Bladder problems

Tagged: Bladder malfunction

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June 1, 2018 at 2:29 pm

Post count: 10

#28424

Hi
I had a L4-L5 left disc herniation in December. Feb. 27th my left foot and big toe went weak and numb. MRI showed L5 nerve compressed badly. March 14th I started having frequent urination and urgency. A new MRI showed no central canal compression. And the neurosurgeon didn’t think my urinary symptoms were connected to my back. I also have grade 1 spondylothisis at L5-S1. After my foot went numb and weak I had no leg pain. The local neurosurgeon would only do a L4-S1 fusion. I went to Mayo Clinic for a second opinion because I wasn’t having symptoms from the L5-S1 level. They did a minimal invasive discetomy on L4-L5 MAY 8th. For two weeks following surgery all my urinary symptoms went away and I had no pain. Then after bending over wrong way my leg pain and urinary symptoms returned. I’m also having bad pain where my bladder is. A new MRI showed post operative change of asymmetrical disc bulge to left side which contacts L5 nerve and no central canal narrowing.
My leg pain has gotten better and I can start to raise my toes off floor so weakness is little better
My question is it probable that my urinary symptoms and bladder pain are from my disc?
And should I consider the two level fusion they offered because of urinary and bladder symptoms.

Donald Corenman, MD, DC
Moderator

June 1, 2018 at 3:35 pm

Post count: 8660

#28426

Neurological urinary symptoms originating from the lower spine typically would be from cauda equina syndrome (a massive disc herniation-see https://neckandback.com/conditions/cauda-equina-syndrome/).

A disc herniation, no matter how large it is, if it only compresses one side of the canal would not cause cauda equina syndrome as the bladder nerves live on both sides of the canal and both have to be severely compressed to cause urinary symptoms.

The most common cause of urinary symptoms in my practice is pain inhibition associated with prostatic hypertrophy in men and pelvic diaphragm incompetence from carrying children in women. Either one can cause bladder dysfunction.

There is no reason to consider fusion due to bladder problems in your case.

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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June 2, 2018 at 10:39 am

Post count: 10

#28434

Is it possible that when I stand up the central canal narrows and irritates the bladder nerves? I’ve read of other people having frequent urination/urgency/or bladder pain with disc issues. I know it’s probably uncommon.
Also do I have to worry about my new disc bulge getting worse and will it get better on it’s own?
Here is my MRI report
FINDINGS:
There are chronic bilateral pars defects at L5 and mild grade 1 anterolisthesis of L5 on S1. Vertebral body heights are maintained. Facet joints are normally aligned. No evidence of acute fracture or subluxation. There are postoperative changes of recent left laminectomy and microdiscectomy at L4-L5. Mild postsurgical fluid remains within the left paraspinal soft tissues at the L4-L5 level. The spinal cord terminates at the L1 level. Signal within the distal spinal cord is within normal limits. The visualized paraspinal soft tissues are unremarkable.

Segmental analysis:
L1-L2: No disc bulge, spinal canal narrowing, or neuroforaminal narrowing.

L2-L3: No disc bulge, spinal canal narrowing, or neuroforaminal narrowing.

L3-L4: No disc bulge, spinal canal narrowing, or neuroforaminal narrowing.

L4-L5: There is been prior microdiscectomy at L4-L5. The previously seen extruded left paracentral disc material has been resected. There remains circumferential bulging of the L4-L5 intervertebral disc which is asymmetric towards the left. Bulging disc narrows the left lateral recess and contacts the traversing left L5 nerve root. No spinal canal or neuroforaminal narrowing. Mild bilateral facet arthropathy.

L5-S1: Chronic bilateral pars defects at L5 and mild grade 1 anterolisthesis of L5 on S1. Mild to moderate left neuroforaminal narrowing. No spinal canal narrowing.

IMPRESSION:
1. Status post recent left laminectomy and microdiscectomy at L4-L5. Left paracentral extruded disc material seen on the prior exam from 3/14/2018 has been removed. There remains circumferential disc bulge at L4-L5 which is asymmetric towards the left, narrows the left lateral recess, and contacts the traversing left L5 nerve root.

2. Chronic bilateral pars defects at L5 and mild grade 1 anterolisthesis of L5 on S1. Mild to moderate left neuroforaminal narrowing at L5-S1.

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Participant

June 2, 2018 at 10:45 am

Post count: 10

#28435

Also my X-ray shows that when I stand up L5 slips more on S1 so MRI looks better when I’m lying down.

detoured
Participant

June 2, 2018 at 6:06 pm

Post count: 10

#28438

One more question is that I have some strength in my big toe but none in my second toe?? Is that from the L5 nerve and do you expect it to get better?

Donald Corenman, MD, DC
Moderator

June 2, 2018 at 9:05 pm

Post count: 8660

#28439

Your bladder problems do not neurologically originate from your spine problems. An isthmic spondylolisthesis at L5-S1 will typically compress the L5 root which facilitates extension of the great toes and smaller toes. If weak, strength could improve but I would be somewhat concerned if you had foot drop.

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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