Just told I have FBSS due to Epidural Fibrosis? Any hope?

Tagged: Third recurrent herniation lumbar

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Vin
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May 30, 2016 at 6:45 pm

Post count: 11

#22284

Hi,

I have had two herniated discs in the last 8 months with 2 microdiscectomy ops. The last being 7 weeks ago. I reherniated the disc again (3rd time) but was told by my Surgeon that basically, that’s it…no more surgery due to epidural scarring and more surgery would equal more scarring and could make things worse. Odd because 7 weeks ago prior to the 2nd surgery he said if the Microdisectomy fails we can always try a fusion.

On top of the current now 3rd L5 S1 disc herniation I am walking around with, I also have severe Bilateral Neural Foraminal Narrowing at the L5 S1 level with severe disk narrowing and degeneration (as per my MRI report).

I am going to ask my GP for a couple more referrals to other spine surgeons for 2nd and 3rd opinions.

But if the consensus is what this current surgeon has told me, that I have FBSS, scarring and nothing can be done at all about my current issues due to scarring then I wanted to ask you about percutaneous epidural lysis of adhesions.

Do you offer this procedure at your practice and if not can you recommend any reputable Doctors that do?

Any other insight is welcomed.

I have numbness, tingling and cramping up and down both legs/feet, lower back pain across entire lower back and sciatic pain down my right glute and leg (side of disc herniation).

Thank you very much for your time.

Donald Corenman, MD, DC
Moderator

June 4, 2016 at 10:53 am

Post count: 8660

#22315

If you have an MRI noting a recurrent disc herniation, a third surgery including a decompression and a fusion would be called for. I an unclear as to why your surgeon does not think is is a viable option.

Percutaneous lysis of adhesions is generally considered using a small scope through the skin to try and free the nerve root. This is a recipe for disaster. With significant scar, you have to be looking directly at the nerve root through a microscope with a good assistant to help with suction and retraction.

You also have bilateral foraminal stenosis at this level. Do you have buttocks and leg pain with standing/walking? See https://neckandback.com/conditions/lumbar-foraminal-stenosis-collapse/ to see if this condition fits your symptoms.

I would advise at least a second opinion.

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.

Vin
Participant

June 4, 2016 at 10:51 pm

Post count: 11

#22321

Hi,

Thanks so much for your reply.

I do indeed have the symptoms of pain in the glutes on both sides, especially when standing and walking, worse in the right side.

I also have transient bilateral numbness, cramping and tingling down the back of both legs and feet. I am guessing this is from the Bilateral Neural Foraminal Stenosis?

I have right sided sciatic pain and weakness down my right leg from the current 3rd right sided disc herniation at L5 S1 Level.

On top of all this, chronic lower back pain across entire lower lumbar.

I am in the process of gathering all of my imaging and surgical records, reports etc., and am interested in sending them to you for your MRI review service.

I am also completely puzzled by my surgeon dismissing me. Prior to the second microdisectomy he said that we will see how it goes but that I may need a fusion because of recurring herniations.

So I reherniated again after the second microdisectomy (3rd herniation at right side L5 S1 Level in 8 months) and when I went into see him he just said that he looked at the MRI and that I have another herniation but it is smaller than the last one (10mm x 5mm x 6mm this time) but that I have a lot of scar tissue from the first 2 surgeries so he isn’t doing anymore surgery and said he is diagnosing me with FBSS due to epidural scarring.

I pleaded with him about the constant agony and pain I was in as I can’t sit for more than 15 minutes but he just said nothing he could do and to try some physical therapy and maybe it would help some with the pain.

I don’t get it? I have referrals in for two new orthopedic surgeons locally but it will likely be 6-8+ months for an appointment here.

Anyways, thanks again. Any other input is welcomed.

Donald Corenman, MD, DC
Moderator

June 5, 2016 at 6:24 am

Post count: 8660

#22323

Again, why your surgeon dismissed you is a question I think only he can answer. You might have significant scar tissue and that makes the fusion surgery harder but not impossible. Your other symptoms of foraminal stenosis certainly could be resolved by a TLIF fusion surgery. If you have any interest in a long distance consultation, please call my office and talk to Lori Fugate at (970) 476-1100.

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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