Athlete with L5-S1 DDD

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benbuxton2
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April 21, 2012 at 10:13 am

Post count: 2

#6055

Dr. Corenman – First of all I wanted to thank you for the tremendous amount of useful information on your website – it has been very helpful in better understanding the anatomy of the spine, diagnosis, as well as treatment options.

I am a 46 yr old male who has been a competitive endurance athlete for many years including road cycling, mountain biking, and nordic and alpine skiing. I have managed several L5-S1 disc injuries over time and have been able to manage these injuries with conservative care including physical and massage therapy, manual therapy, as well as focused core strength training of deep stabilizers of the core and back. Within the past year, I have also included pilates strength training and found it to be very helpful.

In Nov. 2010 after rigorous mountain bike training, I had another flare up of back pain, and begun conservative care, but with limited to no success. In May 0f 2011, I underwent several steroid injections without significant relief. In June of 2011, I incurred a significant herniation at L5-S1 and experienced significant pain (9/10) and began to suffer nerve pain and loss of function (dorsal flexsion) in my left leg. Upon seeing a spine surgeon and review of my lumbar MRI, it was determined I needed a micro-discecotmy to relieve the excruciating back and leg pain and relieve the pressure on spinal nerves. The surgeon removed a significant disc fragment and after several months of recovery I was back to my activities, but still was experiencing back pain in the 2-4 range.

I’ve had 2 significant flare ups since Nov. 2011 and have continued to manage it conservatively, but have not been able to get to the level of athletic activity I want to be at. My most recent MRI from Dec. of 2011 (post surgery) showed that I continue to have a small-moderate sized broad based central disc protrusion with an associated annular fissure at L5-S1. There was additional mild degenerative spondylosis and mild to moderate DDD as well as difuse buldging of the disc annulus and minimal bilateral neural foraminal narrowing at the L5-S1 level. While there was minimal vertebral body end plate osteophyte formation at both L4-L5 and L5-S1, L4-L5 showed no signs of annular fissure or disc protrusion.

That brings me to now. A week ago, I had yet another flare up after alpine skiing. I have gotten to the point where I need to consider the next steps to provide me relief. After nearly 18 months of on and off back pain and surgery, I’m now seeking out whether to pursue a fusion such as a TLIF. I have consults scheduled with 2 spine surgeons in the Denver area in the coming weeks and would appreciate any advice you can provide. My questions include:

1. Do you think a discogram would be a useful diagnostic tool for my condition?

2. Are there any other conservative care options I could consider?

3. Given my history and desire to return to athletic activity, do you think a lumbar fusion would be a good option for me to address both the pain and return to my desired level of activity?

I’m at the point where I feel like my life has been on hold for nearly 2 years and the chronic pain is always there and I really need to figure out the next steps. One thing that sticks with me is how you’ve discussed that disc injuries are cumulative and it seems that my disc injury has advanced to the point where it’s beyond continued conservative care. In the end, I’m desperate to return to the life I’ve enjoyed and move beyond this injury.

Thanks…Ben B.

Donald Corenman, MD, DC
Moderator

April 22, 2012 at 3:40 am

Post count: 8660

#6068

By your history and the sounds of your symptoms, you would probably be a candidate for a TLIF at the L5-S1 level. I am somewhat concerned about the osteophytes at L4-5 but if that disc has a normal appearance, you should be OK with just an L5-S1 fusion. The discogram is important if there is some confusion regarding the symptoms or the appropriateness of patient selection but I don’t believe that is a concern in your case.

You have already undergone reasonable physical therapy and rehabilitation and epidurals with continued symptoms. You can try chiropractic treatment if you so desire. Other than that, you are probably a candidate for fusion surgery.

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.

benbuxton2
Member

April 22, 2012 at 12:32 pm

Post count: 2

#6073

Thanks for the info and opinion on me being a candidate for a TLIF.

With respect to the osteophyte at L4-5, what is the potential concern relative to doing the L5-S1 fusion? The radiology report terms it as marginal and minimal, but am interested in potential issues.

Donald Corenman, MD, DC
Moderator

April 22, 2012 at 10:40 pm

Post count: 8660

#6076

Osteophytes can be an indication of an enthesopathy which is an abnormal motion of a vertebra causing a pull on the insertion of ligament. This might be a finding that can cause no particular problem but I always look more carefully at this disc level if bone spurs are present. There are other non-worrisome disorders that can cause these spurs like DISH (diffuse idiopathic skeletal hyperostosis).

If the disc back wall is jet black and flat to concave on the axial MRI T2 and the sagittal MRI demonstrates a well hydrated nucleus (back wall of the jelly donut is jet black on the top down view and on the side view, the disc looks like all the others except L5-S1), there probably is no significant problem with the disc.

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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