Gastronemius weakness/Fatigue with walking

Tagged: leg weakness and peripheral neuropathy

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Donald Corenman, MD, DC
Moderator

January 26, 2013 at 9:58 pm

Post count: 8660

#7820

“So the gastrocnemius weakness cannot be attributed to compression due to anatomy”?

Correct, based upon your MRI reading and the history.

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.

Pafrmboy
Participant

March 9, 2016 at 11:04 pm

Post count: 8

#21511

Hello again Dr. Corenman… It a bit over 3 years now since I posted and I am still struggling with my back/nerve/gastro issue. From my 1st post, I would like to correct that that loss of orientation I eluded to when I was running, was actually numbness. At 3 years further out now, I have BOTH medial gatros with near complete atrophy. My right lateral gastro is less than 20 percent in my opinion and my left gastro is about 50 percent. I have severely impaired gait and balance issues. My upper leg strength is intact. I favor to the left, as that is the stronger leg and because of that, I feel that I am weakening the right a little more. I do get near daily sciatica pain in the LEFT leg with some foot numbness, but that pain is low and in the 2-3 range. I have been to a neuro surgeon that I know and have worked with and trust. (I’m an RN, masters level) and he did not feel that there was a surgical issue with me. When returning to the neurologist, he felt that there WAS a surgical issue and then ordered a new MRI (with motion) to better see this. That MRI dictation is:
The conus medullaris and conus equina are intact.
L1-L2 Shows no evidence of central canal or foraminal narrowing.
L2-L3 There is no evidence of central canal or foraminal narrowing.
L3-L4 There is no evidence of central canal or foraminal narrowing.
L4-L5 This level shows a modest circumferential disc buldge of 4.1mm slightly impinging on the thecal sack and producing mild foraminal narrowing on the right.
L5-S1 This disc level is narrowed and the disc end plates are slightly irregular. There is a broad based HNP of 4.2mm greatest in the left parasagittal plane and producing modest impingement on the thecal sack. There is no evidence to suggest spinal stenosis or foraminal narrowing.
There is total lumbarization of S1 with S1 and S2 being unremarkable.
Conclusion:
Diffuse 4.1mm disk bulge at L4-L5 producing mild right foraminal narrowing, but no evidence of central canal or other areas of significant narrowing.
Decreased L5-S1 disc space with irregular somewhat edematous enplate. There is a 4.2mm left parasagittal centered HNP with no significant spinal or forminal stenosis produced.
Total lumbarization of S1 through the disk level is otherwise intact.
Flexion and extension views show no changes in the bulges, nor in the disk space alignment.

A second neuro doc says that he also feels that it’s a surgical case based on all the clinical facts and presentation.

I manage to get all of life’s chores done, but feel now that the right leg is getting far to weak for my comfort. Yet I have conflicting medical opinions. I’m at a loss.

As I remember back to my youth, I remember having sciatica as early as 16 years old and then at 20 and then every 5 years or so it would flair up. (I’m 51 now) Could it possibly be that my anatomy is just small and it does not take much to cause symptoms? This round of weakening/atrophy started in 2009 and has taken 7 years for me to get to this point. I would value your opinion and suggestion.

Thanks, Todd

Pafrmboy
Participant

March 9, 2016 at 11:14 pm

Post count: 8

#21512

An added note is that the sciatica that I get is left sided and only when standing for extended periods. never when sitting. I’m also developing this new issue of frequent cold feet and calfs. (Pulses and capillary refill are good on my feet/PAD is not a concern). After all this atrophy with the muscles, I guess no heat is being generated. When I wake in the morning however, legs/feet are warm from being under covers. But throughout the day, I can feel the calfs become cool.

Also, I have implemented inversion therapy. After 15 minutes of that, I can distinctly feel a bit stronger in my gastros…even with the atrophy.

Todd

Donald Corenman, MD, DC
Moderator

March 10, 2016 at 6:05 am

Post count: 8660

#21513

By the significant motor loss, atrophy and cold feet, this could be Charcot Marie Tooth (CMT) Disease. Compression of the roots in the spine (radiculopathy) typically will not give you these symptoms, especially with your MRI findings (left sided leg pain with standing and only “mild foraminal narrowing on the right”).

I think another visit to a neurologist with an EMG/NCV study and the discussion of peripheral neuropathies including CMT disorder will be a good next step.

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.

Pafrmboy
Participant

March 10, 2016 at 11:42 am

Post count: 8

#21516

Thanks for your opinion again….much appreciated. I will have to just pin the neuro doc down. Or better yet, maybe see a 3rd one.

Best regards, Todd

Donald Corenman, MD, DC
Moderator

March 11, 2016 at 5:57 am

Post count: 8660

#21522

Please keep us posted.

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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