felt a really bad sharp pain down my left buttock and now feel it on my left calf and shin. I couldn’t take two steps without feeling sharp intense pain on my left buttocks. I was referred to a chiropractor, he took x rays and determined that I have a herniated L5 disc. He advised me to get treatment 5 times a week, pain has subsided a bit, I would say about 45% better. He performs manually decompression. I can now walk around without my crutches but cannot walk too far because my left buttocks and calf will have nerve pain.

Do you think this is progress? Or is my body naturally trying to heal? Pain is felt on my calf and top of my foot now, is this a phase of progression? My chiropractor informed me that I have a antalgic tilt from nerve being compressed. Other than getting pain free and resolving my disc issue, will my tilt straighten out without surgery? I’ve had this tilt for about 18 months now.

Please let me know your thoughts. I’m considering surgery depending on now I feel in the next 30 days and if I know for certain that surgery is the only way I can correct the antalgic tilt.

Thank you in advance,

Brandon
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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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