3 month post-op l5s1 fusion; pain lower leg...

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Jbeans9999
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August 21, 2013 at 2:46 am

Post count: 13

#9253

Dr. Corenman,

I had a PLIF on my l5s1 3 months ago (Previously had 2 microdisectomies at same level) but since my original herniation the 2 discs above have been bulging; especially the l4l5 but I have never had any problems with my lower leg at any point in last few years.

In the past few weeks I have been getting pain in my lower outside leg (same side; left) and also increased numbness in my foot moving further towards big toe (but no pain/numbness in big toe). Right now I “know” I herniated it and have appointment with surgeon next Monday.

In your experience you likely have had many patients with repeated herniations who “know” when they herniate without a doubt.

Based on your experience, my having that feeling of “knowing” I herniated my l4l5, and basic symptoms (pain lower outside of left leg), do you think I should be concerned?

Donald Corenman, MD, DC
Moderator

August 23, 2013 at 9:24 pm

Post count: 8660

#9267

What was the purpose of the PLIF surgery at L5-S1? Was it for a recurrent herniation? Did you have nerve pain (radiculopathy) that was the indication for fusion surgery? You note you haven’t had “any problems with my lower leg at any point in last few years”. Did you have the fusion for lower back pain?

You most likely did not reherniate your disc at L5-S1 as the PLIF surgery should have ablated this disc. Now, the cage (PEEK spacer) at L5-S1 could have displaced which would compress the nerve root or you could have herniated the disc above at L4-5.

A good physical examination will help to indicate why you have developed new onset leg pain. You might need a new MRI.

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.

Jbeans9999
Member

August 29, 2013 at 7:05 pm

Post count: 13

#9290

The PLIF at L5-S1 was from a 3rd herniation of that disc (I previously had 2 microdisectomies at the same level; first in 2008 and the second in 2012).

I had the fusion due to pain in the back of my upper left thigh, but really never had back pain.

Now i have pain in my lower left leg (outside) and increased numbness in my foot across more of my foot (with other herniations numbness in foot limited to left 2 toes, now numbness all way to big toe). Also, I now have more pain in my back, but it is hard to know if the pain is from healing of the fusion or this new problem.

I know I can not reherniate after the fusion which is why I suspect herniaton of the l4-l5, especially since it is the same type of pain and very localized.

I saw my surgeon the other day and he ordered an MRI which I got this morning. I guess we will see.

Thanks,

Jbeans9999
Member

August 30, 2013 at 1:46 am

Post count: 13

#9292

I was able to get the surgeon to look at the MRI and these are the findings they gave to me based on his looking (without the final report from the radiologist):

1. The L5-S1 operative level looks OK, no obvious nerve impingement.

2. The next two levels up, L3-4 and L4-5, look the same as before surgery.
Some disc bulging, but no disc herniation, and certainly no NEW nerve compression.

3. So I think this is some nerve inflammation, nothing that would require any further surgery.

Most people would not say this, but I was hoping for herniation because now I am worried about permanent nerve damage. I have probably spent a combined total of a year (if take all time periods from herniation through surgery) dealing with this type of pain/sensation on a continual basis over the past 4 years. Even my physical therapist and I were discussing and based on what hurts vs. does not hurt for different movements it sounds like nerve pain.

Could the continued (and worsening) pain be a sign of permanent nerve damage?

If so, is it even possible that if I had problems at l5-s1 I would be exhibiting pain in areas more commonly associated with l4-l5?

Is there anything you would recommend in terms of tests or literature?

I am at a loss for words and in fear of becoming one of those people with chronic pain issues. Any advice would be greatly appreciated.
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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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3 month post-op l5s1 fusion; pain lower leg…