ADR

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Ckelly
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August 1, 2013 at 11:33 am

Post count: 2

#9113

Hey Dr Corenman

Love the website its one of a kind

Here is my question for you i have 2 level ddd with large herniation’s L4 right side with only in the last month weakness in my quad/kneecap i can feel not as strong and pain at the tear drop and about the knee, is that the fermoral nerve ?

and L5 left side which happened 23 months ago and had me admitted for a week surgeon looked at mri and scans and didn’t warrant surgery as tho i had pain it died off and no foot drop but there was a clear lose of muscle size but i could still flex and take my body weight on that calf singular

now fast forward to present i worry about the new knee issue and sent my scans to a few neurosurgeons in mainland Europe (i am based in ireland) and all came back with 2 level adr using either the m6 L or cadisc L disc

so my question is at L5-s1 is the much degree of movement as my irish surgeon thinks along the lines of hybrid fuse that segement and adr above and also would i get more size back in the left calf after decompression ?as about 40% is still there in the inner section as the outer is still full size

also Dr Corenman during all of this i along with my brothers got diagnosed with myostatin which seems to have caused the spinal issues as all of us had ddd in one or more levels

Donald Corenman, MD, DC
Moderator

August 1, 2013 at 11:08 pm

Post count: 8660

#9116

I alway find it useful to break the problems down into the respective parts and then determine what surgery could be helpful for each individual component.

Lumbar DDD or degenerative disc disease can cause lower back pain. I notice your complaints do not involve back pain but do involve leg pain and weakness. Do you have lower back pain as a significant component of your symptoms or only leg pain and weakness?

If no lower back pain and only leg symptoms are your complaint, then an artificial disc replacement (ADR) or fusion is probably not necessary (unless there is vertebral instability along with nerve compression in which case an ADR would be the wrong choice.

An L4 right sided disc herniation with quadriceps muscle weakness would have to mean that the herniation is in the far lateral position (outside the canal on the side of the spine) as this is the only place at this level that could compress the L4 nerve root. If the herniation is in the typical posterolateral position, this would compress the L5 nerve which does not supply the quadriceps and I would have to question the diagnosis. The femoral nerve (L2-L4) supplies the quadriceps muscle.

Let us assume for the time being that you have significant lower back pain as a part of your compliant and that you would be a candidate for ADR or fusion. You can read my opinion of lumbar ADRs on this website and you will see that I am not a fan of this procedure in the lower back. Could you have a hybrid procedure for this problem? The answer is yes. I do this all the time for the cervical spine and this would also apply to the lumbar spine.

I am unclear as to what the disorder “myostatin” is. Is this the muscle disorder that is obtained by taking statins for high cholesterol?

Return of muscle diameter after a nerve injury is not common. Why you would have calf atrophy is unusual as the calf muscle is an S1 nerve and your prior L5 nerve problem should not cause severe atrophy in the lower leg (it is connected to the tibialis anterior muscle in the lower leg which is a small muscle and atrophy will not cause a significant size difference).

There are many unanswered questions here.

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.

Ckelly
Member

August 4, 2013 at 7:42 am

Post count: 2

#9133

Hey Dr. Corenman

You are correct i don’t really have any back pain just leg pain from the herniated discs which is like a lighting bolt some days and dull the ache the most of the time but my calfs is in spams and left inner caif is lost muscle size

but no foot drop cant still walk on tippy toes and take full weight of my body on that leg, but as soon as it hernated the L5-S1 disc 2 years ago that was instant the weakness calf but my irish surgeon didnt want to do anything and mri then and now didnt show other pain factors, they gave me a Nerve root block i block and it worked great bar cramp no to the left S1 nerve root and no pain till now as the Disc above a blown and causing spams in quads

But like i said recently i am getting quad and knee pain, tender to touch, and new mri of 2 weeks ago the german and english surgeons said 2 level adr, But i am thinking hybrid as correct me if i am wrong is there much movement of the L5-S1 disc ? or would fusing that cause Si joint issue further down the line ?

“myostatin” sorry its a rare genetic disorder which gives me muscle hypertrophy and all the males in my family have it as in brothers and the neurosurgeon thinks its a factor in our spinal problems as the muscles are alot stronger than the support structures can take ? curious what you think as it has left to tendon injuries also in the shoulders

And sorry to pick your brain but is there an natural supplement i can take to help my nerve injury ? and is there any chance of the S1 nerve root recovering or is it dead the connect i mean to the calf as parts of it still move just sections of it dont, but i have full use of the foot and leg just bar the deep cramp

and on the hybrid surgery would you do the fusion ALIF ? with the adr above or what is the best way ?

last comment dr as i know your busy but also when i feel my left calf i get like a shock is that neuroma ? as in its sensitive to touch ?

its a wee bit funny to look at as due to my disorder i am muscle bound so one skinny calf looks odd in shorts so just so i know with decompression now that wont get any better ? or will at least stop the string pulling like feeling i get in my leg from the herniation ?

And thanks in advance love your form and what your doing its a pity ireland is like 3rd world in medicine compared to germany and the usa

Donald Corenman, MD, DC
Moderator

August 4, 2013 at 10:38 am

Post count: 8660

#9136

Not being able to toe walk is an indication of gastroc/soleus weakness which is an S1 nerve injury. I have a policy of decompressing a lumbar nerve root that demonstrates weakness as soon as feasible as recovery is generally not good without a decompression. Other surgeons and maybe other country policies may be different.

A fusion (or ADR) is a procedure used for lower back pain and not for leg pain. Leg pain is generated by nerve root compression which generally does not require fusion or ADR.

See the section under “Nerve injuries and recovery” and then “Nerve damage and healing” to fully understand how nerves heal.

By “myostatin”, I assume you mean myostatin related muscle hypertrophy. This genetic disorder I have only a little experience with but this should not be related to your herniations or weakness.

If you have continued compression of your nerve, you need a decompression (microdiscectomy) and not a fusion or ADR.

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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