Bad back and leg pain l5 s1 with annular tear

Tagged: Herniated disc l5-s1 with annular tear, work comp

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Backpain14
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November 6, 2016 at 3:50 am

Post count: 7

#23368

Hi I had a back fall on wet tiles back in August, that painful that I could get myself back up. I was taken straight to doctor where I had a X-ray and was told I was just badly bruised and to just rest. About a month later I was so in bad pain in my lower back and pains going down both my leg and numbness. My doctor sent me for a MRI and ct plus referred me to a specialist.

MRI came back with
Findings: gentle curve to the spine which is concave to the right on the coronal T2 weighted sequence. There is also loss of t2 weighted signal at l5-s1 disc level.
L4-5: no major disc herniation, no foraminal narrowing, minor facet joint arthropathy on the right.
L5-s1: paracentral disc herniation with annular tear extends back between the s1 nerve roots. Could be irritation to the right s1 and left s1 nerve root. The exit Forman l5 is also very mildly narrowed bilaterally worse on the right.

Ct came back with

L5-s1: large right central posterior of the disc causing impression on the thecal sac and abutting the nerve root. Disc bulging into both right and left lateral recesses. The posterior joints appear normal. No canal narrowing.

Vertical coccyx

After scan I then had a nerve root injection in the right and left side that for a week after I lost major feeling in legs and was in even more pain for 2 weeks then went back to how I was feeling before injections. I have been done about 8 physio appiontment where I was in even more pain after? I walk with a limp now can’t hey comfortable when sleeping, drive for no longer them 15 mins, do anything active. By my reports can you please tell me what all this might mean and what I could maybe do to help me get better. I don’t quite understand the MRI and ct and what the extends this can have on me later in life as I am 26 with 3 young children

Thank you for your help

Donald Corenman, MD, DC
Moderator

November 6, 2016 at 8:20 am

Post count: 8660

#23370

You first need to describe your symptoms a manner that I can use to help you. See the section https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-lower-back-and-leg-pain/ to understand how to describe 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.

Backpain14
Participant

November 6, 2016 at 4:06 pm

Post count: 7

#23376

Thank you for your reply, I have numbness in both legs and they feel heavy, I can’t sit for long periods, or do anything active. My middle section of my back down to my tailbone is always in pain. I have shooting pain that goes down my legs to my feet. I also have 2 small bones that stick out at my tailbone area. So can not lay flat. In the morning I feel ok with just slow walking and taking it easy by the night time I have worse pain. I can only lay on each side for so long then have to change laying positions. Weakness in the buttocks and legs like I have done a major workout. Pain in about 5 in morning bare able then about a 8 at night time. Bending forward is painful causing that shooting pain down leg but bending back wards is bare able. My back feel really weak. I hope that’s enough information :) thank you

Donald Corenman, MD, DC
Moderator

November 8, 2016 at 5:31 am

Post count: 8660

#23383

By your symptoms, you sound like you have radiculopathy from this disc herniation at L5-S1 and back pain from the annular tear at the same level. I will assume you don’t have motor weakness as if you did, that would be a surgical indication. You can test for motor weakness yourself by following the advice on this section; https://neckandback.com/conditions/home-testing-for-leg-weakness/.

Treatment for this condition (without motor weakness) is physical therapy and epidural injections along with medications. If symptoms do not improve in 3 months, then surgery would be recommended.

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.

Backpain14
Participant

April 13, 2017 at 3:45 am

Post count: 7

#24656

Hi doctor, I wrote to you 5 months ago with the above information. These month later I have tried injections and exercise physio where I ended up finding myself in severe pain after exercise physio I ended up in emergency. Due to rural area I have been waiting days to be seen by someone. Could this of aggravated my disc? Also With severe pain in back, shooting, numbness and lose of movement on left leg and 2 middle toes numb and also have not had bowel movement in 6 day and have no urge? I can’t lay flat walk with a limp and now have been trying to get better 8 months now. Do you think I need surgery or to keep trying with physio? Due to this being a work injury i feel I am not being pushed in the right direction. 2x surgeons have now said u need surgery and insurance company’s doctor said no. I can’t live with this pain anymore I am only 26 with 3 children and I am struggling.

Thank you so much for taking the time to ask people like me in pains questions and I do understand you can only give advice

Donald Corenman, MD, DC
Moderator

April 14, 2017 at 8:02 am

Post count: 8660

#24657

8 months of incapacitating back and leg pain certainly deserves a surgical work-up in my opinion. If two respected surgeons have each stated that surgery is called for and your work comp company denies their opinion and ignores your incapacity, you need to have a work comp attorney review your case. This situation is unfortunately not uncommon with some work comp companies to deny surgical opinions.

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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