35 years of back pain with no help from my doctors!!

Tagged: leg pain and numbness, lower back pain, Neck pain, Upper back pain

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Jsolich
Participant

May 19, 2017 at 10:57 am

Post count: 2

#24818

I’m 48 y/o and was diagnosed with fibromyalgia in my mid twenties, after years of doctors telling me that there was nothing wrong with me. I have had severe and chronic back pain and numbness for well over 35 years. I’ve had multiple X-rays, CT scans and MRI’s and have been told that nothing in any of these image findings shows anything that would cause the types of pain and discomfort that I am experiencing. I just want someone to tell me that yes there is something wrong and yes it is causing you pain and I can do something to help!!!

Below are exact copies of both MRI AND CT results newest to oldest:

INDICATION: Radiculopathy, lumbar region
Lumbago with sciatica, left side
Lumbago with sciatica, right side
Other chronic pain
Paresthesia of skin
LBP with numbness in the bilat LE/groin for years. No injury

MRI LUMBAR SPINE WO CONTRAST

COMPARISON: Lumbar spine MRI examinations May 2013 and June 2014 and lumbar spine CT scan August 2014 and January 2008

FINDINGS:

VERTEBRAL ALIGNMENT: There is a grade 1 spondylolisthesis at L5-S1 secondary to bilateral L5 spondylolysis.
VERTEBRA: Very mild spondylosis and minimal benign degenerative endplate signal changes are present.
FACETS: Very mild degenerative facet changes are present L3-4, L4-5 and L5-S1
DISTAL SPINAL CORD / CONUS MEDULLARIS: Normal.
L5-S1: There is degenerative disc disease. The thecal sac and S1 nerve roots are not compromised. There is mild narrowing of both neural foramina.
L4-5: The disc is desiccated but maintains adequate stature.
L3-4: Normal
L2-3: There is mild degenerative disc disease. Annular bulging flattens the anterior thecal sac. There is very mild central canal compromise and mild left neural foraminal narrowing.
L1-2: There is mild degenerative disc disease. Bilateral neural foraminal narrowing is present.
ADDITIONAL FINDINGS: None

CONCLUSION: In comparison with the examination of June 2014 there has been no interval change. Mild degenerative changes are present as described above. At L5-S1 there is a grade 1 spondylolisthesis secondary to bilateral L5 spondylolysis.

TIME OF DICTATION: 5/15/2017 11:44 AM…………………..

INDICATION: Other intervertebral disc displacement, thoracic region
Mid back pain radiating around into bilat rib cages (R>L) since open heart
surgery 3/13/17. No injury

MRI THORACIC SPINE WO CONTRAST

COMPARISON: Thoracic spine MRI October 2015.

FINDINGS:

VERTEBRAL ALIGNMENT: Vertebral alignment is normal in the sagittal plane.
VERTEBRA: The thoracic vertebral bodies are normal in stature. Mild spondylosis and benign degenerative endplate signal changes are present.
DISC SPACES: At T1-2 there is a small central disc protrusion which causes adjacent anterior thecal sac deformity. CSF still surrounds the cord. At T6-7 there is a small right-sided disc protrusion which effaces the adjacent subarachnoid space but does
not contact the cord. At T7-8 there is a central and right-sided disc protrusion effacing the anterior subarachnoid space but not compressing the cord. At T8-9 there is a central disc protrusion which effaces the anterior subarachnoid space but does not
compress the cord.
FACETS: Normal.
THORACIC CORD: The thoracic cord is normal in caliber and signal intensity.
SOFT TISSUES: Normal.
ADDITIONAL FINDINGS: The neural foramina are patent.

CONCLUSION: Disc protrusions at T6-7, T7-8 and T8-9 are stable in comparison with the prior study. There is a new small central disc protrusion at T1-2 which does not contact the cord. The thoracic cord appears normal. There are no compression fractures.
The neural foramina are patent.

TIME OF DICTATION: 5/15/2017 11:54 AM…………………..

INDICATION: DISPLACEMENT OF THORACIC INTERVERTEBRAL DISC WITHOUT MYELOPATHY.
THORACIC DISC HERNIATION. THE PATIENT COMPLAINS OF MID BACK PAIN FOR 15-20 YEARS
WHICH RADIATES INTO THE ENTIRE SPINE. NUMBNESS AND TINGLING IN THE UPPER AND
LOWER EXTREMITIES, NECK AND POSTERIOR HEAD. BILATERAL HAND WEAKNESS.

MRI OF THE THORACIC SPINE

FINDINGS: The thoracic vertebral bodies are normal in stature. There is no
alignment abnormality in the sagittal plane.

The thoracic cord is normal in caliber and signal intensity.

At T8-9 there is disc desiccation with preservation of disc space stature. A
central disc protrusion is present which effaces the anterior subarachnoid
space. There is still CSF posterior and lateral to the cord.

At T7-8 there is disc desiccation with preservation of disc space stature. A
broad based central disc protrusion effaces the anterior subarachnoid space. CSF
still surrounds the cord.

At T6-7 there is a small right-sided disc protrusion causing effacement of the
anterior subarachnoid space. There is still CSF posterior and lateral to the
cord and anterior to the cord to the left of the midline.

The thoracic neural foramina are patent.

IMPRESSION: Disc protrusions efface the anterior subarachnoid space at T6-7,
T7-8 and T8-9 as described above. There is no thoracic cord compression or
signal abnormality. The neural foramina are patent. There is no compression
fracture. Diffuse mild spondylosis is present……….

