Discogram

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Anonymous
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October 12, 2011 at 3:11 am

Post count: 8

#4990

Injuried back in July resulting in a series of epidural injections that didn’t help. I was having some numbness down left leg with some discoloration in feet. I do have djd in L5 S1 with more pain on left side of back into buttocks. The surgen decided to do a discogram since the mri didnt show any pinched nerve. I also had a ct of the pelvis and hips cause of where alot of my pain is and it was normal. I was injected at L3,4, and 5 during the discogram and 3 and 4 were normal but 5 about blew me off the table with pain. It started in low back radiating to lower left side where my pain is now. Upon follow up, dr said all the contrast leaked out everywhere on L5S1 so he feels this is where my pain is coming from. I’m scheduled for a fusion on Oct. 24th. My big question is why would I have more left side burning and pain than in the L5S1 area where the problem is suppose to be? I’ve had Chrio care and nothing has worked and I can’t live like this. I hope you can help me feel better about my decision for surgery. Thank You. I am 46 years old

Donald Corenman, MD, DC
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October 12, 2011 at 7:52 am

Post count: 8660

#4991

You report that you injured your back in July- some 3-4 months ago. You have pain in your back that radiates into your left leg and report degenerative disc disease in the L5-S1 level. You have tried chiropractic care but the symptoms did not improve. The MRI did not note nerve compression so a discogram was completed. The levels L3-4, L4-5 and L5-S1 were tested. L3-4 and L4-5 did not cause pain but L5-S1 was extremely painful and apparently reproduced your typical pain but at increased intensity. The test prompted your surgeon to recommend a fusion of L5-S1. Do I have it correct so far?

Some questions. Do you have more pain in the left buttocks and leg than you do in the back? If so, is the pain worse with standing and walking or with sitting and bending? Do you have more back pain than buttocks and leg pain? What happened with the spidural steroid injections? Did you keep a pain diary (see website for this)?

If you have more leg pain than back pain and the pain is increased with standing, you may have lateral recess stenosis or foraminal stenosis. There are various surgical treatments for these diagnoses and fusion could be one of them. It all depends upon the pain generator involved.

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.

Anonymous
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October 12, 2011 at 10:59 am

Post count: 8

#4992

Thank you Dr

I don’t have much leg pain but most of my pain seems to be left side pain leading into the buttocks. However, pain does occur in low back spreading across to left side. Low back hurts more sitting and standing, bending etc. and hurts when coughing or sneezing with a catch on the left side. The 3 injections I had did nothing. The longest one lasted was for a few hours. When I stretch, it seems to help for a short period of time but then comes right back and at times even worsens with stretching. What does it mean when the contrast all leaked out when they injected the L5 S1 level? Is that concidered a herniation? Because the MRI didnt show any nerve pinching, and the discogram recreated my pain, its his determination that the disc is the source of my pain. Dr said I may still have back pain but If the disc is the problem and it’s removed, then why should I still have backpain? My thinking is that if the disc is gone, how can I still have disc pain or would I? They said 60-70% have succes from the surgery so I’m hoping I’m in the percentage. Thank You for your help!!!

Donald Corenman, MD, DC
Moderator

October 17, 2011 at 2:22 am

Post count: 8660

#5005

Your back pain is central and left but most of the pain is in the lower back and not in the buttock and leg. If this is true, then your disc at L5-S1 is the most likely source of your pain.

The discogram noted full tears through and through the disc wall (the annulus) which allowed the dye to lead out of the center part of the disc. This finding is typical for significant degenerative disc disease (see website under lumbar degenerative disc disease and under discogram).

You have to understand that there are different causes for back pain and leg pain. Leg pain but not back pain is typically caused by nerve compression. The fact that you have no leg pain and no nerve compression would be expected based upon your MRI findings.

Back pain is typically caused by a degenerative disc. The fact that the discogram at L5-S1 reproduced your back pain and the discogram noted significant wear and tear of the disc also fits with this disc as the cause of your lower back pain. The upper discs tested (L3-L5) that caused no pain indicates that you have no pain processing issues in your lower brain.

Percentage success for surgical solution of this problem in my hands is about 90% for two thirds relief of back pain. Most likely, this surgeon has the same percentage.

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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