Is surgery really needed?

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Abit
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November 2, 2013 at 7:56 am

Post count: 1

#9740

Dear Dr. Corenman,
Thank you in advance for taking for my question and for your generosity of your time. I have a friend living abroad and she was told that surgery was necessary for her condition. She is 23 years old. She has pain and numbness in her leg. Would you please take a look at her MRI and give your opinion? She really needs an honest second opinion.

MRI Report
On the series of lumbar T1 and T2 weighted MR-images in sagittal, coronal and axial planes, lordosis is normal.
On T2 disc level height and signal intensity of L4-S1 and L5-S1 discs are lowered. The height of the rest discs is normal.
There is a left side posterolateral herniation of L4-L5 disc with the size: anteroposterior – 7.8 mm, vertical – 9.8 mm, which is causing compression on the front wall of dural sac and lateral recess, and spinal root on the left. The size of anteroposterior vertebral spinal canal is 0.90 cm. The width of the spinal canal is 0,85 cm.

Left side posterolateral herniation of L5-S1 disc. Its size: anteroposterior – 3,7 mm, vertical – 5,6 mm. There is a compression of the front wall of dural sac and spinal root on the left. The left intervertebral foramen is narrowed. Anteroposterior size of the vertebral spinal canal is 1,3 cm.

Findings: Dorsal herniation of L4-L5, L5-S1 discs with a sign of stenosis of the spinal canal on level L4-L5.

Donald Corenman, MD, DC
Moderator

November 13, 2013 at 9:26 pm

Post count: 8660

#9784

I cannot tell you with this information if your friend needs surgery. She does have two disc herniations on the left at L4-5 and L5-S1 that are compressing the two left nerve roots (L5 and S1). See the section on the website “When to have lower back surgery” to understand the indications for surgery.

Also check out the section “Symptoms of lumbar nerve injuries” to understand what the symptoms she is exhibiting really mean. You will have a much fuller understanding of the treatment options.

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.

callshirley2004
Member

November 27, 2013 at 4:27 am

Post count: 1

#9857

Dear Dr. Corenman,
I was blessed to come across this Forum while searching for answers on my debilitating cervical and lumbar pain. I read your responses and it was very educational. I am 51 years old and had multiple injuries ( falls) while working as a teacher. Below were excerpts of my latest MRI . I hope and pray you can enlighten me more. The physical therapy didnt help in any way and I cant live with Pain killers because they make me drowsy and has increased my risks for fall..

Clinical History:
51-year-old female with neck pain and low back pain, bilateral tingling in the upper and lower
extremities. Status post fall September 2013.

Technique:
The examination was performed with sagittal T1 weighted images, STIR and T2 weighted images, and axial T2 weighted images of the lumbar spine. Coronal T2 weighted images were obtained as well.

Comparison:
Lumbar spine MRI dated 01/22/2012.

Findings:
The lumbar lordosis is straightened. There is mild S-shaped scoliosis convex to the right at L1 and to the left at L4-5. Mild endplate osteophyte formation, disc space narrowing, endplate degenerative
changes are present at L4-5. There is dehydration of the L4-5 and L5-S1 discs. The conus medullaris is normal in position and signal intensity. Paragraph there is a small roundhyperintense hemangiomata in the L5 vertebral body.Schmorl’s nodes and endplate degenerative signal changes are present at L4-5 with minimal anterolisthesis noted at this level.

At L1-2 L2 pull, L2 dish L3, and L3-L4 no focal disc herniation, stenosis, or foraminal compromise is present.

At L4-5 there is the aforementioned anterolisthesis. There is associated shelf of disc material within the inferiorly migrating disc extrusion centrally and to the right of midline. Mild bilateral facet
hypertrophy is present. There is no nerve root compression. The central canal and neural foramina are patent.

L5-S1 there is a central and right-sided inferiorly migrating disc protrusion which abuts the right S1
nerve root. There is no central stenosis or foraminal compromise.
No paraspinal masses are present.

IMPRESSION
Central left-sided inferiorly migrating disc protrusion at L4-5 unchanged the previous exam.

Central left-sided inferiorly migrating disc extrusion at L5-S1. . The extruded disc is larger than on the
previous exam and the right S1 nerve root compression is new.

Donald Corenman, MD, DC
Moderator

November 27, 2013 at 10:15 am

Post count: 8660

#9858

MRIs do not help diagnosis unless the symptoms are spelled out. See the section on “how to describe symptoms” to better convey what impairment you have.

The radiologist spells out (obliquely) that you have a degenerative spondylolisthesis (see website) of L4-5 with what sounds to be (IDR), isolated disc resorption). It also sounds like you have an angular collapse at the L4-5 level on the left but this is not spelled out well. This is a well known cause of lower back pain.

You also have a disc herniation at L5-S1 on the right which can cause right buttocks and leg pain.

The radiologist stated that ;”Central left-sided inferiorly migrating disc extrusion at L5-S1. . The extruded disc is larger than on the previous exam and the right S1 nerve root compression is new”. I assume that since he does not identify any left herniation in his main report that the conclusion is mis-dictated.

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 25, 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 10, 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 8, 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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