Advanced DDD L5-S1

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Bronson
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February 12, 2019 at 8:12 pm

Post count: 3

#30152

Dear Dr. Corenman,
For the second week now, I am in constant unbearable debilitating low back, pelvis and leg pain. Pain killers don’t help much. This pain is deep, dull, but also nerve-like, excruciating. It doesn’t get better in any position. It feels very irritating, tingling and tight in both thighs, inner side of both buttocks, perineal area, pain and feeling full in rectal area, occasionally painful feet and calves, and constant low back pain. My legs get very week.
I’ve had this before but with much lower intensity.
Can you please advise on the following:
– Is this an acute phase?
– Is it time for the injections, physiotherapy or surgery?
– Is this all from DDD, pinched nerves and the herniations?
– How to survive this? It is unbearable.
History
– I am a 39 year old male. My low back pain started 3 years ago after few months of heavy renovations in my house. For about a year, the pain wasn’t so bad and I continued to play sports and live normally without significant pain from any activity. It was worse in the mornings and present only on the low back left side. It was nevertheless bothersome and in Apr 2017 I had an MRI with the following results: “Moderate uniform L5-S1 disc space loss. Moderate to severe broad-based posterior disc bulge with a superimposed left paracentral disc herniation. Measures 16 mm at the base and 6 mm in AP dimension. Severe obliteration of the left lateral recess. Severe right neural foraminal narrowing. Severe left neural foraminal narrowing. Moderate central spinal stenosis. Displacement of both the descending S1 nerve roots, left worse than right.

– In Nov 2017 I fell very badly on my right side of my low back. It took few months to recover from the injury. I went back to sports but after few months decided to stop as the pain was progressively worse, again especially in the mornings, not during the activities. Physiotherapy, Chiropractors or any physical activity would aggravate my back left side and front of the left leg. After this I stopped with all physical activity except walking. Here and then I try a little but I always get badly aggravated, not immediately, sometimes days after. This does not feel like sore muscle but like a nerve pain. In Feb 2018 my second MRI results were: “Advanced (significant) DDD at L5-S1 with disc height loss, endplate osteophytosis, probably some associated endplate edema, mild hypertrophy of the facets, Disc osteophyte complex with central disc herniation and mild central stenosis, abutment of the traversing S1 nerve roots however without significant displacement of them. Overall improvement from the prior MRI which had a left paracentral herniation. Moderately severe stenosis of the foramina which may irritate L5 nerve roots. Mild disc bulging at L4-5.

– Third MRI was done in Nov 2018. It shows a significant and progressive L5-S1 disc height loss and the same herniation looks smaller on the same side but larger on the opposite side (front side of the disc).
Thank you very much for your help!

Donald Corenman, MD, DC
Moderator

February 13, 2019 at 12:55 pm

Post count: 8660

#30156

Your MRI notes “Moderate uniform L5-S1 disc space loss. Moderate to severe broad-based posterior disc bulge with a superimposed left paracentral disc herniation. Measures 16 mm at the base and 6 mm in AP dimension. Severe obliteration of the left lateral recess. Severe right neural foraminal narrowing. Severe left neural foraminal narrowing. Moderate central spinal stenosis. Displacement of both the descending S1 nerve roots, left worse than right”. This is an indicate of severe degenerative disc disease at L5-S1 where this level can generate central lower back pain as well as nerve pain due to both roots being compressed.

Your follow-up MRI after your bad fall notes advanced isolated disc resorption of L5-S1; “Advanced (significant) DDD at L5-S1 with disc height loss, endplate osteophytosis, probably some associated endplate edema”. However your nerve compression has improved.

See https://neckandback.com/conditions/isolated-disc-resorption-lumbar-spine-idr/ to understand this disorder. You will probably need a TLIF eventually based upon your symptoms and failed treatment.
See https://neckandback.com/treatments/transforaminal-lumbar-interbody-fusion-tlif/

You could most likely use some diagnostic/therapeutic injections. 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.
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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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