MRI results and back

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Johns
Member

August 30, 2013 at 9:02 pm

Post count: 5

#9295

Hi Doc

I contacted you a while back, about problems I had (back pain, referred leg / hip pain, antalgic lean). Well, things flared up and I was referred for an MRI – but in the intervening 4-5 weeks (bless the NHS) there has been a huge improvement, no referred pain, I can sleep OK, leg moving ok, no weird feelings etc but a slight lean still in my back. I got the result summary back from the MRI this week, my GP said I had a disc lesion, and as things were OK at the moment, best to leave well alone. He advised to carry on as I am (cycling, but he said no to running).

I can understand most I think of the MRI, most of it seems to talk about general wear and tear in the back, but not all is clear. Apparently there is a paracentral disc hernia T11-T12 impinging the thecal sac, although I don’t think this is causing any issues?

Moderate degenerative changes L4 to S1 with dessication of the discs, slight loss of height, mainly at L5-S1, and disc bulges, combined with small marginal osteophytes at the adjacent endplates.

At L4-L5 a left paracentral inferiorly migrated disc hernia is compressing the left L5 nerve root in the lateral recess. No spinal canal or foraminal stenosis. The conus medullaris and the caudal equine are normal.

Conclusion – moderate degenerative changes L4 to S1. A disc hernia at L4-L5 is compressing the left L5 nerve root.

I suppose what I want to know is does this sound kind of normal for a 42 year old – should I be worried? Can I do anything about disc dessication? I had a disc problem 4 years ago, resolved and complete (to my knowledge) recovery. This latest problem started in December 2012, and although it is so much better now, its taken a long time of ups and downs. I am usually very fit and active (was running most days of the week, cycling 5 days a week, as well as walking dog every day).

Is running out of the question? I had been running in a ‘barefoot’ style, landing on my forefoot. I know some docs are dead against running, whilst others think its OK.

The MRI said that the nerve root was compressed, but there is no pain at the moment? Is this hernia likely to resolve?

Sorry for all the questions, I really want to get a handle on this and as it is virtually pain-free now, I want it to stay that way and avoid any tinkering around the spine if possible!

Thanks in advance

David

Donald Corenman, MD, DC
Moderator

August 31, 2013 at 5:15 pm

Post count: 8660

#9303

First, MRI findings do not exist in a vacuum. You must convey your symptoms so that a comparison can be made to the MRI findings.

For example, you have a large herniated disc on the MRI (“At L4-L5 a left paracentral inferiorly migrated disc hernia is compressing the left L5 nerve root in the lateral recess”). Do you have left leg pain, weakness of the leg or antalgic posture ( a lean to or away from the left side?

As far as running, your doctors are correct that running increases the load on the lumbar discs. It is not a matter as to if you can run but if you are willing to take the risk that the added load on the spine can advance the degeneration of the lumbar discs.

There are less stressful spine loading cardiovascular activities that you can participate in (cycling, swimming to name a few) but I understand if you need to run and are willing to take the risk, then by all means continue to run.

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.

Johns
Member

August 31, 2013 at 6:13 pm

Post count: 5

#9306

Hi

Thanks for quick reply. I did have left leg pain, specifically in the hip, but that has pretty much gone. I do still have slight, away from the left, antalgic lean,which but it’s much better. Overall I feel the best since it started in December. I suppose what worries me is if I can do something to help my back, so looking to the future to try and lessen chances of relapse.

Thanks again

David

Donald Corenman, MD, DC
Moderator

September 2, 2013 at 10:31 am

Post count: 8660

#9321

You can help your back by core exercises. There are many ways to obtain core strength but I think the best way is with a Pilates program. Heavy impact and load will increase the risks. Try to avoid BLT (bend twist and lift) all at the same time. You can do one, occasionally two but avoid all three at the same time.

The chance of recurrent herniation is about 10% in an active population. This statistic is unavoidable but the risks can be diminished somewhat. I would not worry about recurrence and live your life smartly.

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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