Chronic post-op radicular and localized pain without a diagnosis. HELP

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shels16
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December 12, 2013 at 5:21 am

Post count: 2

#9937

Dear Dr. Corenman,
I desperately need your help. I am writing to you on behalf of my husband. He had L4-L5 disc replacement and L5-S1 fusion with an anterior approach on 4.11.12. He is now in worse shape than ever and we don’t understand why. We are both physical therapists so we do have a good amount of knowledge about anatomy and physiology but we don’t know where to go from here. He has had xrays, mri, myelogram, and his surgeon said everything looks fine. We have been to a pain management doc and a neurosurgeon for another opinion which is who ordered the myelogram. They both dismissed him and the neurosurgeon said because he’s not a surgical candidate, there was nothing he could do for him. I have done some research and I have come up with a condition called arachnoiditis which I believe you are familiar with. He fits the description well but we don’t have an official diagnosis. He is only 39 and is now becoming disabled and fast. He is extremely depressed because of this and his pain level never goes below a 7/10 even on his pain medication. He is currently taking 10 mg Methadone 2x day and Percocet for breakthrough pain. He has tried other meds but what he is currently taking seems to help the most. He has to get up at 4 in the morning just to make it to work by 8 because his pain is not being controlled. He has a horrible time trying to get to sleep at night but we don’t want to use ambien in conjuction with his pain meds. He averages about 3 hours a night of sleep. His pain c/o’s consist of burning in his feet and heels, anterior tib pain, lower back pain where his surgery was and he has pain with BM’s and increased urgency with urniation. There doesn’t seem to be a pattern to his pain. Sometimes his R leg is worse and other times it’s his L. After my mom and I found your website, I called your office to schedule a consult with you. Unfortunately, your office is not contracted with our insurance. Your scheduler was nice enough to refer us to another highly recommended doc, however, after calling there, this doc will not take any patient who has had a previous surgery. We are at such a loss and don’t know where to go. No one should be in this much pain especially after a surgery that was supposed to make things better. I feel we may need an experienced radiologist to read my husband’s diagnostic scans but I have no idea how to make that happen. My husband is afraid to have any other work done to him due to all of this and has not been very open to the idea of a spinal stimulator of internal pain pump. We desperately need your help! Is there anyway you could help us knowing all that you know just by responding to this message? I would be so grateful. I am so afraid my husband’s depression is going to get worse if we don’t figure out some way to help control his pain.

Thank you so much!

Donald Corenman, MD, DC
Moderator

December 21, 2013 at 9:40 pm

Post count: 8660

#9979

I assume these symptoms began after the surgery and were not present before. Was the surgery performed for incapacitating lower back pain and your husband did not have leg pain?

Burning symptoms make me think of nerve injury. This could be arachnoiditis or chronic radiculopathy (see website). Does the pain change with position? For example, does flexion (bending forward) improve the pain and standing make the pain worse?

A careful physical examination and close perusal of the imaging should be the next step. With significant leg pain, it might be helpful to obtain a neurologist consultation with an EMG/NCV test to determine what injury the nerves have suffered.

If we assume that this is not a surgical problem (and this is a big assumption), then spinal cord stimulation can be very helpful. See the website for that topic. I can refer you to very good specialists for that consultation. Medication should include membrane stabilizers (see website under medications for description of those medications).

Dr. Corenman

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.

shels16
Member

December 31, 2013 at 2:08 am

Post count: 2

#10015

Thank you so much for responding. The systemic/sympathetic issues began after his surgery and were not present before. The surgery was performed due to having virtually no disc at L5S1 with bone on bone and radiculopathy. The pain does not seem to change with position.

I agree he needs careful perusal of the imaging but need someone who is experienced to review them. I saw in a previous post on here you had recommended a radiologist in Denver that was experienced in recognizing arachnoiditis. Can you give me their name?

My husband did obtain a neurologist consultation and he ordered a myelogram. This doc said nothing remarkable showed up and he just wanted to send him to another pain specialist.

I strongly believe this is the result of the surgery whether it be scar tissue somewhere causing this or arachnoiditis, something is definitely not right with the symptoms he is experiencing on a daily basis.

He has tried Neurontin and Lyrica and neither have helped with his pain/symptom management. He also has localized pain in his back. He has stated to me that he feels like there is acid in his spine and that he feels that he is not fused. Have you had anyone else ever tell you that?

Donald Corenman, MD, DC
Moderator

December 31, 2013 at 11:50 am

Post count: 8660

#10019

Arachnoiditis is relatively easy to spot on an MRI and there should be no need for a radiologist specialist to make this determination. Nonetheless, if you so desire, you can call the office and my staff can refer you to a good radiologist who we trust.

Chronic radiculopathy does not have to originate from arachnoiditis and most commonly does not. If this is CRPS (complex regional pain syndrome-the new title for RSD), this diagnosis is made by history, physical examination and injection testing using sympathetic blocks.

Now-if he has lower back pain as his primary complaint, he needs an FBSS workup (failed back surgery syndrome). This includes understanding if the correct initial diagnosis was made and the initial workup to get to that point, how the surgery was performed, how success the surgery was (did it do what it was supposed to do) and if there was further problems that developed after the surgery healed. There are other factors but those are the basic items to be looked at.

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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