back surgery

Tagged: Pain requirement for surgery

Viewing 6 posts - 1 through 6 (of 9 total)

1 2 Next

Author

Posts
gwccbc
Participant

August 25, 2015 at 12:22 pm

Post count: 2

#20277

I have just seen a neurosurgeon, and after an MRI, EMG, PT, Epidural and diagnostic shots, the doctor is wanting to do a left sided L5-S1 microdiscectomy with left L5 foramenotomy. He was hesitant about this procedure because he could not understand why I am not on any pain medication. The pain I am having is usually on a scale of 1-6 out of 10. My biggest complaint is not the pain but the inability to a lot of things I used to do, such as walking 3 miles 5 times a week, gardening, and household chores. Is everyone always in extreme pain before doctors will do surgery?

Greg
Participant

August 27, 2015 at 7:40 pm

Post count: 29

#20279

I have a friend that had your same surgery that you are contemplating. He asked his Neurosurgeon about me and the doctor said he would not do surgery on me because I did not have Siatica. He commented that he does not do surgery on people that have back pain only as that apparently means that there is no nerve damage. Nerve damage seems to be the metric used for surgery. The considerations are loss of feeling and muscle atrophy that can cause loss of use of a limb.

Donald Corenman, MD, DC
Moderator

August 28, 2015 at 7:38 am

Post count: 8660

#20280

It is not uncommon for neurosurgeons to only operate on nerve root compression. Some have not been trained in understanding back pain disorders and will not consider an operation to treat this family of disorders.

Pain is one of the parameters for consideration of surgery. I am unclear as to why you would need to be on narcotic pain medications for this surgeon to consider you for surgery. If you have a mechanical disorder that compresses your nerve and you can still stay off narcotics, that should not be a disqualifier for surgery. In fact, some surgeons think that a patient off narcotics is a better surgical candidate.

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.

megabeck
Participant

September 12, 2015 at 11:53 am

Post count: 1

#20323

To whom it may concern,

I have suffered with severe lower back pain since 2002. I’ve spent many thousands of dollars on chiropractors with only very moderate and short term relief. I’ve even been in traction machines (in physical therapy) which, while in the traction machine, relieved an unbelievable amount of pain; but as soon as the traction was over, I could barely walk for hours after.

(For pain relief I need no less than direct pressure on the muscles lateral to my spine in the injured area. It requires more pressure than can be applied with a thumb. Honestly, anything less than my Fiancé’s full body weight applied with the point of her elbow does nothing at all).

I’ve taken so much ibuprofen now that my stomach is in terrible shape.

I would have done much more, much sooner, for my back but I’ve received very poor advice from various sources early on. Moreover, I lost my job due to the pain and haven’t had insurance since 2003.

I now have an option for some seemingly fantastic Aetna* insurance through my university.

I had an MRI about a year ago that revealed an S1 L5 annular tear and some degenerative issues as well.

The pain currently radiates my entire sacrum and almost constantly effects both of my legs. Bending, lifting, sitting, standing and laying all hurt, all of the time. The pain is always present and lever less than a 3-5. If I do something to aggravate it, which is almost daily, it’s a 6-9.

At this point, the stress from this problem is almost as crippling as the injury itself. In that I barely have the will to even write this simple letter.

What should I do?

Sincerely,
Beckett

Greg
Participant

September 12, 2015 at 12:38 pm

Post count: 29

#20324

Dr. Corenman may be on vacation at this time as he hasn’t been on the site recently. L5, S1 issues. How old are you? Be more specific about the MRI is a suggestion. I am amazed that you have not had an epidural injection. Find a pain management specialist that does not charge a premium for the use of the fluoroscope guided x ray. Many charge for their medical service and another fee for their outpatient surgery room. Those can get costly. My PM dr charges 232.00 for a guided epidural injection without medication. They don’t hurt. I had the same results with traction in a chiropractor’s office. They tend to apply too much pounds per square inch pressure to your back and you walk out in pain. I don’t use that machine for that reason. They want to get to 100 psi when 40 psi is all you need. The Epidural which is combined with a steroid and lidocaine will flush out the irritating chemicals that exited the disk and relieve the excited nerves that are causing the pain syndrome. Steroids work wonders on annular tears. I have had injections, 1-3 per year for 10 years and they take me from debilitating pain to complete remission within one month. Within a few days you will have noticeable results and it just gets better from there. My injections have lasted for up to a year on several occasions. My last injection in July from my worst spasm ever has resolved itself in full. I did have another injection two weeks after the first just to make sure this episode was over. Not everyone is helped by physical therapy and manipulation above and beyond deep body massage. Work on your posture too. We all roll our upper backs forward. That is not good. Sit up straighter whenever possible with your head back. You want that curve in your lower back to be present whenever possible. You are creating a form of extension in the spine that is good for the disks. You are a perfect candidate for epidural injection. If your spasms tend to happen on one side exclusively you want the injection to be placed on that side of the vertebrae. Get one next week.

gwccbc
Participant

September 15, 2015 at 7:04 am

Post count: 2

#20325

Beckett, I had the same problem years ago with my back and I found the only thing that helped was walking, about 3-5 miles a day. In a few months, the back pain was completely under control. I am now going to have back surgery but I had many years of relief just from walking on a regular basis. I have had many steroid injections over the years and they have NEVER worked for me and I don’t know anyone that they have worked for! Good luck, and I hope you can find a good neurosurgeon to fix your problems if it comes to that.
Author

Posts

Viewing 6 posts - 1 through 6 (of 9 total)

1 2 Next

You must be logged in to reply to this topic.

Donald Corenman, MD, DC

Average rating:

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel