Can't stand the pain

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Jeannie
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November 7, 2012 at 12:25 am

Post count: 3

#7350

Teally hoping for some advice. I had back surgery in march. Originally the pain Seemed so much better. However, since then I have has increasing issues. I still have pain in my right leg with weakness. I had nerve test done with showed mild adnormLty in that leg. Since my surgery I have horrible pain in my butt when I sit. I can’t sit more than an hour without wanting to crawl out of my skin. Now I M having pain in my right side. With the pain in my leg butt and side I can’t stand it. I saw a pain doc who prescribes cymbaltA And nucynta. It’s been a month with no improvement. My latest MRI reads:
Sagittal images demonstrate slightly progressing discogenic endplate signal changes at l5 s1 now demonstrating a mild amount of increased stir signal intensity suggesting reactive edema. A mild amount of endplate enhancement is seen. There is a stable disc disk cation throughout the lumbar spine with stable mild to moderate loss of disc height at l4 s1.

L1s1 l2 l3 stable appearance of a small filum terminale lipoma

L3 l4 l4 l5 there is a stable mild broad base annular bulge facet and ligamentum flavum hypertrophy resulting in mild canal and minimal left neuroforaminal narrowing at L3L4

At l5s1 there is a new right hemilaminotomy detect enhancing granulation tissue is seen within this region abutting the posterior lateral aspect of the thecal sac without evidence of deformity. Enhancing granulation tissue peridural fibrosis changes are seen extending into the disc operative defect. There is a small broad base posterior central disc protrusion indenting the ventral thecal sac. Stable superimposed mild broad based annular luging and facet hypertrophy again resulting in mild neuforaminal narrowing.

While this finding is thought to be postoperative fibrosis and underlying mild discitis and endoplate osteomitis would be diifficult to rule out.

L3L5 mild canal narrowing at L4

I don’t see my surgeon until January and feel like my legs are getting worse. Any insight would be appreciated.

Donald Corenman, MD, DC
Moderator

November 7, 2012 at 5:59 pm

Post count: 8660

#7354

You underwent a microdiscetomy on the right L5-S1 level in March for what I assume was a disc hernation. You improved initially but now the pain has returned in your right leg. You mention no lower back pain so I am unclear how much of this pain is buttocks and leg (nerve originating) and how much might be lower back pain (disc originating). Prolonged sitting causes significant right buttocks pain.

The MRI notes reactive endplate changes at the surgical level. There are inflammatory changes that surround the nerve and extend into the disc at the level of surgery.

The two possibilities for these changes are inflammation (healing tissue that is turning into scar tissue) or infection. Some simple laboratory tests can help to look for infection. If these tests are inconclusive, you could have an interventionist put a needle into the area and “wash and culture” the region, looking for a possible infection. One of the infecting organisms that has to be considered is P. Acnes. If infection is ruled out, an epidural steroid injection can be helpful.

You need to approach your surgeon and ask him about the possibility of infection.

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.

Jeannie
Member

November 8, 2012 at 2:05 am

Post count: 3

#7359

Thank you for the response. I’ve had blood work which came back fine. Since I started the medicine the sharp pain is reduced and now I feel the deep pain in my lower back. The pain in my butt is more the center I guess it’s called the coccyx . I’m concerned that the next step is going to be a fusion. Does anything in the report suggest this and if not why am I having so much pain

Thank you again

Jeannie
Member

November 8, 2012 at 3:55 am

Post count: 3

#7360

Should I be concerned about an infection?

Donald Corenman, MD, DC
Moderator

November 8, 2012 at 10:44 am

Post count: 8660

#7362

If your lab tests were normal, it is still possible but unlikely that you have an infection. An epidural steroid injection would be the next step if you were my patient.

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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