Equipment: Siemens Somatom Definition dual source CT Scanner (128-slice)

COMPARISON STUDIES: MR 06/25/14.

INDICATION: Low back pain radiating into bilateral lower extremities with
numbness, tingling and weakness and radiating into the hips.

CT OF THE LUMBAR SPINE:

Focussed CT through L5-S1 was performed as per the physician order.

A 4 mm anterolisthesis of L5 on S1, which is pseudo-anterolisthesis due to
bilateral L5 pars interarticularis defect is stable. A somewhat triangular
nonspecific 10 x5 mm ossific density, medial to the right pars defect and
anterior to lamina on the right, is noted, unchanged. This is confined to the
ligamentum flavum, barely abutting the CSF space. It is probably part of chronic
fractured medial part of pars defect. Mild uncovering of the disc by the
pseudo-anterolisthesis with a small disc bulge noted without significant central
canal stenosis. Stable mild subchondral cystic erosive changes at right pard
defect (image 34, series 10) are likely benign given stability since 01/28/08
without progression. There is a bifid spinous process of L5 with nonfusion at
the spinous process of L5, which is likely developmental.Epidural lipomatosis at
L5- S1 is again noted in the ventral as well as the dorsal aspect of the central
canal without significant distal central canal narrowing.

Bilateral sacroiliac joints are symmetric and unremarkable. The sacral foramina
are patent.

IMPRESSION:

Old bilateral L5 pars defect. Grade 1 pseudo-anterolisthesis of L5 on S1 is
stable. Posterior fusion defect at the spinous process of L5….

Equipment: 1.5 Tesla Siemens Espree OPEN MRI with ultra high-performance
gradients

COMPARISON STUDIES: MRI lumbar spine 05/10/13.

INDICATION: Lower back pain for years. No history of injury.

MRI OF THE LUMBAR SPINE:

Vertebral bodies are normal in height with developmental hypoplasia of the L5
vertebral body secondary to bilateral L5 pars interarticularis defects which are
chronic and have been present since prior CT lumbar spine 01/28/08. There is
subsequent pseudo-anterolisthesis at L5-S1 of less than 3 mm with disc
degeneration at this level. The L1-2 disc is also decreased in signal and
height. Marrow signal shows no evidence of acute compression deformity. Conus
terminates normally and is unremarkable. No developmental spinal canal stenosis.
The visualized retroperitoneal and other structures partially assessed on the
localizer sequences show no focal findings.

L1-2: No posterior disc contour abnormality. Mild flaval ligament thickening
without spinal canal or neural foraminal narrowing.

L2-3: Minimal diffuse disc bulge, mild flaval ligament thickening and facet
joint hypertrophy without spinal canal or neural foraminal narrowing.

L3-4: Disc unremarkable. Mild flaval ligament thickening and facet arthropathy.
No spinal canal or neural foraminal narrowing.

L4-5: Moderate prominence of the epidural fat circumferentially narrows the
thecal sac. The disc demonstrates an annular fissure anteriorly. However, there
is no posterior disc contour abnormality, neural foraminal narrowing or spinal
canal stenosis.

L5-S1: Minimal broad-based disc bulge is unchanged. The previously noted
epidural lipomatosis appears mildly improved. the spinal canal and neural
foramina are patent.

IMPRESSION:
1. Bilateral L5 pars interarticularis defects, which are chronic, with
developmental hypoplasia of L5 posteriorly and grade 1 pseudo-anterolisthesis at
L5-S1, chronic and unchanged from the prior lumbar spine CT. No clinically
significant disc bulge, neural foraminal narrowing or spinal canal stenosis. No
nerve root impingement.
2. Some interval improvement in previously noted epidural lipomatosis at L5-S1,
although it remains present although to a lesser a degree. Otherwise, no
interval change in the appearance of the lumbar spine from the prior study…………

Donald Corenman, MD, DC
Moderator

May 20, 2017 at 7:08 am

Post count: 8660

#24840

Well. Your symptoms of “severe and chronic back pain and numbness for well over 35 years” certainly could have an explanation. You have an isthmic spondylolisthesis of L5-S1, a common cause of lower back pain and leg symptoms. See “https://neckandback.com/conditions/isthmic-spondylolisthesis-slipping-of-a-vertebra-because-of-fracture/. This disorder won’t cause neck or arm symptoms however.

If you do have Fibromyalgia, you would need some diagnostic injections to help prove that the isthmic spondylolisthesis at L5-S1 is one of the pain causes. This can be done with a discogram or a SNRB at L5-S1.

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.

Jsolich
Participant

May 20, 2017 at 5:06 pm

Post count: 2

#24846

What exactly is a discogram and/or a SNR? Can it be performed on both the thoracic and lumbar spine?

Donald Corenman, MD, DC
Moderator

May 20, 2017 at 5:54 pm

Post count: 8660

#24847

Please read the website.

Discograms can by found here: https://neckandback.com/treatments/discograms/

SNRBs can be found here:https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic/

also: https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections/

Read about isthmic spondylolisthesis and foraminal stenosis

https://neckandback.com/conditions/isthmic-spondylolisthesis-slipping-of-a-vertebra-because-of-fracture/

https://neckandback.com/conditions/lumbar-foraminal-stenosis-collapse/

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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