Epidural Fibrosis?

Tagged: epidural fibrosis

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Vin
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February 22, 2016 at 10:23 pm

Post count: 11

#21404

Hi,

I am 4 months post microdiscectomy for a severe L5 S1 right side herniation that caused paralysis of right calf muscle (unable to do anything even close to a toe raise). Surgery went great, felt great and I was on the road to recovery. I regained full function back in my calf!

Then around 3 months post op I experienced a gradual onset of lower back pain, numbness / tingling / sciatic pain in now BOTH legs, feet and glutes.

I cannot now sit for more than 30 mins without my feet / legs going numb, cannot walk more than 5 mins at a time without numbness coming on in feet and back pain. The only relief is lying flat which I have been forced to do for 18 hours of the day. That often will settle the numbness / spasms / sciatica down.

I was doing so well, was up to walking an hour a day, physio once a week etc. Then this all came on over the 4th month. I saw my neurosurgeon today and he said that it is possibly scar tissue that has developed pressing on the nerve OR I have possibly herniated the other side or reherniated the right side again, or it could be a bad post op flare up.

He has ordered an MRI with dye contrast. It will not happen for about a month or so.

The numbness and pain is transient and waxes / wanes, jumping all over both legs / feet / glutes / back. Very different from initial herniation which was only down one leg and the pain / numbness was constant from the onset of injury.

I still have full motor function however, for that I am at least greatful.

A few quick questions regarding the dreaded Epidural Fibrosis (if that is what it is).

1. Does epidural fibrosis form between weeks 6-12 and stop? Or does the scarring / fibrosis keep growing? If so, for how long?

2. Surgical removal and / or laser are not recommended due to the great risk of the scar tissue growing back much worse. Correct?

3. When he requests an MRI with dye contrast, will they also do a regular MRI at the same time or is that a separate MRI that I will need to also request?

4. Is there any hope of epidural fibrosis working itself off the nerve over time through stretching and PT? I have read mixed opinions / views. Some say impossible while others say it can take a year for the fibrosis to settle and detach from the nerve. Thoughts?

Any other insight is welcomed!

Thank you so very much for your time!!!

Donald Corenman, MD, DC
Moderator

February 22, 2016 at 11:37 pm

Post count: 8660

#21405

First-the chance of epidural fibrosis is not high. Typically, symptoms are not associated with lower back pain. I would assume there is something else going on and not epidural fibrosis.

Epidural fibrosis normally takes about 6 months for symptoms to generate but this is variable. Most of the patients with epidural fibrosis that I have in my practice actually have mild symptoms although your symptoms can be from this disorder.

There is no surgery for epidural fibrosis. Any attempts to fix the fibrosis will make the condition worse.

MRI with dye contrast is an MRI with gadolinium. The normal MRI along with special images included will occur.

The fibrosis is scar and as such will “not detach from the nerves”. Nonetheless, the symptoms can improve over time.

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.

Vin
Participant

February 23, 2016 at 9:01 am

Post count: 11

#21408

Thank you so much for your response! I am actually hoping / praying that it is not epidural fibrosis as this condition from what I understand is palliative with no treatment option (as you mentioned).

As crazy as it sounds, I would prefer a reherniation and even potentially a fusion at L5 S1 as it would at least give me some hope of relief.

I think I was lucky to regain the motor function back in my calf as my calf was literally dead. For that, again I am truly thankful but the pain in my lower back and legs is increasing.

I also wanted to share this study with you that I came across. Perhaps you are already aware of it. It may be of interest to you.

Kind Regards,

Resolution of symptomatic epidural fibrosis following treatment with combined pentoxifylline–tocopherol

http://www.birpublications.org/doi/abs/10.1259/bjr/62051205?journalCode=bjr

Donald Corenman, MD, DC
Moderator

February 23, 2016 at 12:29 pm

Post count: 8660

#21410

I should clarify that there are occasions that epidural fibrosis can be operated on successfully. If the root is adhered mainly on one side, an adhesolysis surgery (freeing up the nerve and trying to prevent it from re-adhesing) can be done but only with a 50% satisfaction rate.

I think that study you note is not helpful. This was one patient only and the results could have been from “tincture of time” only. It is unlikely that the medications had anything to do with it.

Again, lower back pain is generally not associated with epidural fibrosis.

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.

Vin
Participant

February 25, 2016 at 5:55 pm

Post count: 11

#21421

Hi,

Thanks again for your respons!

This procedure looks quite interesting. I understand that this is performed by an experienced anesthesiologist in a Pain Clinic type setting? This is not something that is performed by a neurosurgeon, correct?

Also, does this carry the risk of increasing the scarring, similar to actual surgical removal? Or does the failure just result in no relief.

Finally, if I do a lot of light lifting, moving around, I seem to irritate the issue, the numbness / pain flares up in the feet / legs and will then settle once I lay in bed flat, for a few hours. The numbness and lower back pain are transient, waxing and waning. Is this typical for epidural fibrosis? Or is the numbness / pain usually constant / static?

I have a dye contrast MRI tomorrow but don’t see my surgeon to go over the results for a month. I will post the radiologist evaluation once I receive it.

Thanks again!

Donald Corenman, MD, DC
Moderator

February 25, 2016 at 7:16 pm

Post count: 8660

#21426

Sorry but I had to delete that link. This website is anonymous. The video purported to note an adhesolysis but performed without any mechanical changes to the surgical site. It is performed thru an approach that is very old school (called a caudal epidural approach). That is exactly what it is. This radiologist or anesthesiologist is performing an epidural steroid injection through a catheter placed in the sacral hiatus. There really is no lysis of adhesions in spite of what this physician is alluding to.

Again, epidural fibrosis is not associated with lower back pain. I would suspect degenerative disc disease as the cause of lower back pain. If you have 50% or greater low back pain, you might be a candidate for a fusion work-up.

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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