Which Surgery is Right?

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dapalumbo
Member

August 16, 2012 at 3:31 am

Post count: 3

#6770

My Question has to do with the recommended surgery. Why only fix one damaged disc and not the other? The Othopaedic suggested a Discectomy on the L5-S1 disc. What are my surgical options to repair or replace both discs?

35 Active Male,

Never had any back injuries just knee and shoulder, infact pre-employment x-ray illusrated no issues. No history of disease or other problems. Injured spine from trauma at work.

IN Sept. 2011 MRI of Spine

L4-L5 minimal disc buldge with PA tear and central Disc protrusion
S1 root impinged & central canal narrowings bilateral neural foraminal narrowing

L5-S1 minimal disc buldge with PA tear and left Disc protrusion
S1 root impinged L paracentral narrowings.

1st TX: 1 Epidural with PT along with medication
Returned to work in December although never was 100%. Found myself missing days starting the new year and by May 17 Ive missed all my sick days and 2 weeks of vacation, I needed another MRI.

June 2012 MRI Findings w/ contrast
L4-L5 disc buldge with moderate superimposed central herniation. S1 Root Impinged

L5-S1 disc buldge with moderate superimposed Left paracentral/subparticular herniation. Inferior extrusions w/ fragment extending to left lateral recess. S1 root impinged & central canal narrowings bilateral neural foraminal narrowing

Other Findings: Degenertive Disk disease at L4-L5 L5-S1 with disc herniations at these levels Both herniations appear incresed LPC herniation has inferior extrusion or sequesteration impinging upon the transfersing S1 root. Endplate changes with disc desication seen at L4-L5 L5-S1

TX as of 8/14:
2 Epidural injections
Medications
Auquatic therapy
Othopaedic surgeon recommended Discectomy of L5-S1

I am meeting with a Nuerosurgen tomorrow for a second option. This is a work related injury therefore I want to be sure it’s taken care before I return.

I have dull aching pressure pain to the left of spine and about an inch higher on the right side. I can’t get comfortable and don’t sleep very well. I feel sharp pains felt in lower abdomen w/ burning sensations in saddle area and behing the knee. My left leg pain shoots from my butt down in the middle through the back of leg to the back of knee; the pain then wraps around calf to front of shin to the interior lower leg then to feet. My pain is associated with numbness (pins and needle feeling) as well as circulation problems at toes. My Toes will turn blue in color. I have difficulty voiding yet Caudia Equinis was not diagnosed yet the problems stems from the injury.

My right leg pain had just started within the last month. I have a burning sensation in the saddle area. with hip issues , tingling in toes. Pain Not as bad as left.

Pain Scale: If 10 is losing a limb then Id say a 6-8 depending on time of day. I can handle pain well yet its constant and it hurts.

Donald Corenman, MD, DC
Moderator

August 16, 2012 at 7:27 pm

Post count: 8660

#6776

Your new MRI notes an L4-5 central herniation. You description is difficult to understand. Central herniations cause central canal narrowing (central stenosis). This will cause symptoms of neurogenic claudication (see website) but you do not complain of this disorder. If however, the hernation is off to one side, this herniation can selective cause nerve root compression. You note an “S1” nerve compression at this level but I believe you mean an L5 compression. If this is true, which side is the compression on?

You have an L5-S1 herniation on the left. This explains your left leg pain. If you have undergone significant treatment with poor results, you might be a candidate for a microdiscectomy. I cannot comment on the levels to be addressed surgically as the L4-5 level needs to be described further.

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.

dapalumbo
Member

August 17, 2012 at 5:56 am

Post count: 3

#6778

Dr.Corenman,

I first would like to thank you for taking the time to read and answer my post. I also appologise for the issues with the post. Im in a lot of pain and just miserable, and with an inability to stay focused as well as not being able to sleep; I’m a mess.

You are absoulutely correct and the L5-S1 herniation impinges the S1 and the L4-L5 would impinge the L5. The MRI report combines both herniated disks in one sentence then states the impingement. The S-1 is the only root impinged in the 6/12 MRI. I do have a side by side comparison of my 9/2011 and 6/12 MRI’s on Disk as well as the MRI reports in PDF. I can email or post them with priveliges if you like? I just need to know how to post a file. Sorry for the mistake.

I just returned from my appointment with the Neurosurgen. He is concerned with my symptoms as well and has reordered the MRI. He feels there is another issue which he has noticed yet no mention in report. He feels I do need a discectomy on the L5-S1 disc yet will wait for the MRI to decide on any other surgical treatments.

Thanks for your help,
Dave

Donald Corenman, MD, DC
Moderator

August 17, 2012 at 5:44 pm

Post count: 8660

#6783

You can send any MRI that you would like to be reviewed by calling (970) 476-1100 and asking for one of my nurses.

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.

dapalumbo
Member

August 28, 2012 at 4:50 am

Post count: 3

#6846

Dr. Corenman,

Thank you again for helping me.

I just received my report on my 3rd MRI and will call to have the information sent to you.

It seems the L5-S1 is still herniated with an annular tear, yet is not impinging.
– Still very concerned

The L4-L5 is a broad herniation compressing the Thecal Sac.

Is this why my I have bowel and urinary problems as well the other symptoms I mention in my 1st post?

Dave

I would like you to look at when you can. I appreciate all your help.

Dave

Donald Corenman, MD, DC
Moderator

August 28, 2012 at 7:38 pm

Post count: 8660

#6851

If you had a massive herniation that filled up the spinal canal and caused cauda equina syndrome, this could cause your bowel and bladder symptoms. Cauda equina syndrome is very rare and many people with even huge herniations do not develop it. You have seen a neurosurgeon who was not concerned by your report so I have to assume that you do not have this syndrome.

Bowel and bladder symptoms can be caused by many different disorders. Prostatic hypertrophy, pain, medications, pelvic wall dysfunction (rectocele and cystocele in a female) are some of the other potential functional modifiers.

I await your films.

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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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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