5 months out from MD - whats going on

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Dweber
Participant

March 8, 2021 at 10:53 am

Post count: 3

#33708

Firstly thank you Dr Corenman, your website has been super helpful (long time reader and lurker) and the fact you take the time to reply is amazing.

I will keep it brief and to the point as best I can

M(38) ex athlete (rowing/crew) – non smoker/otherwise very healthy

had MD on L5-S1 October 2020 – nothing in particular caused it. Over the course of a week I couldn’t walk or sit and after 8 weeks it was really bad but no foot drop etc

After surgery everything was going fine (even started light machine weights at the gym at week 10-12..nothing more exciting then some bicep curls) then at 3.5 month mark (again feeling great) I went to the beach (live In florida) and I left something in my car (a bucket with a few water bottles in it) so I jogged back to go get it maybe 500m round trip total. I used to crank out 5-10mile runs several times a week just before the injury in October

The following day I had lower back pain about a 4/10 (took prednisone and it went away in a few days ) but I developed much more numbness in my original affected foot (left) and also some pain in my right foot which before had not been effected at all. And my left glute would twitch all the time

I had a second MRI taken and it does not look like I re-herniated it (the radiologist couldn’t rule it 100% out however it was unlikely and the Neuro looked at the CD and said I didnt). My Neuro told me to just get off my feet and decompress my spine.

I, like many sit down for work (a lot of driving) and at 6 weeks since that beach moment I started to develop occasional pain 4-6/10 in the bottom of my left foot (causing me to let out a light yelp when I was driving) with my glute randomly twitching again (it had stopped by week 3 after the re-injury)

Wondering if you might have any nuggets of information. My neuro suggested that if it is still acting up that perhaps trying an injection (though I am told they aren’t as effective after an MD due to scar tissue).

I live in the USA by byself with the rest of my family in Europe and there is no way I could survive a 10 hr flight home presently and not that it matters to you but I haven’t seen my parents for over a year and they are very much older and im concerned for their health etc. Before I reinjured it at the beach 6 or so weeks ago I for sure would have been fine on a flight of that length

Any suggestions would be great.

Thank you and all the best

Donald Corenman, MD, DC
Moderator

March 9, 2021 at 9:09 am

Post count: 8660

#33711

You might have reherniated a small fragment which can be easy to miss on a repeat MRI. Did you get gadolinium in an IV during the procedure? If there is not a recurrent fragment present, I would consider an epidural steroid injection (TFESI-see https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic/).

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.

Dweber
Participant

March 9, 2021 at 3:46 pm

Post count: 3

#33713

Thank you Dr Corenman for replying, I can only imagine how busy you are.

My PCP was the one to order the repeat MRI and they did not do it with contrast/Gadolinium, just a regular old MRI. The radiologist report did recommend to 100% rule out a reherniation to repeat the MRI with contrast.

I have a follow up appointment with my Neurosurgeon on Monday – are there any questions you would recommend I ask?? (currently at 5 months post op on march 16th)

Just an idea but if you had a charity fund etc on here I would happily donate to your cause of choice for your helpful replies. thank you

Thank you again

the report for the L5/S1
The large extruded disc fragment present on the prior study has been resected with a new left laminectomy defect. There is abnormal soft tissue surrounding the left lateral and anterolateral thecal sack as well as the origin of the left S1 nerve root. Soft tissue extends into the left neural foramen. increased signal intensity along the posterior annual margin extending into the left neural foreman is noted. difficult to exclude a recurrent foramina disc herniation given this appearance without IV contrast as granulation tissue may sometimes simulate the appearance of a recurrent disc herniation. prominent transverse processes of L5 are noted but no definite sacralisation . Sacroilac spurring noted with osseous bridging on the right

Donald Corenman, MD, DC
Moderator

March 13, 2021 at 7:32 am

Post count: 8660

#33725

I would recommend an MRI with gadolinium to different recurrent herniation from epidural scar formation.

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.

Dweber
Participant

March 14, 2021 at 8:09 am

Post count: 3

#33737

Thanks for the input – I will keep you updated on the progress

Thank you

D

Donald Corenman, MD, DC
Moderator

March 14, 2021 at 2:38 pm

Post count: 8660

#33741

Thanks,

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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Viewing 6 posts - 1 through 6 (of 6 total)

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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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5 months out from MD – whats going on