Does "disc bulging" and "moderate nerve pinch" mean herniated disc?

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d.aaron
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April 19, 2013 at 11:00 pm

Post count: 4

#8458

I just had an MRI yesterday and the results showed “mild disc bulging and an area of mild to moderate pinching of the nerve [for my] left leg”. Is this indicative of a herniated disc, where the disc is bulging and impinging on my nerves?

Would you also suggest obtaining a copy of the MRI images for myself? I can do so, and get them on a CD.

My question is, with conservative therapies such as simple stretching as has been suggested, will the bulging disc repair itself? Will that prevent future flare-ups of major back pain? So far I’ve had 4 episodes in the past 3 months, this latest resulting in 2 weeks of missed work, dr. note and 3 different medications to control the issue.

All I want to know is if this can get better more or less on it’s own as my provider (KP) suggests, or am I in for a lifetime of repeated episodes and pain?

Your thoughts are appreciated.

~David – severely frustrated with these repeated episodes and time lost at work.

Donald Corenman, MD, DC
Moderator

April 20, 2013 at 11:06 am

Post count: 8660

#8463

“Mild disc bulging and an area of mild to moderate pinching of the nerve [for my] left leg” is a very unusual reading by a radiologist. Nerves become “compressed” and not “pinched”. A mild bulge will not compress a nerve. If there was a herniated disc, the radiologist should have noted this. Was this truly a board certified radiologist?

Always obtain your own images on a CD and get two copies in case you need to send them off for a second opinion.

Discs do not repair themselves. See anatomy of the lumbar spine and herniated discs on this website to understand the problem.

You can improve over time with physical therapy and epidural steroid injections. After three months with little improvement however, consideration of surgery should be made if a microdiscectomy is the solution (as long as the pain is mainly in your buttocks and leg-not your back).

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.

d.aaron
Member

April 20, 2013 at 11:44 am

Post count: 4

#8464

Regarding the reading, that was how my PCP conveyed the results to me. All I can say is I hope the radiologist running the MRI and interpreting the results was board certified…

Since I have been dealing with back pain radiating to my legs with reported tingling, numbness and severe flare-ups like the one I am just getting to the other side of ( muscle spasms bad enough to make me cry out / scream in pain ), it sounds like from what you are saying is best to get an out of network ( away from my provider ) 2nd opinion. I’m working on getting the MRI results from them.

They have a history of this issue going back to late 2008, and still harp on keeping with a conservative approach which so far has not had any longer term curative effect as i keep winding up throwing my back out at some point, from doilng little things like washing my hands; turning to pick up a bottle of shampoo in the shower etc.

Thanks for your reply & advice. Any further advice eg how to get the provider past the conservative approach they seem stuck on would also be appreciated, but I understand if this a place you can’t go.

~Dave

Donald Corenman, MD, DC
Moderator

April 20, 2013 at 8:28 pm

Post count: 8660

#8465

For the life of me, I just don’t understand what the reluctance is for some family docs to refer to an up-to-date spine surgeon. Spine surgery now is generally safe and very effective, especially for surgery to remove a disc herniation. My success rate and satisfaction rate is higher for this surgery than my well esteemed partners for their scope procedures but there still is reluctance by some general practitioners to refer for this surgery. Maybe reluctance developed from the nightmares that occurred thirty years ago with non-specialized surgeons who would not understand the procedures or had poor results.

Print out and show him or her this email. I would be happy to talk with them personally. Have them call 970 476-1100.

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.

d.aaron
Member

April 20, 2013 at 11:41 pm

Post count: 4

#8473

Thanks for your reply. I have my own ideas as to why Kaiser Permanente continues on their wholly conservative (a.k.a. least expensive to their for-profit company) approach, but I won’t go into that on your forum – it’s not the right venue for that methinks.

Thanks for the suggestion, I will take it under advisement.

Donald Corenman, MD, DC
Moderator

April 21, 2013 at 12:38 am

Post count: 8660

#8475

Ah- Kaiser. That explains the reluctance to refer. Kaiser is somewhat like the British Nation Health Service or the Canadian Health Service. Medical care is expensive and rationed.

The best way to reduce costs if you manage the organization is to prevent referrals to an expensive specialist. With Kaiser, I have seen referrals if you complain hard enough. The squeaky wheel gets the grease! Good luck.

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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