Cauda Equine Symptoms

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irelandigo
Participant

June 10, 2017 at 5:27 pm

Post count: 7

#25188

Dr Corenman,

I am climbing the walls in pain, which so much acts like cauda equine or conus but getting no answers. Are there other things which can mimic this, or I’m wondering if I am just not being diagnosed correctly.

11 years ago I was fused at L4L5, as well as C5-C6. Unfortunately I took a fall this last year and it sounds as if I will need to be now fused at C4-C5 an C6-C7 due to movement.

However eight weeks ago I squatted down trying to be careful with the neck (instead of bending forward) and boom when I came back up I wasn’t the same.

Immediately I couldn’t stand up straight I had two issues, it felt like the area of T7/8 had shifted and I couldn’t catch my breath, (I apparently have a small disc bulge there and am offset a bit there).

But then, the worst came on, horrendous pain started in the lower back. It was so hard to tell where it was coming from it felt like I was ripping apart from about T12 down, and through the center of my body.

At first it felt like when a disc ruptures and all the material leaks and it burns, but then it also started to feel like every nerve that goes down the center of your spine was ripping apart; pain to the abdomen, low back, buttocks, perineal area, rectum etc, as well as I had severe pain down both legs, front and back to the toes and two knots coming out from the sacrum where the sciatica is.

Next I lost my bowels and my urine and I have not been able to hold them since just have to go right away. The following three four days I couldn’t walk at all my legs were just weak, like mush. Wouldn’t hold me.

Eventually I went to the Er they did an MRI and didn’t see anything. They thought for sure I had cauda equine or ruptured disk but saw nothing.

Todate, I am upright but still in horrible pain down both legs, seems the back legs are worse than the front now. I still can not sit, due to the nerve pain, it just unbearable. I still have saddle paresthesia,and the nerve pain in the private areas, and still very little rectal tone, numbness, and the tissue hanging in the bum area, its like the distribution of cauda equine/ or I guess one would say S2?. And the pain is from the back to the toes.

I still feel stuck like my bum/sacrum are in the wrong position, like above and below my lumbar fusion. And three days ago, all I did was stand up and my upper back, shifted again and the pain is now all the way around the chest, and so painful to breath. And my tissue in both areas are so hot. I also seem to be experiencing some sort of reflexia every time I have a bowel movement and I nearly back out, and my bp goes very high and I feel awful. Its like all the nerves are being ripped.

I have had a couple consults and they say they see nothing, but they can clearly see I am struggling to stand up or walk and in horrible pain.

I used to be a triathlete and marathoner and I know biomechanical when something is not right, as well as have a high threshold of pain. I can hardly move both due to the pain but also that I am misaligned somehow. Since the squat my abdomen is distended out, like the lumbar and pelvis are not aligned, so I have to try to pull it back pain and all, and my upper back I have to kind of roll that forward. Nothing feels lined up. I’m a mess….

I keep trying to move but it is nearly impossible too, and when I do finally get to sleep =the pain will wake me from sleep as if its traveling up and down my spine and I’m ripping apart as well as aches in the low back like when you have a fracture.

Oddly I have not been able to lay on my left side or even pulling legs up towards my chest or behind me. I had great agility before the squat so something’s not right at all.

Again, I had been doing exceptionally well until I fell last year and messed up the neck again, yet even then my T Spine and lumber where in great shape until that dog gone squat. wish I cold take it back…..argh…. I had
Until the fall last year, and the neck issue I had been walking religiously ten miles a day, sometimes more. Was really looking forward to getting the neck figured out so I could get back on the road…now I can’t even walk a few feet makes no sense.

So what do you think……do you think the cauda or conus are impinged or I have a fracture and they just cant see it? Structurally, the low back feels like its tipped inward and stuck there, like the anatomy is pressing inward from the back. And my upper back feels like pushed inward towards the chest as well……..

Any thoughts would be so greatly appreciated.

Thank you
Mary

Donald Corenman, MD, DC
Moderator

June 10, 2017 at 11:50 pm

Post count: 8660

#25191

Your pain starts at the lower thoracic spine and not the lower lumbar spine? I hope that you had a new thoracic MRI after the onset of this pain. I assume you had a new lumbar MRI that did not note a difference from the old one.

Your symptoms ” I still can not sit, due to the nerve pain, it just unbearable. I still have saddle paresthesia,and the nerve pain in the private areas, and still very little rectal tone, numbness, and the tissue hanging in the bum area, its like the distribution of cauda equine/ or I guess one would say S2?. And the pain is from the back to the toes” certainly can be from caudal equina syndrome but could be from lower cord compression too. I emphasize an MRI of the thoracic spine and even cervical spine to make sure there are no compressive lesions above the lumbar spine.

If there are no compressive areas of the spinal canal, we will talk further.

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.

irelandigo
Participant

June 11, 2017 at 5:50 pm

Post count: 7

#25193

Thank you very much Dr. Corenman for the quick reply.

So I had an MRI of my cervical on 4/13/17, which was like two days before the squat episode that resulted in the Tspine and lumbar issue. They then did lumbar and Tspine on 4/23/17 as a result of that new pain from the squat.

Then unfortunately as I mentioned two weeks ago, while still reeling from the squat pain, I stood up and it felt like something slipped more in tspine, right behind/below the sternum, and radiated around the chest. But if I try to stand up, I seem weak from about the bottom of the ribs/Tspine to the belly button/pelvis. The are we kind of consider the small or our back?

If I sit, I note I am weak from this area too, and it definitely radiates down the back, I’d say on both sides of the spinal column/down the center, around the belly, and then down through the pelvis and into the legs and other areas I mention.

On these 4/23/17 scans they said they did not really see anything, on the Tspine or Lumbar, which kind of made me wonder as they really didn’t mention much about the T7/T8 bulge or being offset, as they did on images in prior years.

They also did not mention any changes in the lumbar, which was also kind of odd to me too as they didn’t even mention an issue with the L4 nerve impingement that we also knew about previously but that pain is nothing like what I am dealing with. That pain didn’t stop me from activity at all. Only flared once in a while. I understand d different radiologist read things differently.

Forgive me if I am confusing, lately pain is not being my friend.. :-)

So are you thinking I should push to have another MRi of the Tspine since I felt something more slip there two weeks ago and even worse? I know they worry about too much radiation, but argh. What does one do?.

As for the cervical, I did notice yesterday that as this Tpsine has worsened, if i move my neck at all, I now have pain radiating from neck to the chest, both shoulders now and down inbetween the shoulder blades but I assumed that might be spasms from the tspine. Just makes sense to me if something was now out in the Tspine/lumbar the neck was going to give me more trouble,a nd of course not safe.

Thank you
Mary

Donald Corenman, MD, DC
Moderator

June 12, 2017 at 12:13 am

Post count: 8660

#25196

Mary, what you need is a thorough physical examination. There are findings that can go along with your complaints such as long tract signs, specific motor weakness testing and even rectal tests to look for central disorders. If these signs are not present, you might have a metabolic disorder or even something unusual like Lyme disease or MS (unlikely). You need to find a careful diagnostician to help you sort through these possibilities.

Since you had MRIs of your thoracic and lumbar spines after the actor onset of symptoms, you have had appropriate care to this point.

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.

irelandigo
Participant

June 13, 2017 at 11:12 am

Post count: 7

#25202

Thank you so much Dr. Corenman for all your insight and help!!

All the best,
Mary
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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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