L4-5 bulge w/ tear

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Tuthmover
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February 8, 2013 at 9:46 am

Post count: 3

#7939

[map]41 yo male, 8 days ago, was doing stretching exercises and while doing Cat’s meow (flexion) while standing, felt pop and lightning up and down back and legs. Could barely hobble fo bed. Spent next 24 hours in bed, unable to move without pain. Taking 800mg IB q4h and Norflex 100mg BID.

Next day was able to get up and take 1-2″ shuffle steps. Visit to MD who showed me slight narrowing of posterior disc space of L4-5 and recommended MRI. Discontinued IB & Norflex, added Medrol 4mg Dosepak, Soma 350mg TID and Oxycodone 7.5mg. Fearful of addiction, I put the Oxycodone away.

Within a day my hip joints started feeling bad so on the day of the MRI, I told doc that I would like to go back to IB 400mg q4-6h and discontinued Medrol. Also switched the Soma to Diazepam 5mg TID. Also, began to get 1st symptoms of leg involvement, though intermittent with no weakness. As suspected, disc pathology.

With minor exceptions, I have been getting better. In the beginning, sitting was extremely painful on the lower back. Standing is also hard on the lower back. But I can now step a little better than toe to heel. I try to rest on bed 1 hour than walk/sit one hour. Sometimes I can go for two hours. Sitting has actually gotten easier on the lower back and I just do a lot of squirming. I find the easiest position is leaned forward at the dinner table.

I was going to get the epidural steroid, but backed out since I read that some of the side effects were similar to what I had on oral corticosteroids. I am trying to see if I can do this with starting physical therapy alone. But if I need surgery, perhaps it is best to do this quickly. I do feel my leg symptoms have gotten a little worse, but after laying down they usually go away. No pain, just some mild numbness. Sometimes left is worse than right.

I have a dental practice that I am afraid I will have to sell since I have heard surgeries can keep you out for 6-12 months. Also, my wife expecting child number 4 in almost 6 months. Thank goodness for long term disability insurance.

I have saggital views, but do not know how to add photos.

Donald Corenman, MD, DC
Moderator

February 8, 2013 at 10:53 am

Post count: 8660

#7941

You note disc pathology but do not describe the pathology. Is it a herniated disc, disc bulging, lateral recess stenosis or???? Read off the radiologist’s report to determine what they think.

If I had symptoms like yours, I would have an epidural steroid injection. For your type of pain, it is the quickest, most effective single treatment available.

Any surgery would depend upon the pathology. A disc herniation surgery is generally a simple surgery to recover from (back to dental practice in one to three weeks part time to full time). A fusion takes more time but probably back to part time work in three to six weeks.

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.

Tuthmover
Member

February 8, 2013 at 11:13 am

Post count: 3

#7942

Sorry I forgot to mention. He mentioned during the post-MRI consult, that it was a bulging disc with annular tear. The technical term was lumbar displacement. The axial view showed pretty much straight posterior. I do not have the radiologist report with me…only the CD of the MRI. Is their a way to load the MRI saggital slices?

Tuthmover
Member

February 8, 2013 at 11:24 pm

Post count: 3

#7945

Was able to post 6 saggital slices 8-13, with 10-11 looking to worst.

w w w DOT flickr DOT com/photos/charlestonbraces/

Hopefully you can view the pics. In my last post, I answered your request for the disc pathology as “bulging with tear”, but after reading your extensive website material on anatomy and disorders, is that just the same thing as herniation?

Anyway, worried about the epidural steroid gaining rapid access to the periperheral circulation. After only 10 tablets of 4mg Medrol in two days, my hips do not feel great. And I think it is more than sciatica related since there is also some popping of the hip joint (L >> R) and occasional minimal popping of my R ankle.
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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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