Granulation Tissue Pain after Micro Discectomy.

Tagged: epidural fibrosis (scar) vs recurrent disc hernation

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zman
Participant

October 18, 2016 at 7:29 am

Post count: 12

#23225

Just an update. Pain became so 2 weeks ago severe that i could hardly walk or stand up. Insurance company denied another MRI with contrast, so NS filed an appeal . Waiting on decision from appeal now. Meanwhile, had an transformal esi injection about a week ago and feeling relatively better than before. Still have pain when walking or standing up but not severe as before. Will keep you posted.

Donald Corenman, MD, DC
Moderator

October 19, 2016 at 3:36 am

Post count: 8660

#23230

This is helpful. Thank you.

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.

zman
Participant

October 24, 2016 at 6:54 am

Post count: 12

#23259

Well, finally MRI with contrast was done and below is the report. Look like no re herniation but i am not sure what is causing the pain then!.Is it the granulation tissue? If so what are my options? Had a transforaminal esi done about 2 weeks and pain seems to better after the injection but still have pain after 6/7 minutes of walking or standing. Have an appointment with NS this week. Please advise on what to discuss with him and my next step.Thanks Dr. Corenman.

“History: Low back pain with radiculopathy

MRI-3T LUMBAR SPINE PRE AND POST IV CONTRAST

History: M51.26 Herniated disc lumbar spine

MRI examination of the lumbosacral spine was performed on a 3.0 Tesla ultra high field
wide bore magnet and multiplanar multi-sequential techniques were used. 9 cc. Gadavist
contrast was administered intravenously. Images were obtained prior to and following
contrast administration.

Examination of the sagittal imaging demonstrates normal alignment and a degenerative
appearance of the vertebral bodies. The conus medullaris is seen to be normal.

The intervertebral disks demonstrate decreased T2 signal.

Examination demonstrates at L4-5 once again left-sided postoperative change. There is mass
effect within the left lateral recess which has decreased as compared to prior examination
and demonstrates contrast enhancement consistent with postoperative change.

The remainder examination is unchanged with mild degenerative changes.

Impression:

Postoperative change. No herniation noted.

ICD 10 Codes:
Degeneration L5-S1 level. M51.37
Degeneration L1-L5. M51.36
Hemilaminectomy. Z98.89

zman
Participant

October 31, 2016 at 10:45 am

Post count: 12

#23324

Dr. Corenman-Went to see NS, he suggested since there are no re herniation, pain will go away eventually, meanwhile manage the pain via injections and do stretches and exercise. As far as surgery, only option is Fusion but he’s reluctant to do it, at least not yet.I also asked him if it could be “foraminal stenosis” but he said he doesn’t see anything like that from MRI. Pain is bearable after transforaminal esi but still there specially walking or standing. If you could please take a look at the MRI report and advise.
Thanks Dr. Corenman.

MRI-3T LUMBAR SPINE PRE AND POST IV CONTRAST

History: M51.26 Herniated disc lumbar spine

MRI examination of the lumbosacral spine was performed on a 3.0 Tesla ultra high field
wide bore magnet and multiplanar multi-sequential techniques were used. 9 cc. Gadavist
contrast was administered intravenously. Images were obtained prior to and following
contrast administration.

Examination of the sagittal imaging demonstrates normal alignment and a degenerative
appearance of the vertebral bodies. The conus medullaris is seen to be normal.

The intervertebral disks demonstrate decreased T2 signal.

Examination demonstrates at L4-5 once again left-sided postoperative change. There is mass
effect within the left lateral recess which has decreased as compared to prior examination
and demonstrates contrast enhancement consistent with postoperative change.

The remainder examination is unchanged with mild degenerative changes.

Impression:

Postoperative change. No herniation noted.

Donald Corenman, MD, DC
Moderator

October 31, 2016 at 5:58 pm

Post count: 8660

#23327

The MRI reading is less than impressive but does note a “mass effect” still present at L4-5. It is hard to determine but this could be a recurrent herniation as the statement “demonstrates contrast enhancement consistent with postoperative change” does not answer the recurrent herniation question or whether the “mass effect” is from granulation tissue or from a non-enhancing material which could be herniation (old or new).

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.

zman
Participant

November 1, 2016 at 9:14 am

Post count: 12

#23336

Thanks Dr. Corenman.I think the radiologist made it short since nothing much was changed since last MRI w/o contrast. I summarized the MRI with and without contrast for you below.
MRI w/o contrast: At L4-5 there is evidence of left hemilaminotomy with postoperative change. Soft tissue is
seen within the left lateral recess is unclear as to whether this represents postoperative
change or disc material. There is apparent mass effect upon the left L5 nerve root.
Impression:L4-5 postoperative change with question disc herniation versus granulation tissue.”

MRI with contrast: Examination demonstrates at L4-5 once again left-sided postoperative change. There is mass
effect within the left lateral recess which has decreased as compared to prior examination
and demonstrates contrast enhancement consistent with postoperative change.
Impression: Postoperative change. No herniation noted.

If I understand correctly, he did said, there were no herniation. My NS also concurred that after reading MRI but it could be scar tissue and i’ll eventually get better over time. Any suggestion on what do next ?
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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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