bulging disc

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michael
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May 26, 2011 at 11:47 pm

Post count: 7

#4603

Hello Dr. Corenman. First of all, thank you for all the information on this site, I have learned more from your site than all the visits to any of the doctors I have seen for my back pain/leg pain.

This may be a bit long but I want to give you the most detailed information. I am 38 in good shape and have no health issues other than my back. 4.5 years ago I was working out doing back extentions when I felt a pain all the way down the back of my left leg into the foot. I immediately stopped working out and went home. The pain increased and was pretty moderate and mostly when I sat. Standing was much better. From that point on I saw a chiro, an othopedic surgeon, and nuerologist. I had an MRI done, but not one doctor went over the results with me. But I did get the radiolists report so I was able to read that I had a bulge at L4/L5. But that’s about all I understood since I’m no doctor. I found these doctors to be of zero help so I just quit going.

The pain in my leg when I sat seemed to improve over time and eventually after a year or so it either subsided enough to not really bother me or I was just so used to it that it didn’t really bother me. I would still notice it, but it didn’t affect any of my activities too much.

So I got back into working out (didn’t do any back extentions again or anything else that really used the lower back) and did fine up until this February when I took my neice bowling. Bowling 3 games really made my back tight and hurt badly and both legs began to hurt. I noticed a lot of very low/central back pain, pins and needles in legs, pain, numbness, or what I like to describe as “circulation being cut off” to the lower legs (kinda like how your arm feels when they put a blood pressure pump on). I also have a tad bit of weakness in my right calf and hamstring. (feels more like I have worked my leg out and it’s tired). All of these syptoms are felt in the bottom of my feet, toes, outside of feet, lower legs, lower thighs. The syptoms come and go in intesity depending on what I’m doing.

I am an airline pilot and now these new symptoms were affecting my job. I had a new MRI and for the first time I am able to see the images and there’s an obvious bulge at L4/L5 (it’s obvious to anybody with eyes!). I went to a nuerosurgeon (took 6 weeks to get an appt.)and while he didn’t go over the images with me, he looked at them and also stated that my L5 has slid forward over S1 a few millimeters and that is affecting me also. (I’m no doctor but I have looked at the images ad nauseum and I cannot see this spondylolisthesis he’s talking about). He didn’t recommend anything other than some back exercises he gave me.

I’m frustrated! I have improved some from the bowling day, but I still have lots of lower back pain and pain and all the symptoms (in varying intesities) described above when I sit . Any type of strenuous activity just makes my back knot up and hurt and the symptoms get worse. Walking makes it feel better. But as a pilot I cannot get up and walk around in the plane! I am going to see another nuerosurgeon on June 6th.

What’s your opinion given what I have told you and not seeing the images? I have been very tempted to get myself to your office as you have come highly recommened by a USAF General friend of mine who says the USAF flight surgeons speak very highly of you. There’s gotta be something that can be done to improve my quality of life.

Thanks for taking time to read this.

michael
Member

May 29, 2011 at 12:31 am

Post count: 7

#4605

I should also mention that when I sit, the symptoms are very light in intensity and then gradually increase the longer I sit. They will almost go completely away if I stand up and walk around. I can also sit in one chair and have very light symptoms and get up, move to another chair and have much worse symptoms. Some chairs are great, others are not! So it’s constantly changing all day.

The bulge at L4/L5 is also centrally located.

Donald Corenman, MD, DC
Moderator

May 29, 2011 at 12:40 am

Post count: 8660

#4606

It appears that you suffered a disc herniation at L4-5 when doing back extensions so many years ago. The L5 root was compressed and you developed radiculopathy. You don’t mention any foot weakness (the L5 nerve could cause foot drop, weakness of ankle inverters and a trendelenberg gait)- see web site for these conditions.

Normally with a disc herniation, the symptoms will slowly decrease over time. The tear in the back wall of the disc however does not heal. Since the process of degeneration does not stop, the nucleus (inside jelly) can disrupt and become another free fragment. A recurrent (repeat) disc herniation occurs in about 10% of patients. This is what probably happened after the bowling incident.

The comment by the neurosurgeon about one vertebra slipping on the other sounds like a spondylolysthesis. There are two types that might affect you- isthmic and degenerative. These should be obvious on x-ray and MRI. Look at the radiology report to confirm this slip.

If you have back pain and leg pain- what is the percentage of back vs. leg? This makes a difference as back pain is generally caused by the spinal column itself (instability, degenerative disc disease or spondylolysthesis) and leg pain which includes buttocks pain is caused by nerve compression.

The fact that sitting causes more pain is somewhat encouraging as this may indicate that the disc herniation is causing much of the pain. However, the percentage of back vs. leg pain will help to understand the correct diagnosis. Please feel free to send your films into the office.

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.

Donald Corenman, MD, DC
Moderator

May 29, 2011 at 12:47 am

Post count: 8660

#4607

The fact that standing and walking do not aggravate your symptoms is helpful. Central spine pain with standing normally stems from instability or discogenic pain so absence of this pain makes the prognosis much better. The “central bulge” at L4-5 does not really describe how large the herniation is or if it lateralizes to one side or the other. Please send in your films.

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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