Bulging disc between L4 and L5

Tagged: Sacroiliac pain

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Weldon
Participant

August 9, 2019 at 12:05 pm

Post count: 9

#30830

I have experienced the SI joint slipping out of alignment five times over 18 months. Three times in the last five weeks of which the last time the pain was excruciating. My neighbor is a PT, PhD at an out-patient clinic attached to a hospital and is helping me with an exercise program. After several days of the last instance, he and my P.A. suggested an MRI, which I had a week ago.

Here are the results,
Exam: Xray lumbar spine minimum four views (72110)
History: Sciatica
Technique: 5 views of the spine
Comparison: None
Findings: There is no fracture or aggressive lesion. There is a trace degenerative anterolisthesis at L4-5. There is moderate lower lumbar degenerative disc disease and facet arthropathy. There is no soft tissue abnormality.
Impression: No acute osseous abnormality. Moderate lower lumbar spondylosis.

I am 71 years old and been active all my life. After two weeks and diligent exercising, I still have pain in my upper left glute, sometimes down the outside left thigh and then to the lower part of my left shin to the ankle (like shin splints). Pain level is about a 3-4 when not hurting too much but is 6-7 when really aching. It is affecting my gait and sometimes I can barely walk. Hard to sleep and lucky to get 4-5 hours per night. The pain percentage varies between 70 – 30%, thigh to ankle but sometimes flips to more ankle than glute.

I am from southern Arkansas and both neurosurgeons I know have retired and moved. My questions is: Can this be improved by exercise with the PT supervision or might I need some type of surgical intervention?

Donald Corenman, MD, DC
Moderator

August 10, 2019 at 4:09 pm

Post count: 8660

#30835

The most common disorder that causes pain in the sacroiliac joint is a nerve compression syndrome like a disc herniation or a foraminal collapse. See https://neckandback.com/conditions/herniated-disc-lumbar-spine/ and https://neckandback.com/conditions/lumbar-foraminal-stenosis-collapse/.

The x-ray is a good test for alignment and stability but will not give information regarding nerve compression. You would need an MRI for that. Once the disorder is diagnosed, surgery is only one of the treatments for these disorders.

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.

Weldon
Participant

August 10, 2019 at 4:27 pm

Post count: 9

#30837

Dr. Corenman,
Thank you for the fast response. I had the Xray 30 days ago and the report was “You have some arthritis in the lumbar area.” After further problems arose, I had an MRI August 2nd. My post included the only results from the one page result. From researching the MRI medical terms in the report through your website and a couple of others, it appears that my problem is related to arthritis and aging.

I hope that I can mitigate further damage and maybe make improvements with diligent physical therapy. If this were you, would you try that options first? In addition, I read on your site about nerve damage and its symptoms. Last night and this morning,I started to get numbness in the tip of my left big toe, which was a symptom pointed out on the site.
Thanks for you help and for your efforts in helping others!
Weldon

Donald Corenman, MD, DC
Moderator

August 10, 2019 at 4:59 pm

Post count: 8660

#30840

If you have no motor weakness (https://neckandback.com/conditions/home-testing-for-leg-weakness/) then you can continue with PT and hopefully gain some relief.

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.

Weldon
Participant

August 11, 2019 at 9:15 am

Post count: 9

#30846

Dr. Corenman,

Again, thank you for your help, especially over a weekend. You have a passion for helping people!

I read through the link on leg weakness twice. My first thought is that the problem is the L5 Nerve Root. That is because I had noticed I could not control my toes on the left foot from “slapping” the ground as soon as my heel hit. This seemed to match your “foot drop” description. So, I tried to do the “duck walk” and could not keep my toes from hitting the ground. Would this mean that I may need more than PT? Should I share this home test with my PT?
Thanks you again for the help!
Weldon

Donald Corenman, MD, DC
Moderator

August 11, 2019 at 10:40 am

Post count: 8660

#30847

You have weakness of the tibialis anterior muscle, probably a direct result of compression of the L5 nerve root. In my opinion, you need an MRI and surgery if the MRI notes a herniated disc causing compression of the nerve root. The nerve may not recover if you wait. See https://neckandback.com/conditions/how-muscles-recover-from-nerve-injuries/

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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