Chronic Pain with no help

Viewing 6 posts - 1 through 6 (of 6 total)

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Davidmt00
Participant

January 22, 2017 at 12:20 pm

Post count: 3

#24202

I am a war veteran with 50% disability with migraines. I have suffered low back pain beginning around my time of service. It has become an on and off debilitating pain. I can go months with mild pain and then a week with not even walking straight because of the pain. Not a day goes by there is not some type of pain. My upper back has not stopped hurting in 3 months. I cant wash my hair without major pain. I have a hard time sleeping and getting out of bed. Last few days it feels as if my neck and shoulders are not strong enough to lift my head up when getting out of bed. The VA has been doing all the medical but it seems as if they are not trying to help me and I had prior surgery there for other things and i just dont trust them.

Procedure/Test Name: MRI SPINE CERVICAL W/O CONTRAST
Date/Time Exam Performed: 05 Jun 2015

C2-C3 and C3-C4: A very small left posterolateral disc osteophyte
complex. Minimal narrowing of the left neural foramen. No
central canal stenosis.
C5-C6: A moderate-sized left central disc osteophyte complex. No
central canal stenosis or neural foraminal narrowing.
C6-C7: A large central and left posterolateral disc osteophyte
complex. No central canal stenosis or neural foraminal narrowing.
Multilevel lumbar spondylosis as above.

Procedure/Test Name: MRI SPINE THORACIC W/O CONTRAST
Date/Time Exam Performed: 15 Nov 2016

Multilevel disc desiccation and height loss is noted. Cord signal
intensity is normal.
There is no evidence of epidural hematoma.
T5-T6: Moderate to large size central posterior disc protrusion
causing complete effacement of the anterior thecal sac and smooth
indentation on the anterior aspect of the cord. No central canal
stenosis or neural foraminal narrowing.
T6-T7 and T7-T8: Very small central posterior disc protrusion. No
central canal stenosis or neural foraminal narrowing.
T9-T10: A small central posterior disc protrusion. No central
canal stenosis or neural foraminal narrowing

Procedure/Test Name: CT THORAX W/CONT
Date/Time Exam Performed: 01 Jan 2016

Scattered small suspected Schmorl’s
nodes within thoracic spine. Mild multilevel degenerative changes
within thoracic spine.

Procedure/Test Name: MRI SPINE LUMBAR W/O CONTRAST
Date/Time Exam Performed: 05 Jun 2015

L2-L3: A very small broad-based posterior disc bulge with annular
tear. No central canal stenosis or neural foraminal narrowing.
L3-L4: A small broad-based posterior disc bulge. Mild bilateral
ligamentum flavum and facet joint hypertrophy. No central canal
stenosis or neural foraminal narrowing.
L4-L5: A small to moderate-sized posterior disc extrusion. Mild
bilateral ligamentum flavum and facet joint hypertrophy. Mild
narrowing of the left neural foramen. No central canal stenosis.
L5-S1: A very small broad-based posterior disc bulge. Moderate
bilateral facet joint hypertrophy. Mild narrowing of the
bilateral neural foramina. No central canal stenosis.

Donald Corenman, MD, DC
Moderator

January 22, 2017 at 2:59 pm

Post count: 8660

#24203

I’m going to focus on your lumbar spine. You have chronic mild to moderate lower back pain with severe exacerbations and aggravation with activity. You report no leg pain.

Your MRI of your lumbar spine notes: L2-L3: A very small broad-based posterior disc bulge, L3-L4: A small broad-based posterior disc bulge, L4-L5: A small to moderate-sized posterior disc extrusion and L5-S1: A very small broad-based posterior disc bulge. Moderate bilateral facet joint hypertrophy.

Your multilevel degenerative changes indicates a genetic predisposition to degenerative disc disease. There is no note of focal disc degeneration of a severe nature (endplate fractures, severe disc narrowing or Modic changes) but the radiologist might not have reported this). You have no significant central canal narrowing. You do have degenerative facet disease (“moderate” at L5-S1).

If the facets are causing pain (rare but possible), you could try lumbar facet blocks and if you get relief, then you could consider ablations (see website).

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.

Davidmt00
Participant

January 22, 2017 at 4:01 pm

Post count: 3

#24204

Thank you for taking time to reply. I do greatly appreciate it! I do get occasional buttock pain and some leg pain. Nothing that was so bad i needed a pain pill for that. But definitely would need the occasional pain pill for the lower back and would feel deeper as if the SI joint. From what i understand from you is I may be only 37 years young but my lower back is just wore out? Nothing majorly wrong

Donald Corenman, MD, DC
Moderator

January 22, 2017 at 4:53 pm

Post count: 8660

#24207

Without seeing the films (including X-rays) I could not give specific comment but probably yes, you have CBS (Crappy Back Syndrome). Core strength, medications and activity restriction would be the best treatment for that disorder. See https://neckandback.com/treatments/conservative-treatment-mechanical-lower-back-disorders/ to understand the mechanics of this problem.

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.

Davidmt00
Participant

January 22, 2017 at 6:26 pm

Post count: 3

#24210

It may not sound like good news but from other people with back problems i’m taking it as good news. Would I be correct to say the mid back and neck is pretty much the same deal?

Donald Corenman, MD, DC
Moderator

January 23, 2017 at 9:00 pm

Post count: 8660

#24219

I would assume so. Genetics of the spine covers the entire spine.

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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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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