Disc height, considering microD

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Paulo
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July 22, 2012 at 6:07 am

Post count: 2

#6559

Hello Dr Corenman. Thanks for this website it is a great resource. About a year ago I herniated l5/s1 at the rear right side, was considered mild. I did a session of PT, but I waited until march of this year to get an MRI which confirmed the herniation, then went back to my life. It never really resolved, I believe i went about it with too little caution. The herniation is pressing on the nerve enough to cause numbness but sciatica hasn’t been too much of a problem, only after I do something strenuous. Up until recently I’ve always just had this pressure and seemingly constant backache, as well as a minor crick in the back when I bend a certain way. My symptoms have been improving, up until yesterday when i went at splitting logs with a 20 pound sledge. I also do a lot of lifting and moving patients in the ER, and for the first time yesterday i dealt with intermittent numbness in my left foot, as well as the occasional numbness in back of left calf and semi usual sciatica. I am 21, 6’4″, 185 lbs in good shape.

Most of the pain can be controlled with NSAIDS and its not constant or overbearing, but I am supposed to get my first epidural shot on Monday. I dont know if this is the right move. Ive seen three orthopedic surgeons now, the two good ones told me to wait on surgery and thus far I have, but I don’t know if the epidural shot is worth it because I’m worried with my job I will just keep pushing the inner disc material out of the wound. My body mechanics have greatly improved but Im terrified i will lose too much disc height, not be able to contine sports, and end up needing to get a fusion. The MRI did not show any noticeable loss of disc height but that was 4 months ago, may have made it worse yesterday, and I can not have this problem further deteriorate.

At this point I don’t know how much more the disc is going to heal, and I don’t want it to get any worse given my lifestyle. I am willing to try one epidural, and I think I may have to in order to give the disc some inflammation free healing time. However I feel that I can overcome the change in spinal integrity that comes from shaving down the facet joint, even though I’m not pleased about that part. Please I need some advice here. Is it worth it to get the epidural and give this 3-4 more months of careful living and physical therapy? Or should I bite the bullet, find the right surgeon and just get this damn thing over with? Like I said, if it’s going to just get worse I can not afford to have that happen, especially at 21. Thank you.

Donald Corenman, MD, DC
Moderator

July 22, 2012 at 7:11 am

Post count: 8660

#6560

By the sounds of it, you have had chronic but mild compression of the root at L5-S1 right (the S1 nerve). The symptoms were stationary. That is, they never became better or worse over time.

When you really loaded your back with splitting firewood, the symptoms progressed but not severely. The numbness increased but the pain did not become significantly worse. More likely than not, you suffered a small recurrent herniation. This slightly increased symptoms but not to the point the increase affected your lifestyle.

The epidural I think is a good move. It won’t hurt you (performed correctly) and could “toughen up” the nerve enough to reduce symptoms for the long term. Do not worry about loss of disc height as this is inevitable regardless of what you do. It is my opinion that some patients are “wired” for back pain and some are not. In my practice, I have many patients with severe DDD and only mild aching in their back.

I don’t understand “shaving down the facet joint”. An epidural steroid injection will not effect the facet joint.

You are at the point that an epidural injection might give you relief for three to twelve months. Repeat steroid injections are typical when the last one “wears off”. A surgery might be helpful as long as you remember that there is a 90-95% success rate and not 100%.

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.

Paulo
Member

July 22, 2012 at 2:21 pm

Post count: 2

#6567

Ok thanks for the advice, for now I will go ahead with the epidural, and maybe try a second one if it helps enough the first time around.

When referring to shaving down the facet joint I meant for microdriscectomy, I am prepared to deal with the changes in spinal integrity if my condition does not improve. I honestly feel that all I’ve learned about core strengthening, posture, and lifting mechanics would prevent another herniation from occurring but since I can’t know for sure, I am going to put off surgery at all costs like I have been doing, I just don’t want my situation to keep getting worse and end up with a fully sequestered disc because I didn’t get surgery and just let the thing heal. I may post bak again in the future, thanks again

Donald Corenman, MD, DC
Moderator

July 22, 2012 at 10:37 pm

Post count: 8660

#6572

Just because you have a disc herniation now does not mean it will re-herniate with a larger fragment. The chances are higher to re-herniate (10%) than if you never had a hernation (1%) but that is a long way from “an inevitable reherniation”.

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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