Can a screw in L4-L5 disc be causing chronic pain?

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Scott
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February 7, 2012 at 3:17 am

Post count: 12

#5517

I have had 3 back surgeries in about three years. I am only 34 years old and my Dr. drove a screw into my L4-L5 disc while fusing the L5-S1 disc.Can that be the cause of my pain now in your professional opinion? I’ve been told that there is nothing that can be done and the screw is right where it should be. It doesn’t seem right to me. I’ve heard great things about you from friends and I hope you can help me. Thank you.

Donald Corenman, MD, DC
Moderator

February 7, 2012 at 7:47 am

Post count: 8660

#5518

Please reveal what prior surgeries you have had. Apparently, one was a fusion of L5-S1 with pedicle screws. Let me know where your pain is located. Do you have continued back pain or leg pain or both?

You note that one screw inadvertantly went into the disc space at L4-L5. This typically will not cause back or leg pain but can increase the chance of degenerative changes of the L4-L5 disc. I am not sure that removing the screw from the disc space if it is not irritating a nerve will help you.

I have just written a section under “conditions” called “Failed Spine Surgery Syndrome” that will be implanted on the website this week. Please look for it as this section will explain why some patients do not do as well from surgery.

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.

Scott
Member

February 7, 2012 at 12:23 pm

Post count: 12

#5519

Hi doc. Thanks for your reply. I had a fusion at L5-S1 and was healing well and after a number of months, the dr. said I was ready to go back to work. I was worried because I’m a logger in Oregon so I told him over and over just what my job entails. He told me that it would take a car wreck to damage the fusion so I went back to work.
About three days later the pain was back and the spacer between my vertabrates had slid out of place. We waited it out but it wouldn’t fuse from the movement apparently. So he went through my belly and fused it again. The pain didn’t go away and that is when the screw went into the L4-L5 disc. I went to see a pain management dr. and she felt it was the hardware from the first surgery through my back so she injected steroids at each screw and it worked. I felt great for about a week but my surgeon said he didn’t think the hardware was the problem but he removed it anyway. The whole time he said I needed a fusion at L4-L5. When the hardware removal failed to work he had changed what he had been thinking and said he couldn’t do anything more for me.
When I woke up from my first surgery he told me that the disc was bad and the L4-L5 disc was also bad but he still didn’t want to fuse it. Maybe I can send you my most recent x-ray, MRI and CAT scans if you think you may be able to do something. I need to find some relief to get back to work and be a good dad to my kids again. Hope to hear more. Thank you!!!

Donald Corenman, MD, DC
Moderator

February 7, 2012 at 10:25 pm

Post count: 8660

#5520

It was obvious from the results of heavy lifting that your fusion was not solid at the time you went back to work. The movement of the spacer in your disc space should not occur as it should be incased in solid bone. Did the spacer migrate into the canal? Was there any leg pain associated with the spacer migration?

You underwent a re-operation from the front of the spine to try and get a solid fusion. Was the displaced spacer removed at that time? Apparently, the surgeon placed anterior hardware as you note that is when the “screw went into the disc space” unless he replaced the screws in the back of the spine at the same time. You had an instrumentation injection block and then had the screws in the back removed without improvement.

Questions. Do you have a solid fusion at the L5-S1 level or is it a pseudoarthrosis? Are your symptoms more in the lower back or more in the buttocks/leg and by what percentage? How do you know that the disc at L4-5 needs a fusion?

I would be happy to review your films. Please contact Diana or Sarah at (970) 476-1100 and tell them your story.

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.

Scott
Member

February 8, 2012 at 12:26 am

Post count: 12

#5521

I have a solid fusion at L5-S1. The pain seems slightly higher than at my fusion and it is horrible. Roughly 95% of the pain is in my lumbar area and only minor leg and foot numbness. I have degenerative disc disease at L4-L5 and L5-S1. As stated in my post operative discharge papers, I was noted to have spondylolysis with hypermobility at L4-L5. I have not received all of my most recent films yet but when I do, I will send them to your office.
I find it amazing that you take the time to do this for all these people. I’ve never met a doctor who would chat outside of the office and do it without pay!!! You are a great person truly trying to help people. Thanks again.

Donald Corenman, MD, DC
Moderator

February 8, 2012 at 3:49 am

Post count: 8660

#5523

I am concerned about the report of spondylolysis at L4-5. Do you mean spondylosis? This is confusing but spondylolysis is a fracture of the back of the vertebra (see website for description) and spondylosis is simply degenerative disease.

If you do have spondylolysis, was it present prior to the L5-S1 fusion or is it new? You note hypermobility. Was this proven on flexion-extension x-rays?

If you do have spondylolisthesis with instability (see website), you may need a fusion of that level or possibly a pars repair if the disc is still intact (again- see website for pars repair). You did note previously that the disc at L4-5 was degenerative and that would preclude the repair of the pars.

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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