Already had 5 back surgeries, 42 yrs old and in desperate need of help

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Ivor
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September 4, 2013 at 6:06 am

Post count: 3

#9329

I shall start by telling you my history.

At the age of 18 is when I started having problems with my lower spine. Im now 42 and have undergone 5 operations on my lower spine to treat frequent disc prolapses between L4-L5, L5-S1. All these operations were performed via open surgery with the incision always being around 5 inches long. A microdiscectomy has never been offered to me. My 4th operation was a spinal fusion just using bone grafts, no metal work. This proved unsuccessful as I had another disc prolapse between L5/S1 afterwards which required another discectomy.

During my last disc prolapse I lost feeling in my left foot and could not pull my toes towards me. Despite my last operation the feeling has never come back. My surgeon said he could not remove all of the disc bulge and said it would cause more damage if he tried.

Recently I had another MRI scan as I continue to suffer low back pain and sciatica. The scan revealed severe disc degeneration between L4-L5, L5-S1, a small disc prolapse between L4-L5, a central and left sided disc prolapse between L5-S1. A cyst was also diagnosed within a disc fragment. Finally scar tissue at the L5-S1 nerve root.

Now I have been told nothing more can be done for me. I asked for my MRI disc and was mortified when I looked at the scan images because I was alarmed what my untrained eyes were seeing. Im not happy being left like this and fear what may happen as I get older.

Donald Corenman, MD, DC
Moderator

September 7, 2013 at 11:16 pm

Post count: 8660

#9343

You have had a very rough course from your prior spine surgeries and the attempted fusion you underwent unfortunately had a low rate of success. Without mechanical stabilization of the vertebra (rods and screws or an immobilization brace), fusion rates are very low (maybe in the 50% range).

You have lower back pain and sciatica. What is the percentage of both together? Do you have more back pain than leg pain (70/30, 60/40) or the reverse?

The disc prolapse at L5-S1 can possibly be surgically treated and your lower back pain can also respond to surgery. You need to find an experienced and thoughtful spine surgeon to perform a complete work up.

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.

Ivor
Member

September 8, 2013 at 6:23 am

Post count: 3

#9345

Thank you for replying.

As for my pain in my lower back, sciatica then I would say it depends on what I do. I can only walk/stand by using two crutches. Upon standing from sitting the pain is probably 70% in my lower back, however after around 10mins of standing/walking the focus of the pain shifts down my left leg and then becomes 50/50.

I do have an additional problem with my bowels as I tend to lose control on a regular basis. However when I received my MRI results via a telephone call I was told nothing in the scan suggested my spine was causing a problem with my bowels.

What alarmed me the most about my scan is the discs above L4 were clearly visible. Between L4 to S1 it was just blackness and even more scary was how the vertebrae between L4-L5 are virtually touching each other. The disc at this level is non existent.

Finally its worth adding that I live in the UK. All my treatment was via the NHS and like I said earlier the likes of disc replacement or microdisectomy were never offered to me. These techniques are generally reserved in my area in private hospitals which I cannot afford. I don’t even have the money for a consultation let alone treatment!

Donald Corenman, MD, DC
Moderator

September 8, 2013 at 9:49 pm

Post count: 8660

#9346

Your symptoms sound to be severe but believe it or not, better for a potential solution. Your back pain as described seems to be from a typical severe degenerative disc disease condition called isolated disc resorption (IDR-see section under “causes of lower back pain” under “conditions”).

Your leg pain I was worried was caused by chronic radiculopathy (nerve injury that won’t heal-see website) but leg pain that increases with standing and walking also has a stenotic cause called foraminal or lateral recess stenosis. See the website for these conditions.

Your bowel condition may have nothing to do with your spine but I have seen patients with severe lower back pain have bowel control issues on occasion due to the intense nature of this lower back pain.

Maybe if you can make a case to the NHS for your back pain being caused by IDR and foraminal stenosis (possibly by using the information off this website and the paper in spine I just published which covers your condition), the NHS will consider a TLIF fusion of L4-S1 which very well could be the answer to your symptoms.

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.

Ivor
Member

September 14, 2013 at 6:03 am

Post count: 3

#9372

Thank you again DR Corenman for your reply.

I had a look at the Isolated Disc resorption on this website and found it most interesting. The MRI scan you used in the article looks similar to mine except I would say mine is a more extreme version of it.

A few days ago I received a letter from my hospital to see a pain management specialist who I have seen many times before. He normally performs an injection via epidural although it will probably be 5 months before I actually have this done due to the waiting times on the NHS!

So far this is the only treatment available to me although I am seriously thinking of taking your advice and seeing my General Practioner again with a view of seeking another spinal surgeon. The problem is this can take a very long time.

Thanks again for your help it is much appreciated.

Donald Corenman, MD, DC
Moderator

September 14, 2013 at 3:58 pm

Post count: 8660

#9373

Please let us know how your treatment progresses.

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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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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