4 years since my last post...things getting worse.

Tagged: lower back pain

Viewing 4 posts - 1 through 4 (of 4 total)

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firecasey
Participant

December 21, 2015 at 10:53 am

Post count: 6

#21053

Dr. Corenman, first off – thank you so much for being such a responsive Doctor to your patients. I first posted about 4 years ago, and my back has progressively gotten worse. I would like to post my MRI results below, to see if you think there is anything more I can do.

Over the last 12 months, I have had approx 5 ESI injections, between L3 and S1 levels, which provided moderate relief for about a month at a time for my back pain and right leg dullness. However, after about a month; it all came back each time. I also had a right sided Facet Rhizotomy, which didn’t do much for my back pain – but the Dr did it anyway with my approval, to try and find out what is causing my pain. I was okay with trying it.

As much as the Pain Specialist and Neurosurgeon believe my pain is NOT coming from a disc…I have a hard time believing that and would like your opinion. They say ‘mechanical’ back pain is just not something that can be easily treated. And I am best going on with my life. Keep in mind; I am a 31 male structural firefighter, who is 6’7 inches tall, with 3 small children. My back is rather important to me – and it is a major hindrance to my life now. Is there anything else I can do? The neurosurgeon LPN (the Dr wouldn’t even see me)…said a discogram is old school and useless.

MRI results:

FINDINGS:

The vetrebral body heighs are normal. The marrow signal is normal. There is disc desiccation at L3-L4 through L5-S1. There are no intraspinal or paraspinal masses. The conus medularis terminates at L1.

L1-L2: There is no posterior disc bulge, spinal stenosis, or neural foraminal narrowing. The AP diameter of the thecal sac at midline is 13mm.

L2-L3: There is no posterior disc bulge, spinal stenosis, or neural foraminal narrowing. The AP diameter of the thecal sace at midline is 12mm.

L3-L4: There is mild facet hypertrophy. There is a hyperintense midline annular tear and broad-based mile posterior disc bulge. The AP diameter of the thecal sac at midline is 8mm. The neural foramina are mildly narrowed bilatterally.

L4-L5: There is a mild to moderate broad-based posterior disc bulge, and moderate bilateral facet hypertrophy. The AP diameter of the thecal sac at midline is 10 mm. There is mild bilateral neural foraminal narrowing.

L5-S1: There is mild board-based posterior disc bulge, with right parasagittal hyperintense annular tear. The neural foramina are mildly narrowed bilaterally. The facet joints are mildly hypertrophied.

Donald Corenman, MD, DC
Moderator

December 22, 2015 at 9:07 am

Post count: 8660

#21057

You do have CBS (crappy back syndrome). You have annular tears and degenerative discs at three levels which in my opinion is a genetic predisposition as well as occupational hazard (firefighting requires substantial stresses to the lower back). Most likely, your lower back pain is disc generated, especially since facet blocks and rhizotomies were unsuccessful.

Mechanical back pain is difficult to treat especially with your occupation. The statement by your neurosurgeon “a discogram is old school and useless” says more about your surgeon than reality. Discograms are essential for some patients and worthless for others. In your case, three level disease creates problems. There is no one particular disc that shouts it is a pain generator. The radiologist might not be skilled in reading disc pathology but I have to assume that the reading is reasonably accurate.

Depending upon your MRI, discograms might be helpful but you have to be prepared to find out you are not a candidate for surgery, Even if you are a candidate, you would have degenerative discs above which could turn into painful discs in the future.

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.

firecasey
Participant

December 22, 2015 at 10:09 am

Post count: 6

#21065

Dr. Corenman,

Thank you for your reply! Would I be able to send my MRI disc to your office for a view? With that, are there any treatments that you feel are beneficial for someone in my condition (aside from pain killers, heat, ice, etc)?

Thanks a bunch!

Casey

Donald Corenman, MD, DC
Moderator

December 22, 2015 at 2:20 pm

Post count: 8660

#21068

I do have a service called a “long distance consult” that I will have you complete a full history, look at your films, and have a discussion with you on the phone as well as send you a report of your findings. This service requires a fee however and you are responsible to get your images to me by Fedex.

I can give free advice to you on this forum but there is no report and I cannot look at images or talk to you on the phone personally.

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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4 years since my last post…things getting worse.