Cauda Equina Syndrome (Post Op symptoms and problema)

Tagged: Cauda Equina Syndrome

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Rebecca26
Participant

September 26, 2018 at 12:29 am

Post count: 8

#29423

Good day Dr. Donald,

I am Rebecca Garcia, im from Philippines asking for your help in regards with my mother’s condition. I hope you could help us and give us opinion on her case.

My mom was diagnose with Cauda Equina Syndrome L5-S1 last January 2017 with a symptoms of bladder and bowel incontinence and operated procesure is Bilateral Facetectomy last Feb 2017 here in Philippines. But until now she is still suffering tingling(butt and vagina), burning sensation and numbness of the left leg. We had a MRI procedure and I ask for another opinion from a neuroradiologist from Manila and told us that there are granulation surrounding the nerve root. I have scans of MRI films and reading here that I hope you can see. My mom is still suffering bladder and bowel control, tingling ang numbness on her left leg.

Is this a bad situation for my mom, after all she undergo operation?

Please help us Dr. Donald. ?

Regards,

Rebecca

Donald Corenman, MD, DC
Moderator

September 27, 2018 at 7:04 am

Post count: 8660

#29428

Cauda equina syndrome is a condition where there is substantial compression of the entire spinal canal at any level from L2 through S1. This compression includes the S2-4 nerves (pudendal nerves) and Nervi Erigantes, the parasympathetic nerves that control bowel and bladder function. If caudal equina syndrome is present, generally a surgical decompression should be performed on a timely basis. See https://neckandback.com/conditions/cauda-equina-syndrome/.

Unfortunately, the severe compression can cause damage to these nerves regardless of how quickly a decompression is performed. It sounds like your mother still has nerve injury; (“still suffering tingling(butt and vagina), burning sensation and numbness of the left leg”) and there is no further compression. There is granulation tissue that surrounds the nerves. Granulation is scar tissue.

It will take up to one year to discover what the full extent of recovery will be.

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.

Rebecca26
Participant

September 27, 2018 at 7:20 am

Post count: 8

#29429

Hi Dr. Corenman,

Thank you for your fast feedback on my consultation. As a daughter I am very afraid and worried for my mother’s condition. Is theres a hope that my mom will recover from this disease? How serious is the scar tissues? is this is an emergency case, do we need to undergo another operation for the granulation? What can you recommend doc?

I hope you could help us even if you are really miles a way doc. Your response is very much appreciated and helpful doc.

Thank you and God Bless you Doc Corenman.

Regards,

Rebecca

Donald Corenman, MD, DC
Moderator

September 27, 2018 at 9:06 am

Post count: 8660

#29430

If the surgery completely decompressed the canal, then there is only the matter of time to determine recovery. A surgery for scar tissue generally is ineffective to resolve root dysfunction. Unfortunately, there is not much more you can do other than wait.

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.

Rebecca26
Participant

September 28, 2018 at 6:36 am

Post count: 8

#29434

I wish I can send some MRI results and films we have before and after the surgery. Dr. Donald, thank you so much for your advice, this is a big help for us and to my mother to lessen her stress in dealing with this disease. Its been a year and a half since she undergo surgery, as of now she has a suprapubic catheter. We will wait and continue to hope that time will come for my mother’s full recovery. Thank you so much, and God bless you. Can’t thank you enough for your help doc. I hope you can still help people who needs your professional advice.

Rebecca26
Participant

October 12, 2018 at 1:09 am

Post count: 8

#29681

Hi Dr. Corenman,

Good day! I just want to ask regarding the recovery timeframe of my mother who has a cauda equina sydrome with bladder and bowel incontenence. You said that we will know the recovery time within a year, but on February 2019, it will be her 2nd year suffering from the incontenence and until now she has a suprapubic catheter.

How we will know the progress of her recovery, Dr? What measurements, or observations can we consider that she is still on a recovery stage?

Hoping for your response, Dr.

Thank you,

Rebecca
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Donald Corenman, MD, DC

Average rating:

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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