Failed back surgery syndrome?

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Donald Corenman, MD, DC
Moderator

May 21, 2020 at 7:49 am

Post count: 8660

#32581

If you can’t hold yourself upright on your right side with a heel raise (up on your “tippy toe”), then you do have some motor weakness and that L5-S1 right sided HNP is causing motor dysfunction. It is my opinion that with motor weakness, surgery is indicated to decompress the root sooner than later. You can wait if you so choose but I find that decompression of the root performed sooner has a better outcome.

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.

MidwestW
Participant

May 21, 2020 at 1:55 pm

Post count: 17

#32589

Thanks. I decided to send you my MRI and records to review. I talked with Sara and you should be getting them soon…so I will talk to you in the near future!

Donald Corenman, MD, DC
Moderator

May 21, 2020 at 4:16 pm

Post count: 8660

#32590

Look forward to talking with you in person.

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.

MidwestW
Participant

June 13, 2020 at 11:23 pm

Post count: 17

#32647

Donald Corenman, MD, DC wrote:

OK. Your right-sided symptoms are a result of your new herniation. Your left-sided symptoms are more likely from the continued lateral recess stenosis. Since you have had two prior decompressions on the right at L5-S1, you do now need a fusion of that level.

However, since you need a surgery of the level above (L4-5) on the left with a prior decompression already under your belt, this level should be considered to have a fusion (TLIF) also. You could choose to have an L5-S1 fusion and a redo 4-5 decompression only but with prior failed surgery at L4-5, a fusion would be a good choice or this level could break down again leading to a future fusion. I still think the TFESI mentioned earlier should be considered to connect the MRI findings with the symptoms.

Dr. Corenman

Dr. Corenman,
You and I spoke last week (I’m Wendy M.), and I’m scheduled with you later this month for a TLIF on L5/S1 due to the third-time reherniation there (copied our prior conversation above since it’s been a while). What we did not discuss on the phone is the left side.

The same time I had my last discectomy at L5/S1, I had a laminectomy at L4/L5 for lat. recess stenosis. While the right got better (until it reherniated), the left only got a little bit better, and I continue to have L5 radicular symptoms on that side. The new MRI, which you have, shows “residual compression of the L5 nerve due to facet hypertrophy,” and I even paid to have the MRI read by a board certified neuroradiologist, who found the same thing (I am copying his report below). Three weeks ago, I had a TFESI at left L5 and had immediate relief that then lasted two weeks. The anesthesiologist told me this confirmed that the compression at L5 in the lateral recess was to blame for the pain.

I actually have an appt to talk with you on Thursday, but thought this might be faster–I’m really concerned that the L5/S1 fusion will help with the right-sided pain, but that I, like you suggested earlier in the forum, also need a TLIF fusion on L4/L5 since I have remaining stenosis that requires a facectomy. I really want to fix all the nerve pain once and for all, and definitely want you to be the one to do it, so wanted to ask you about a TLIF at the L4/L5 level ASAP in case that changes scheduling. Here is the MRI report I got from the neuroradiologist out of New York (I sent the original report with my CD). I’m sorry if this is burdensome to you since we are already talking this week, but as I am in trip-planning mode I want to make sure that if this level is added on the schedule stays the same. Sara has all my info and I’ll talk to you on Thursday but wanted you to have the benefit of this info first. Thank you!

NEURORADIOLOGIST READING:
Narrative to patient: The left lateral recess is stenotic with compression of the nerve roots. There is an annular tear of the L4-5 disc; however, I suspect the root compression from left facet hypertrophy should explain the pain rather than chemical radiculitis. Facet hypertrophy contributes to foraminal effacement at L4-5 and L5-S1. The loss of disc height at L5-S1 may contribute to the development of the hypertrophy. There is stenosis of the left L4-5 lateral recess and direct left forminal effacement at L5-S1. Both of these may contribute to left L5 dermatome radiculopathy.

Report:
L4-5: There is loss of disc height and T2 weighted signal. Mild disc bulge with an annular tear is
noted. Facet hypertrophy contributes to left foraminal effacement and stenosis of the left lateral
recess. The left L5 root is compressed.
L5-S1: There is loss of disc height and T2 weighted signal. There is disc bulge with an annular
tear and a large right paramedian disc herniation with obliteration of the right lateral recess. Facet
hypertrophy yields left foraminal effacement.
Paraspinous structures are within normal limits.
IMPRESSION:
Post-operative changes with disc disease at the L3-4, L4-5, and L5-S1 levels.
Significant right l5-S1 disc herniation yields obliteration of the right L5-S1 lateral recess.
Facet disease contibutes to left L4-5 lateral recess stenosis and L5-S1 foraminal effacement.

Donald Corenman, MD, DC
Moderator

June 14, 2020 at 9:02 am

Post count: 8660

#32650

I am a little unclear regarding your history. I thought you had only one left L4-5 decompression. Did you have one or two decompressions at L4-5? Did you also have a surgery at L3-4 (“Post-operative changes with disc disease at the L3-4, L4-5, and L5-S1 levels”).

Was the nerve block you had recently at the L4-5 level or the L5-S1 level? (“Three weeks ago, I had a TFESI at left L5 and had immediate relief that then lasted two weeks. The anesthesiologist told me this confirmed that the compression at L5 in the lateral recess was to blame for the pain”).

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.

MidwestW
Participant

June 14, 2020 at 10:36 am

Post count: 17

#32653

Hi. I had only one decompression at L4/L5, which did not relieve the pain.

My TFESI was done at L4/L5
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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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