1 Year Post-Op - L5/S1 Lumbar Fusion with continued leg/foot weakness

Tagged: Fusion Nerve Damage

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kevhead
Participant

December 27, 2015 at 1:28 pm

Post count: 3

#21085

Dr Corenman, been “lurking” on your forum for a couple years and I would like to first Thank You for your time and all the information you provide. Quick history, 38 year old healthy male…had a Micro-D in 2011 on L5 after herniating and lifting my kids double stroller. Had severe right leg pain however no numbness/weakness. Immediate relief after surgery.

Fast Forward to January 2015, started having leg pain again. Woke up one morning and could barely move, knew immediately it was the same pain I had before however this time I also had numbness in my foot/calf area. Numbness moved into rear buttocks area and into my mid section. Weakness started appearing about 1 week later. MRI showed large protrusion of disc on S1 nerve root, my Ortho recommended surgery immediately with the loss of strength and numbness. Had a L5-S1 decompression laminotomy, foraminotomy, and diskectomy. My surgeon did a L5/S1 posterior fusion using bone graft using pedicle screws. Woke up in terrible pain and my Ortho said my S1 Nereve Root was severely compressed from 2 large pieces of disc material. Spent a few months at home before going through a couple rounds of PT.

Almost 1 year later I’m in no pain and feel good for the most part. Only downside is that I still never fully recovered from the nerve damage at S1. My right calf muscle has atrophied and I have a hard time pushing off my right foot. I can’t do a calf raise off my right side either. I still have some numbness in my right heel, not as bad as it was previously. I walk with a limp, but I’ve been told that it could take 2 years for the nerve to fully recover as it has to travel down the full length of my leg. My question is this, is the numbness in my right heel associated with the weakness I still have? Would another EMG provide any additional information? As the numbness recovers I hope the strength does as well. I’m hoping that there’s still a chance for the strength to return but after 1 year I’m losing hope.

Thank you again for your generous time and wishing you the best!

Kevin

Donald Corenman, MD, DC
Moderator

December 27, 2015 at 3:01 pm

Post count: 8660

#21087

You obviously needed surgery as you had developed motor weakness from a recurrent disc herniation. Not sure if the fusion was needed for a first recurrent herniation but obviously I was not there and fusion certainly could have been indicated.

I am concerned that you “Woke up in terrible pain” after the surgery. Did the surgery cause you more intense or different pain than you had going into the surgery?

You walk with a limp now. Why? What motor group is weak? Is it S1? See gait analysis on this website to understand how weakness affects gait and look at nerve injury and recovery for understanding of motor recovery. If the strength has not recovered in 18 months, it will not recover.

Yes-heel numbness is most likely related to the current weakness. There are times that an EMG can be helpful for prediction of some recovery but after a year, less likely to be informative.

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.

kevhead
Participant

December 27, 2015 at 3:30 pm

Post count: 3

#21088

Dr. Corenman, thanks for quick reply. When I woke up, the pain was more intense. I was told that my nerves were irritated and there was inflammation. My foot also felt like something was pressing against the bottom of my arch and the whole foot was very sensitive to touch, however nothing was there. My Ortho said it was a result of them “teasing” the disc material off the S1 nerve root. They put me on a steroid a week later to help with the inflammation. My initial thought was they may have inserted one of the pedicle screws through the nerve however a follow up MRI showed the screws were in good positions. I’m still not 100% sure if the nerve damage occurred before or after the surgery. Since I was having symptoms before surgery I assume it happened before.

Regarding my limp, my PT said this was the S1. I have a hard time stimulating the gastroc, when doing stairs I land on my heel first. I don’t really have foot drop, I have strength pulling my foot up however I can’t push off or stand on my tip toes on the right side.

I’m unsure if I really have any more options at this point or what could my next steps be? I have my 1 year follow up in a few weeks with my Ortho surgeon, anything I should ask them? Again, I really appreciate you taking time to read and answer these questions.

Kevin

Donald Corenman, MD, DC
Moderator

December 28, 2015 at 4:48 am

Post count: 8660

#21090

It does sound like S1 nerve dysfunction. You would not have foot drop as that is an L5 nerve involvement. Your “push-off” is the function that would be compromised by an S1 nerve injury.

I think if you have this weakness and an MRI did not note the cause (I assume it was with gadolinium), a CT might be in order. This test is more precise for instrumentation placement (the MRI “blurs” the metal edges) and also will demonstrate fusion mass. Was the S1 nerve swollen or did it “light up” on the gadolinium sequence? If the nerve is not compressed and is “free floating”, there might not be much to be done.

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.

kevhead
Participant

December 28, 2015 at 8:15 am

Post count: 3

#21092

Yes, my last MRI was with gadolinium. My Ortho never mentioned if the S1 nerve was swollen, he just said the placement of the screws looked good. I will ask about a CT scan, I’ve only ever had MRI’s. My Ortho did mention that there was a bit of scar tissue building up around the S1 area. Would a CT Scan reveal more details about the scar tissue than a MRI would and could scar tissue be pressing on the nerve root? I’ve been told since I’m no longer in pain the nerve is “free”. Would a compressed nerve still produce weakness without any pain?

Thanks again Dr.

Donald Corenman, MD, DC
Moderator

December 29, 2015 at 5:51 am

Post count: 8660

#21097

The CT is only for screw placement and fusion mass verification. This is unless for some unusual reason there is bone spur that unintentionally grew around the nerve root or foramen. The MRI is the better test for nerve compression and scar/swelling. Scar tissue could help indicate root tethering but might simply indicate old root injury. Read the report by the radiologist to see if there is any indication of severe scar, recurrent herniation or inadvertent compression of the root.

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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1 Year Post-Op – L5/S1 Lumbar Fusion with continued leg/foot weakness