horrible pain L6-S1. Hit and run accident.

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mendius
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May 4, 2013 at 1:18 pm

Post count: 2

#8580

Dear dr. Corenman,

I am writing you from Italy, I am a 33-year-old gentleman. In September 2002 I had an “hit and run” accident during which I experienced the fracture of L1-L2, with loss of consciousness for about 15 minutes. When I became conscious again, I immediately started to feel a very severe pain between L6-S1 (I have 6 lumbar vertebrae), exactly at the center of the spine in mid location. This pain never stopped since then and has made my life a REAL hell.
The worst problem is that diagnostics could never explain this pain. Neither X-rays or magnetic resonance or CAT could find anything anomalous or able to justify the bad pain I continue to have. Despite this, pain never reduced in these last 11 years. I had several surgeries that didn’t meet expectations, some of them even worsened my previous condition.

SURGERIES THAT DIDN’T GIVE ANY RESULT: 2004-2005,“Denervation” of the “articular faces” of the spine (L5-L6-S1) with radio frequency. This surgery was repeated twice and didn’t cause any effect. In may 2011 I tried the “pacemaker against pain” but it doesn’t improve my condition, so it was removed.
In march 2013 I had a fusion of L6-S1, but the pain is still the same, located just under the fusion.

SURGERIES THAT WORSENED THE SITUATION: Positioning of a DIAM between L5-L6. This intervertebral shock absorber was placed about 9 years ago, with the aim of reducing the pressure on the lower part of the spine. In reality, it was not just unable to diminish the symptoms but pain moved down towards inferior limbs and the disk L5-L6 has undergone a continuous deterioration even reaching a contact with the spinal cord. In July 2010 the diam was removed, and the pain on my legs goes better.

SURGERIES THAT MODIFIED THE PAIN ZONE: In December 2009, “Denervation” of the interspinal ligament of L6-S1 with radiofrequency before and a following surgery of resection of the same interspinal ligament have brought some very small improvements. Also I had an ablation of L6-S1 spinal process. The pain has slightly moved down, both in intensity and in location, but still remaining at the center of the spine. With the denervation with radiofrequency it moved downwards of about 2 centimeters, still remaining between L6-S1 but now much closer to S1. With the following surgery, when the interspinal ligament was removed, pain has slided down in intensity as well as in localization.

Right now the pain continues to be very bad. I can stand upright only for a minute. Pain is not radiating, it is more like a stab. I have tried every kind of therapy, really everything. I had manies check, but receiving always the same answers, that is “diagnostics” is not showing anything special to justify this continuous pain and that I cannot do anything about this and I have to live like this. I must take drugs just to stay at home. I can’t go out because the pain is too much strong.
I am aware that you are used to hopeless situations but I am really desperate. The pain is just unbearable. I am not living … It is like being trapped inside my own body. It is a nightmare I have been living through since 11 years and I would like to wake up. Please, please help me, I am imploring you.

Regards

A.P.

Donald Corenman, MD, DC
Moderator

May 4, 2013 at 8:03 pm

Post count: 8660

#8581

You must go back to the beginning to start to figure out where the pain could originate. I understand you have had multiple failed procedures. The question is still where the origin of your pain generator or generators are.

Has anyone looked at the fracture of L1-2 (or T12-L1 if you have six true lumbar vertebra) for pain generation? Nerve root injury at this level can radiate pain down into the lower lumbar spine. What type of fracture was in the L1-2 area? Was it a simple compression fracture, a burst fracture, a flexion-distraction fracture, a fracture subluxation or dislocation?

Has anyone performed diagnostic blocks (see ESI/SNRB and pain diary on this website) to determine any potential pain structures? Did you have discograms performed (see website)?

If I understand you correctly, you had a spinal cord stimulator placed that was unsuccessful. Where was it placed and why did it not work?

You had a shock absorption spacer placed above the level of your fusion at L6-S1. What does your MRI look like now? Is there degeneration of this level after that spacer was placed?

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.

mendius
Member

May 9, 2013 at 12:42 am

Post count: 2

#8612

The fractures at L1-L2 are simple compression. No discogram was performed. Diagnostic Blocks works only for 5-6 hours, just for the effect of the local anaesthesia. The doctor said that the spinal cord stimulator doesn’t work because the scars are too big and the electrical impulse can’t go across the scars. at the L5-L6 level there is a little bulging.

Regards

A.P.

Donald Corenman, MD, DC
Moderator

May 10, 2013 at 8:50 pm

Post count: 8660

#8623

Simple compression fractures can still result in a significant kyphosis (an abnormal structural bending forward of the spine) which can result in significant problems at this level as well as problems above and below. What is the measured kyphosis at the fracture levels?

Diagnostic blocks that temporarily eliminate the pain are great tools to map out the pain generators (see pain diary on the website). If you had good temporary relief, where were the blocks performed and what type of blocks were they (facet blocks, epidurals, SNRBs)?

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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