Foot Drop due to L5-S1 Herniation

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bensonjacoba
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November 17, 2012 at 3:20 pm

Post count: 1

#7417

Hello Dr. Corenman,

First off, thank you for taking the time to respond to all our queries.

History:
Since 2004, on & off, i have had back pains which was treated with Physiotherapy and traction.
In 2006, my left leg fell numb all of a sudden after 2 days of excruciating pain. The doctor’s refused to conduct a surgery. I was on complete bed rest (23 hrs traction & 1 hour physiotherapy) for 29 days. My left leg became better and i was back to work after a month.

Recent History:
On Aug 8, 2012 I had radiating pain on the left leg going downwards. The next day, my left foot (ankle downwards) fell numb and loss of ability to push towards the body. I opted for traditional ayurvedic treatment. The pain went away, but the numbness and Foot drop remained. Its been 3 months, i have no pain (touchwood) but my foot is 50% numb, i am unable to rise the foot towards my body (i can lower it) and my toes dont have the strenght to push up.I have absolutely no pain or radiating pain on any part of my body, only minor strain at the back due to excessive lifting of my 3 year old son.

MRI dated November 14, 2012
– Normal Curvature & Alignment of Lumbo sacral spine
– At L5-S1, there is reduced disc height and signal intensity on T2 suggestive of the desiccation accompanied by type II end plate degenaration. Its disc shows large and broad central subligamntous extension which is touching the theca and moderately pressing bilateral preforaminal S1 nerve roots.
– Normal marrow signal od examined vertebrae
– Vertebral bodies and appendages are normal
– Facet joints appear normal
– Normal appearence of Spinal cord,cauda equina and filum terminale
– Spinal ligaments and para spinal soft tissue is normal

Neurosurgeon’s Observation & Treatment Plan

The doctors advised that due to the numbness on the feet for the past
3 months without any healing a lumbar micro discectomy (on Nov 26) will be performed to chip out the herniated portion of the disc only, which will reduce the pressure on the nerve. Surgery is advised for avoiding permanent damage to the nerve which may further cause loss of bladder and bowel control. She also mentioned that they cannot guarantee the removal of the numbness & foot drop.

After reading the above,
a) Would you advise a MDisectomy
b) If i choose not to go ahead with the surgery, will i lose the ability to withold my bladder/bowel movement
c) Any other suggestions ?

Thanks doc for your time.

God bless.

Cheers,
Ben

Donald Corenman, MD, DC
Moderator

November 17, 2012 at 9:14 pm

Post count: 8660

#7420

In general, it is my opinion that with substantial motor weakness due to lumbar nerve root compression, a decompressive surgery needs to be performed. What concerns me is that after three months of presence of foot drop (weakness of the tibitalis anterior muscle), the chance of useful return of motor strength is questionable. Nonetheless, I would generally advise a decompression surgery (microdiscectomy or equivalent) to allow the best chance for return of motor function.

There is no chance based upon your MRI findings that you will develop bowel and bladder function loss. The herniated disc or spur is “touching the theca” which simply means that the sack of nerves (thecal sac) is being “touched”- not compressed. It takes significant compression of the entire thecal sack to cause malfunction of your bowel and bladder.

One concern is that the tibialis anterior muscle is normally controlled by the L5 nerve (and less commonly, the L4 nerve). The report notes the S1 nerve is compressed which would not cause foot drop but would cause calf weakness. This weakness would cause difficulty with push-off of the foot- not foot drop. The surgery that is planned is being performed to decompress your left S1 nerve root. Make sure the surgeon has this question worked out before you agree to surgery.

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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