Adhesive Arachnoiditis

Tagged: adhesive arachnoiditis

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Carla
Participant

March 3, 2016 at 7:25 am

Post count: 5

#21471

Are there any legitimate, proven treatments for adhesive arachnoiditis that do not contribute to additional inflammation and scar tissue formation? This pain is unbearable, nobody local understands AA or wants to treat it, and symptoms are worsening. My thecal sac is “empty” from L4 down (previous laminectomy – which failed, several steroid injections, and a fusion at L4/5). How do patients conservatively and legally manage their pain? Thank you.

Donald Corenman, MD, DC
Moderator

March 3, 2016 at 8:59 pm

Post count: 8660

#21477

There is no surgery to cure arachnoiditis. Pain caused by arachnoiditis has to be managed as there is no cure. You do have to make sure that your pain is all originating from the arachnoiditis. I see patients who have had this condition but have spinal pain generators such as a degenerative or unstable disc and can still undergo surgery to relieve the back pain (but not the buttocks and leg pain from arachnoiditis).

Spinal cord stimulators can be effective to help control the lower extremity pain.

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.

Carla
Participant

March 4, 2016 at 5:32 am

Post count: 5

#21481

Dr. Corenman,

Thank you for your reply.

I had an MRI in August 2015 which resulted in the AA diagnosis, and that it when I found the true failure of my precious L4/5 laminectomy of September 2013. What had remained of my disc collapsed, and I had very little to no disc space, resulting in pinched nerves, etc. I did physical therapy for 6 week with no improvement, so I had a L4/5 fusion in December 2015. Prior to the fusion, I had severe left foot drop, and my left leg was numb from the knee down, severe left leg pain and back pain (but the leg pain was 10x worse).

The fusion helped tremendously. After a few weeks, I had regained some feeling in my left leg, the foot drop improved, and my leg strength improved. The pain in my leg and foot, however, worsened.

In February, I had a large area (the size of a soft ball) swell out at the spot of my fusion. My pain levels went from manageable to feeling like Satan was repeatedly stabbing me with a pitchfork. My leg pain can be unbearable at times. My foot drop is back (not quite as bad as pre-op, but causing me problems with walking). My leg is numb again. So, I was sent for an MRI on 2/26.

I just had my follow-up with my orthopedic spine surgeon, and he indicated that everything looks okay. All the hardware is in place – thankfully! I do have some minor inflammation, so he started me on a round of steroids, and I’ll be starting physical therapy soon. But he also said that, even though my spinal cord is tethered from L4 down, he’s not convinced that all the problems are from the AA. If there are no other physical abnormalities in my spine and surrounding areas, what else could it be? Because I know with 100% certainty that this pain is not in my head.

I’m only 36, and I have a life to live. I just want to be as pain-free as possible, understanding that I’ll never really be pain-free. I don’t know what to do at this point. I have faith that the steroids and physical therapy will help, but how much help…only time will tell. Do I request a second opinion of my recent MRI? Or do I wait it out and hope things improve? I would like to get back to actually living my life, rather than scheduling around my pain and inability to sleep.

Thank you,
Carla

Carla
Participant

March 4, 2016 at 5:51 am

Post count: 5

#21482

And I’ll be honest, I’m terrified of spinal stimulators. All the research I have read indicates that they aren’t very effective with arachnoiditis pain; and they are generally short term in relieving pain, as the body adjusts to the stimulation and it becomes less effective over time. My husband had a personal experience with SCS, which has me very leary of the techbnology, as well.

And unfortunately, I’m leary of pain management doctors. My pain has always been there, but it was exaccerbated by epidural steroid injections post-laminectomy. Two steroid injections and a nerve block trial all resulted in a spinal headache, vomiting, etc (and a doctor arguing with me that there was NO way I could be having those symptoms…that he did NOT make mistakes). And my MRI pre injections indicated no arachnoiditis. Then amazingly, months after injections, it’s there. My current surgeon told me that if the AA wasn’t caused by the injections, it was certainly made a lot worse by them.

Perhaps if I found a pain management doctor I trusted, I may consider a SCS, but it’s not like you can really visit too many trying to get a feel for a good working relationship because then you’re accused of being drug-seeking. As a patient, it’s a very frustrating position. I just want to feel better. I just want to contribute in life.

Donald Corenman, MD, DC
Moderator

March 4, 2016 at 5:59 am

Post count: 8660

#21483

The “soft ball sized” swelling is quite unusual 5 months after your surgery. The only things that I can think of that would cause that are a very late onset of a dural leak, a preexisting pseudomeningeocele (an area of the dura that was previously torn but sealed with a pocket of CSF on the outside of the dura) or an infection. All three would be unlikely so far after the original surgery. Nonetheless, all need to be suspected and looked for. The MRI should give some clues.

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.

Donald Corenman, MD, DC
Moderator

March 4, 2016 at 6:02 am

Post count: 8660

#21484

I understand your fears. There are some very good spinal cord implant surgeons who I refer to. You can call the clinic and ask to speak to Laurie. She can give you some names that we refer to.

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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