Disc bulge causing bilateral neural foramina narrowing & compression

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malikfida
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January 24, 2013 at 1:21 am

Post count: 25

#7800

Thanks alot sir for ur response,
I am so much astonished that in my this case both the neurosurgeon
And the orthopaeedic spine surgeon totally contradicts each other,
Becuase the neurosurgeon want to go for discectomy but the ortho one
Go for lumbar spine fusion, sir please give some comments on this,
Some people give me suggesions that the ortho surgeon approach is
littlt bit hard as compared to the neurosourgeon, Sir as far as the instability
Is concerned that is not so much one should go for fixation, Sir
How much the spine should be instable to go for fixation? My neuro
Doc told me that fixation should be done in fracture only, not in this case
He also told me if third herniation occurs than go for fusion,
Sir whar are ur comments regarding this.
Thanks alot.

Donald Corenman, MD, DC
Moderator

January 24, 2013 at 8:26 pm

Post count: 8660

#7805

A fusion is required in the face of nerve pain only (no real lower back pain) only if the vertebra is incapable of maintaining alignment and this malalignment is causing nerve root compression.

For example, if there is an angular collapse of the right side of L5 on S1 (the intact disc normally keeps the two vertebral bodies parallel to each other) because the disc is asymmetrically worn out on the right side, this could compress the L5 nerve in the foramen. If a simple decompression is used (no fusion) and more bone is removed to make room for the nerve, this procedure will fail. The removed bone will allow further collapse of L5 on S1 and the same leg pain will recur within a couple of months.

Now if you only complain of leg pain (no lower back pain) and the vertebra is stable, then a simple decompression surgery only would be recommended.

As you can see, there is no perfect answer to your question. Go back to both surgeons and ask why they had chosen that particular surgery now based upon your new knowledge. Why does the spine surgeon recommend fusion? Make him give good reasons for his decision. Also challenge the neurosurgeon to see if he can explain why his surgery will not destabilize the level. By listening to both, you will gain more understanding and be able to choose correctly.

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

April 3, 2013 at 3:16 am

Post count: 25

#8334

Hello SIr
i have another query regarding my symptoms i met with another neurosurgeon he suggested spinal blocks i.e epidural injections and nerve block sir would u please elaborate over this proceedure, in both of this proceedures which is more effective and durable and possible complications. thanks
MAlIK FIDA

Donald Corenman, MD, DC
Moderator

April 3, 2013 at 8:45 pm

Post count: 8660

#8339

Nerve blocks have two benefits depending upon the injected medication used. Most blocks include a numbing agent (like lidocaine) and a steroid (like Celestone). Assuming these blocks contained both medications, the two benefits are diagnosis and possible therapeutics.

If the injection is placed directly on the nerve root, the numbing agent will temporarily anesthetize the root in question leading to two to three hours of relief. This confirms this root as the pain generator. The caveat is that if the region is flooded by this injection (too much fluid) and the lidocaine then distributes throughout the spinal canal, other structures can be anesthetized leading to confusion with the diagnosis.

The steroid can be very effective for nerve root inflammation sometimes giving months of relief.

The potential complications are that of any injection: infection but this is very rare.

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

April 4, 2013 at 6:28 am

Post count: 25

#8344

HelloSir
I had also done lumbar laminectomy SIr is it true consective third herniation at the same level requires lumbar fusion? moreover if i neglect my current condition and want to live with this condition as my parents want whats your opinion regarding that? significant herniation L4/L5 S1 level this may not cause foot drop? what about cauda equina syndrome? lastly and more importantly as i am unmarried will it may not aggravate badly my married life although untill now i have no erection problems and quite well.
thanks
malik fida

Donald Corenman, MD, DC
Moderator

April 4, 2013 at 7:43 am

Post count: 8660

#8346

A third herniation at the same location generally requires a fusion for two reasons. One is that the chance for yet another herniation is very high. The other is that the nerve has the potential to develop further injury with every herniation. After three herniations, the chances of permanent nerve injury goes up. These are the reasons for fusion.

The chances of cauda equina syndrome are very low but not non-existant. If you have foot drop that is new from a recent herniation, in my opinion you need to have surgery sooner than later to allow the best chances for recovery of that motor nerve root.

The chances of erectile dysfunction from nerve compression of the spinal nerves is extremely low. Do not worry about that 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.
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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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