Drs are stumped...too young for this!

Tagged: Scheuermann's hyperreflexia

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facetjoint
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March 31, 2015 at 2:18 pm

Post count: 5

#17644

Hey Dr. Corenman. Thanks for providing this great service :).
Background: I am a 25 year old male with a history of back problems. I have been doing heavy weightlifting for the past 10 years. My first struggle with back pain occurred around 2008 after heavy deadlifting….mri showed l5 s1 herniation. i never treated it, and within a week i was functional again. over the years i have hurt my back again and again but it always has healed within 2 weeks. i was in a remission state until 2014. in 2014 to keep pressure off of my back, i stopped doing barbell squats. in order to keep my legs strong, i instead moved to leg press and leg extension. in september 2014, during my set of leg extensions i noticed a twitch on my last rep of my lower inner right quadricep by the knee. ever since then my right quad has been atrophied, and i have hyperflexia and spastic reflexes according to the drs ive seen. over time, my left leg also developed the same symptoms due to compensating for the right. in november i had an mri showing that my quadricep was normal…shocked me. i felt it was getting better by december, and stupidly i tried barbell squatting, and then my leg hurt again, and now my back pain has return. it is now march, and ive tried PT 3 times at three different clinics. I have dessicated l5 s1 with compression, slight bulge at l1-l2 with partial dessication, and in thoracic there is hemangiome in the t1-2 vertebrae, and minor disc protrusion at t4-5 and mild bulge at t9-10. my back pain is mainly impacted by bending forward or arching back…yup both. if i bend forward i feel a bony feeling stopping me….it feels like it’s in my vertebrae which made me think facet? similar feeling when i arch back or try to do a cobra pressup. of course there’s other symptoms like neck pain(very mild though) and upper back pain/chest pain that feel connected….but the leg weakness(and now knee issues) and low/lower thoracic pain is the worst. my thoracic back mid to upper also is incredibly stiff the first 45 minutes after waking up from sleeping…i cant bend even a centimeter.

im confused what my next step should be as ive seen orthos, neurosurgeons, neurologists, etc. i can barely tie my shoes anymore. i had an emg which the neurologist claimed was normal, but the neurosurgeon said i have hyperflexia. i also can’t lockout/extend my legs when im sitting in a chair…my PT said it’s tight hamstrings, but i really disagree.The neurosurgeon seemed very concerned about the hyperflexia and wants to see another neurologist at his office, but at this point i feel that’s because he doesn’t know what’s wrong.could the hyperflexia be from a knee issue?

He also didn’t want to entertain the fact that my l5 s1 problem could be causing my pain.here’s what my report said, At the l5-s1 level there is disc dessication there is moderate broad based disc herniation centrally and in the left lateral recess and neural foramen with asymmetric thecal sac and left s1 nerve root compression. no right lateral recess or right neural foraminal stenosis.

havent tried an epidural. to be honest im scared of trying one. i dont really have sciatica, and ive read that epidurals aare not fda approved for epidural use, can lead to paralysis with one slip of the finger, and ultimately make the problem worse and are a temporary masking…but i see you reccomend them so id be open to them? can it help my disc heal?
im scared of being paralied or getting arachnoiditus.

lastly, my thoracic and cervical showed no cord compression :).

Donald Corenman, MD, DC
Moderator

April 1, 2015 at 7:21 am

Post count: 8660

#17743

First, we must assess your symptoms in one place.

You started with medial right quadriceps symptoms including atrophy. This was associated with hyperreflexia. These symptoms then developed symmetrically in the left leg. An MRI noted a “normal” quadriceps muscle. You have lower back pain from both flexion and extension. An EMG was reportedly normal. You have stiffness in your thoracic spine. You probably has both cervical and thoracic MRIs by your comment (“lastly, my thoracic and cervical showed no cord compression”).

Your lower back pain most likely is caused by your degenerative disc disease of L5-S1 as this is the most common cause of lower back pain and is common in weight lifters.

Hyperreflexia is caused by the central nervous system (the brain and spinal cord) so a peripheral nerve issue (lower back herniated disc) will not cause these findings. If you have no compression of the cord in the thoracic or cervical spines, this could be a brain issue or a metabolic issue (many disorders can cause this including hyperthyroidism).

I would agree that a neurologist should evalutate you.

Being a weight lifter, I would have a spine specialist look for Scheuermann’s disorder of the lower thoracic spine to see if this disorder is the cause of stiffness in this region in the morning.

Epidurals are very good for diagnosis and treatment of many spinal disorders. The risk of injury is not high but I do recommend a well experienced and meticulous injectionist to perform the injection.

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.

facetjoint
Participant

April 1, 2015 at 9:41 am

Post count: 5

#17750

thanks for the thorough response. I am definitely writing down your suggestions and will pose them to the neurologist on monday ive heard that emg tests are very dependent on who is administering them, so i figure worst case scenario maybe the new neurologist will do another one. As far as whether I had a thoracic/cervical mri, you are correct. The thoracic showed a minimal disc protrusion at t4-t5 and a minor disc bulge at t9-10. the cervical mri showed hemangioma within t1-2 vertebrae(the way they did the images t1-2 showed up here). there was no compression on either level of spinal cord.

regarding the l5 s1 herniation, im not sure what my next step should be…would a microdiscectomy even be possibly when the disc is completely dessicated? physical therapy isnt doing anything to help me, and all this squatting down to pick things up like pencils is KILLING my knees lol.
if the drs in my plan can’t figure it out, i may travel to either you or johns hopkins to see what can be done.
in the event i traveled to you, if i got any sort of injection do you yourself administer it? as stated, im considering injections but VERY scared and im only considering them if they have the potential to break the inflammation cycle and help the disc reabsorb even a little. i want to make sure who ever is doing the injection knows what they are doing. i was also thinking of trying a facet block first?

anyway, thanks again for your response…ill keep you updated as i have an ortho spine dr appt mon and my neurology consult tues.

ps..i also have a knee mri scheduled. do you think that could cause the leg symptoms and clonus/hyperflexia?

facetjoint
Participant

April 4, 2015 at 6:48 pm

Post count: 5

#18489

in addition to the questions i just post above i had one more . im starting to scare myself, reading a bunch of things that these reflexes could be from motor neuron disease. i see you mentioned thyroid issues could cause it. are there a lot of benign causes like thyroid issues that can cause this, even if it’s asymetric with clonus? i think my thyroid is fine.

facetjoint
Participant

April 4, 2015 at 6:48 pm

Post count: 5

#18490

but i did have a normal emg so who knows. i think im starting to get sciatica now..calf jsut hurt.

facetjoint
Participant

April 15, 2015 at 10:03 am

Post count: 5

#18998

is this forum still active?? or did it move again?
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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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Drs are stumped…too young for this!