Herniated disc on OTHER side 5 months post op

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wmiller
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November 12, 2019 at 8:10 pm

Post count: 30

#31466

Hi. I had an L5/S1 discectomy on my right side five months ago–I have no pain and have gained all muscle function back since then and was doing really well.

About a month ago, I started getting some low back pain on the other side, with radiation down the lateral side of the leg. I was diagnosed with piriformis syndrome and have been doing PT (and a medrol pack) since with no change. The back pain is actually worse, and today I woke up unable to stand up straight. It is not as bad as my initial herniation in which I had foot drop, but I’m in a lot of pain and I have to walk hunched over. I saw a sports med doc today who thinks I have another herniation. I thought this was all behind me and am super bummed! My questions:

-Extension really aggravates whatever is going on. With my other herniation, it was the opposite. The doctor I saw today said extension can also depending on the area of the herniation. Is this possible? I literally cannot walk standing up straight.

-I had no injury that caused this (unlike my first herniation). Could my prior surgery have caused this? Again, I have no pain at all on my surgical side.

-The sports medicine doctor I saw has referred me to a pain specialist to try an injection (I don’t have any weakness this time around, just pain) in L5/S1 on the side on which I’ve not yet had surgery. He said I did not need an MRI before this since they have my pre op one from five months ago that showed some bulging all the way across L5/S1 with the herniation on the right. Is this typical?

-If I end up needing surgery on this side, does that mean I’ll likely need a fusion if it’s the same level? If so, I’m coming to Vail (already had surgery by Dr. Philippon there two years ago)

I really appreciate your help!

Donald Corenman, MD, DC
Moderator

November 13, 2019 at 7:48 am

Post count: 8660

#31469

You need a new MRI regardless of the other opinions as your symptoms have substantially changed since the old MRI. Disc herniations can cause lateral recess stenosis or foraminal stenosis, both of which will cause pain with standing relieved by sitting.

See https://neckandback.com/conditions/lateral-recess-stenosis/ and
https://neckandback.com/conditions/lumbar-foraminal-stenosis-collapse/

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.

wmiller
Participant

November 13, 2019 at 6:28 pm

Post count: 30

#31472

Thank you–my neurosurgeon left the practice so I will have to get a referral to another one and push for an MRI. So I could have herniated and this caused the stenosis. It is very painful and I have weakness but feels different than my first herniation, which was made much worse by flexion and sitting.

One last question–is the treatment for lateral recess stenosis/foraminal stenosis similar to discs like injections, then if that doesn’t work, surgery to remove the part of the disc?

wmiller
Participant

November 15, 2019 at 12:57 pm

Post count: 30

#31475

As an update, I had an MRI yesterday and was just called with results: large disc bulge causing stenosis. Since it is not herniated, is surgical treatment an option?

Donald Corenman, MD, DC
Moderator

November 16, 2019 at 12:16 pm

Post count: 8660

#31478

Surgical treatment is an option with a large enough disc bulge that causes stenosis. You could try epidural steroid injections and physical therapy if you have no motor weakness.

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.

wmiller
Participant

November 25, 2019 at 10:53 am

Post count: 30

#31536

Thanks.
I have injections scheduled for next week for the L4/L5 disc bulge (one level higher than my microD this past summer).

Do you recommend rest from physical activity until this is done? I ride a stationary bike (not in aero position), and it definitely irritates it. I do not want to damage anything further, but is it typically safe to ride as long as the person can endure the pain (I’d say gets to 4/10)? I stopped coming up out of the saddle, as that irritated it a lot.
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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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