Hamstring & leg pain

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morgan1
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September 23, 2011 at 3:52 am

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#4916

I am a 68 year old male and in the last 5 weeks I have been experiencing severe cramps in my hamstrings & calf muscles when I walk for more than a few feet. I can however work on the eliptical machine for sometime and get a lessing of the pain. I had a MRI in March of 2010 and another September 19 & 20 2011. The results are:
L2-3 Mild spondylosis with a bulging disc with mild flattening of the anterior sac. This progressed minimally from previous study, probably not causing significant stenosis.
l3-4 There is a diffusely-bulging disc which causes mass effect on the anterior thecal sac and loss of fat in the upper right lateral recess accentuated by enlarged ligaments and milder arthritic change involving the facet joints. Bulging disk and spur extends lterally and in near-apposition to the right third nerve root at the foramen. This is unchanged from previous study and is causing mild to moderate canal stenosis and borderline right foraminal encroachment.
L4-5 Bulging degenerative disc with mass effect on thecal sac, enlarged ligaments. Disc also extends laterally on the right and in opposition to the right forth nerve root at the foramen and could effect it. Certainly this is causing moderate central and lateral stenosis. This is fairly similar to previous study.
L5-S1 Shows no herination or encroachment on the thecal sac. Small spur extending laterally, only in near-apposition to the right fifth nerve root in the mid foramen. This is simllar to previous study. No mass effect on the S1 nerve roots or thecal sac. Minimal arthritic change involving facet joints.

Based on this I have been told I am not a good canidate for surgery. However, I am still having significant pain. In your openion, what should the treatment be?

Donald Corenman, MD, DC
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September 23, 2011 at 10:16 pm

Post count: 8660

#4917

First- let’s establish the symptoms you suffer from. You have cramping in your hamstrings and calf muscles with walking a short distance. Are the symptoms bilaterally equal or is there much more on one side than the other? Can you walk the exact same distance every time or are there days you can walk further and others that you can’t? If you sit or lie down, do your symptoms go away? If you are at a supermarket and hold onto a shopping cart, can you walk further comfortably?

Are these symptoms actually muscle cramps or pain that feels like muscle cramping? Do you get this cramping in any other muscle groups, especially in your arms? You note that you can work out on an elliptical machine and do not get onset of symptoms- at least for a longer time. Are you bent forward when you work out?

Has someone looked at your feet to see if there are pulses present? Are your feet discolored or swollen? Do you have ankle swelling? Have you lost hair on your feet and are your toenails thickened?

All these questions differentiate vascular claudication from neurogenic claudication (see web site). You very well might have spinal stenosis which leads to neurogenic claudication but your differential is still not established (again- see website).

Assuming neurogenic claudication, a great test and treatment is an epidural steroid injection. If you get good relief, even for a short period of time, this might confirm the diagnosis. You might even get long term relief (3 months or more). Now- if we assume the presence of neurogenic claudication, you might be a candidate for surgical decompression but that depends upon many factors including the spinal stability and your ability to undergo the surgery.

Your MRI does note the presence of central stenosis which certainly can cause your symptoms, especially at L4-L5.

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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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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