10 months post L5-S1 micro, still severe weakness

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Donald Corenman, MD, DC
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June 9, 2014 at 2:12 am

Post count: 8660

#10983

Two answers to different forum participants.

To genwhy1; “Micro nucleoplasty” is an unusual term as it combines two separate procedures that generally are not associated together. Micro implies the use of a microscope and nucleoplasty is a term associated with a percutaneous (needle through the skin) procedure that has no use of a microscope.

Nucleoplasty is the use of a needle type device that removes the nucleus out of the disc space without direct visual decompression of the nerve root. This technique generally is ineffective to decompress the herniation off the nerve root and has gone by the wayside.

Why you have foot drop on the left side from a right approach is confusing. If I assume that the nucleoplasty was on the left side, I cannot understand why you would have right sided foot drop but obviously the L5 nerve root on the right was injured.

To “Ward”; You have a recurrent disc herniation which occurs in about 10% of patients who develop a first herniation (whether or not you have had surgery or not). “superimposed broad based focal disc protrusion at least abutting the transversing S1 nerve roots”.

Your foot numbness can be a result of the herniation but it is impossible to tell even with diagnostic injections. The only way to determine if this numbness results from the recurrent herniation is to have a surgery to remove the disc fragment. I would say there is about a 75% chance that the numbness will abate. The epidural could help but generally will not relieve numbness, just pain and paresthesias (pins and needles).

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.

genwhy1
Participant

June 9, 2014 at 11:48 pm

Post count: 16

#11006

Thanks for getting back to me Dr Corenman. The micro nucleoplasty was also called a percutaneous nucleoplasty. The doctor inserted a electrical device into my disc and heated the end. He explained that this would help firm up the disc while reducing the size of the disc material in the canal thru a process that he described as a 10% reduction in disc shrapnel size that should give me relief. IDD or IDT …..something like that. Yeah…and I guess I was a guinea pig… ?

Before the procedure I was in mental distress from a car accident in Glenwood Springs canyon, so I quickly agreed to a discogram before final procedure decision. The discogram was provocative….When he pumped up the pressure in my L5/S1 disc…my pain while lying flat was 8-9 . I remember leaving my body and being really aggravated at the person who seem to be annoying me. Looking back, it was not one of my shining moments in decision making.

That was then.

This past six months I got some serious run around from the local community. My pain mgt/aenesthia group has a policy that they wouldnt prescribe muscle relaxers. I had been on Soma since 2002….so I was a little concerned that I might have some adverse affect to the steroids if not on Soma….I voiced my concern about this change in my meds and one of the office doctors acquiesced and wrote me a month script for the soma and combined with the second epidural…I had amazing breakthroughs in nerve conductivity and muscular communication. It was the best I had felt in over a decade…..and I reported this to two of the surgeons I was talking too.

I described this breakthrough to my doctors and Golish said i should go for a third to verify that we were in fact targeting the correct areas and the surgery results should try and duplicate the breakthrough sensatiions and experience. I went back in for a third epidural and thats where thepain mgt people said that I would not be getting soma for this round of steroids.

I wasnt told that I should also be aware that there might be issues with Soma withdrawal.

I got the 3rd epidural, thinking that I could make the most of it and just get to surgery. I was wrong. Not only was i unable to take advantage of the epidural window….the roids ramped the pain up to an obnoxious level. I survived it…it was scary, but when meeting with Golish to schedule the decompression surgery, he opted out….using a multitude of excuses.

It was hard take….none of it sounded legitimate, professional…and his decision to not operate revoled around the failure of the third epidural. No mention of the fact that the withdrawal from Soma was a bit frightening…and the pain mgt people were acting very sketchy.

A few days have passed…and Im still here. I have stayed away from the Soma and actually feel better, but I cant drive or sit because the nerve under my piriformis is so testy…it causes several muscle groups in my rump to spasm….with a ramp up on the pain scale by 3.

Im back on the hunt for answers and I would love to have you look at my mris and records…..perhaps even set up a consult in Vail. I need an excuse to get out of Florida, anyhow.

Im thankful for your words. I had no idea how crazy the system has gotten …especially here in south Florida.

Im gonna be in touch with your office.

Ron

Donald Corenman, MD, DC
Moderator

June 10, 2014 at 9:04 pm

Post count: 8660

#11017

You had a procedure called an IDETT or intradiscal electrothermal therapy. It was based upon the principle that heating collagen will “melt” it and cause scar tissue to form. This procedure was hoped to stabilize the disc wall and disrupt the pain fibers (nociceptors) in the wall of the disc.

Unfortunately, IDETT did not work as planned. Heat generated from this device also could cause thermal damage of other nearby structures and this might be why you developed foot drop in the opposite sided nerve.

The discogram did identify your pain generator but the IDETT unfortunately was ineffective.

I cannot comment on the use of your pain medications and muscle relaxants.

Steroid injections can mimic what surgery has the potential to do but remember that these medications are anti-inflammatories. Inflammation is generally the cause of pain (along with nerve damage). The injection might very well forecast a surgical result but it is not a 100% correlation.

Injections are also not foolproof. The volume of the injection can cause a pressure phenomenon that aggravates symptoms and rarely, the fluid can be injected into the incorrect area which can also cause new 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.
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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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