Disc bulge causing bilateral neural foramina narrowing & compression

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Donald Corenman
Keymaster

January 20, 2012 at 2:34 am

Post count: 52

#5420

Dear Sir, I am a 25 year Master’s student (Male) from India. I had a complain of Low back Pain since last 1 year which started due to heavy weight handling. Introductory treatment includes few medicines and Physiotherapy Exercises, showing good response. As the scenario of pain was continuing I had an MRI which shows L5-S1 disc bulge. After that also I was quite good with regular exercises.Until and unless its too much paining I avoid taking pain killer tablet. For last few days the situation is getting worse as I am not able to stand properly/straight without the support of LS Belt. Doctor suggest me surgery where they will remove the disc from that very portion. Do I seriously need a surgery at this point of time. Please advise me. My Height: 5 ft 5 inch, weight: 65 kg, a bit fatty, Age:25 years. Also I like to know whether the surgery (if taken) may have any prolonged effect in my career life where I need to serve an IT industry probably as a Software Developer.

Donald Corenman, MD, DC
Moderator

January 20, 2012 at 11:40 pm

Post count: 8660

#5428

Surgery is necessary for four reasons in the lumbar spine. Nerve compression tha causes motor weakness in important muscle groups, cauda equina syndrome (which you do not have- see website), increasing deformity and the most common reason- pain that you cannot tolerate.

I will assume that you do not have motor weakness (which would be revealed by an examination) and have no signficant deformity. My question to you is do you have pain you cannot tolerate? If the answer is yes and you have failed a course of physical therapy and injections- then you are a surgical candidate. If the answer is no- you do not need surgery.

If you are a surgical candidate, then the question is where the pain is located. If it is back pain only (in the center of your back), you need a work-up for the cause of back pain. If it is leg pain and the examination correlates with the MRI findings (herniated disc) you would be a candidate for a microdiscectomy.

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.

malikfida
Member

January 25, 2012 at 2:30 am

Post count: 25

#5452

respected SIR
I malik fida 25 years from pakistan I had done laminectomy on 14 december 2011
as on MRI report I have L5S1 disc protrusion. sir by profession I am dental surgeon
and untill now I am facing difficulty in ward work and having slight leg pain,SIR i
just want to know that do you recommend me for ward work(dentistry)?
waiting 4 ur helpfull reply.
wishing u all the best.thanks

Donald Corenman, MD, DC
Moderator

January 25, 2012 at 4:42 am

Post count: 8660

#5454

My understanding is that you underwent surgery at L5-S1 for “disc protrusion”. Did you have a bilateral or unilateral decompression? What were the symptoms preop and what are the results post-op? For example, did you have left leg pain radiating from the buttocks to the foot with an intensity of 8 over 10 which is now lessened to a 2 over 10?

What are the current symptoms that make ward work difficult? Do you have any weakness? Do you have any lower back pain?

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.

malikfida
Member

January 25, 2012 at 6:46 pm

Post count: 25

#5459

Sir i had this condition unilateral on right side and microdisectomy is done.
pre operative condition was I have lower back pain radiating to the right buttock and
down the leg to the foot, the pain was excruciating and cutting type along with significant
numbness,My post operative condition is good pain had covered by 2 and 10, numbness is still there, I primary objective is whether in this condition I continue my ward work(dentistry)
as there is sitting alittle bending and tilting in ward work, I am extremely anxoius about recurency that might not happen, SIR moreover after my duty in the dental hospital I have slight pain in the butt area radiating downward,SIR I need your kind advice what should I do I continue my duty or stop it? thanks

Donald Corenman, MD, DC
Moderator

January 25, 2012 at 11:50 pm

Post count: 8660

#5461

It appears that you had a good result from surgery. Your leg pain has improved significantly. The numbness can be present for as much as 6 months and will slowly fade away. Try not to pay attention to it.

Recurrence rates for disc herniations are in the neighborhood of 10%. There is a slight increase if you are an athlete. If another herniation occurs- the solution is another microdiscectomy so don’t be too concerned. Many professional athletes have had a microdiscetomy and have returned to competitive sports.

I think you should continue your ward work. Work on your core strength for prevention of further back problems. (See video on core strength on web site). The one position that puts the disc at risk is BLT (bending and lifting while twisting). Try not to twist when you bend and you can mitigate the risks.

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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