EMG abnormalities; post p-lif; long-term pain probability?

Viewing 4 posts - 1 through 4 (of 4 total)

Author

Posts
Jbeans9999
Member

September 18, 2013 at 4:43 am

Post count: 13

#9418

Dr. Corenman,

I have posted before about my PLIF done approximately 4 months ago on my l5s1 disc due to a third herniation which caused pain in the back of my left upper thigh.

About a month and a half ago I began to have pain in my lower left leg on the outside. We did a follow-up MRI which did not show any new compression.

Today I had an EMG on my left leg and the results are back and not sure how to take it. The doctor’s office called and the results indicated an abnormality in the l5s1 nerve (no specification given to me), and since the MRI did not show any new compression I should follow-up with the surgeon. I have a follow-up with my surgeon in 2 days.

In your opinion, based on what I indicated and your experience in terms of long-term prognosis. If someone is having these symptoms 4 months post fusion, the pain is in a new place, no new compression of the nerves from MRI, and abnormalities in terms of the EMG what is the probability of a permanent injury?

I am freaking out here at the prospect of permanent unending pain, and feel it would be better to brace myself now if the chances are high.

Thanks so much you are a great help, resource, and informative. The best resource I have found online.

Donald Corenman, MD, DC
Moderator

September 22, 2013 at 11:49 pm

Post count: 8660

#9437

My understanding is that you had relief of your leg pain after the PLIF surgery. You were then symptom free (of leg pain) until about three months after your surgery. The leg pain returned and you had a workup to look for the cause of the return of pain which included an MRI and an EMG. You indicate that this leg pain is difference than the original leg pain (“the pain is in a new place”).

Where is your new pain and what makes the pain worse and better (sitting/standing/bending/lifting/etc..)? Did you stop narcotics immediately before your new onset of pain?

Onset of pain three months after a PLIF could be any number of disorders. The discussion of symptoms will help to narrow the potential disorders down.

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.

Jbeans9999
Member

September 24, 2013 at 4:56 am

Post count: 13

#9458

To answer your questions.

1. The pain is now on the outside of my lower left leg, and now I am having sensations of cold and hot both in my lower left leg and also in the back of my left ankle (started last night and intermittent but I just felt it now as I was typing) and the sensations of heat in my ankle is becoming very strong (comparable to when you have a laptop which has been on for a few hours touching your skin; it is pretty hot but not so bad you scream).

Also, I saw the pain doctor today and asked her what the EMG showed (h-reflext latency…. chronic nerve problems with s1 nerve). I don’t have the exact language but hopefully that is enough.

2. The pain started approximately a week after I stopped all narcotics.

In addition, when I saw the dr. this morning she has started me on the extended release drug for gabapentin (I believe called gralise) so we will see how it goes.

I just want to know the probability of this type of result (h-reflex showing chronic s1 damage) will heal itself or if I am more likely to be dealing with this for my entire life. I know every case is different, but I am looking for more likely than not based on the literature and person experiences.

IS that enough to determine likelihood? If not I can provide more detail, because seems like my drs don’t want to speculate (which I understand) but I need to know the chances for my own sanity.

Thanks so much for any input you could provide.

Donald Corenman, MD, DC
Moderator

September 25, 2013 at 9:42 am

Post count: 8660

#9463

EMGs are probably not the best tools to define nerve problems except in some cases. H reflex latency can indicate dysfunction of the S1 nerve but it is non-specific and can be abnormal in some circumstances when the nerve is normal.

In addition, you had surgery initially due to leg pain which indicates the nerve was compressed and probably somewhat injured. You would not know if the residual damage has changed since surgery or if the H reflex was initially deficient prior to surgery and did not improve.

Also, getting off of narcotics can take some time to fully clear the system. Low grade pain that was present but masked by the narcotics can be noticed after clearance of narcotics from the system.

In a case like yours, I would get a new MRI. If no nerve compression residuals (or seroma or ???), I would consider an oral steroid to reduce the swelling in the root. If that was only partially effective, I would then consider an epidural steroid injection.

I would agree with use of the membrane stabilizers (see website under medications).

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.
Author

Posts

Viewing 4 posts - 1 through 4 (of 4 total)

You must be logged in to reply to this topic.

Donald Corenman, MD, DC

Average rating:

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel