L4 Protusion

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dawney 1
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August 16, 2013 at 5:51 am

Post count: 10

#9232

6 weeks ago had L5 herniation surgery fall last sept 2012 Left leg numbness, pain buttocks etc… had Microdisectomy, day 2 severe pain Right side numbness buttocks right foot felt like a knife in right spine, still have numbness left leg with pain pelvic numbness, saddle, thigh, toes, Had repeat MRI with contrast, already had a budging disk on L4 before surgery, New report L4 disk protrusion Large, degenerative disk disease of L4 L5 with prominent left sub articular zone protrusion containing and enhancing annular tear which abuts the traversing Left L5 nerve root, correlate for left L5 radiculopathy no stenosis or narrowing, when I sit to long 2 min max my legs are asleep I have severe pain buttocks back of both thighs calves and outer half of foot with great toe pain at intervals left foot, I have had severs constipation for weeks now I went to ER had MRI same results, My surgeon wants Injections again, but the last ones I ended up in ER with Bladder paralysis high BP no way I am on neuronton 600mg tid and now anti inflammatory will this numbness ever go away will I need surgery again, I had a fall through a dock missing a plank with my left leg I now have pelvic numbness left thigh numbness and toes, had herniation cervical had a fusion tore my left hip labrum tear still hurts from time to time, I walk with a limp it hurts to walk low back pain never stops only in my recliner, cant walk far cant sit long I am a nurse 29 years my life has changed so much its been a year and even my neck is not the same I have pain in it now more than before 54 year old female thin 107 lbs

dawney 1
Member

August 17, 2013 at 10:48 pm

Post count: 10

#9236

should I go for second opinion, get surgery, or do injections, last injections ended up in the ER with paralized bladder, injections are out or should I just leave it alone will it get better

Donald Corenman, MD, DC
Moderator

August 18, 2013 at 8:40 pm

Post count: 8660

#9242

I am unclear if you have written another question on another thread that I have already answered but I will respond again. Forgive me if this is redundant.

This sounds like you have two different problems going on. First is the left leg radiculopathy that resulted in a microdiscectomy at L5-S1 which was ineffective to relieve symptoms. Am I incorrect and this initial surgery was at L4-5?

You had a bulge at L4-5 right side prior to surgery and now you have a frank herniation of this level on the right with resultant nerve compression and nerve pain.

The MRI you obtained after surgery that demonstrated this new HNP at L4-5 on the right will have valuable information regarding the prior surgery. Failure of a prior microdiscectomy has four potential reasons:, recurrent herniation, hematoma, infection or chronic radiculopathy. The first three are generally easily seen on an MRI. The last one (chronic radiculopathy-see website) takes some time to fully diagnose and is a diagnosis of exclusion.

The new herniation at L4-5 right can occur at any time including positioning you on the table during the prior surgery or even coughing while recovering in the hospital. This should be treated as any new herniation, if motor weakness, surgery and if strictly pain and numbness, PT and injections unless the pain is severe or conservative treatment does not work.

Now if you need further surgery at your previously operated level, this new herniation should also be removed.

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.

dawney 1
Member

August 18, 2013 at 11:25 pm

Post count: 10

#9243

Yes Doctor I had an L5 S1 herination with annular tear during surgery they did a discogram, he checked both levels and found my pain was on Left side with L5 2 days after surgery I began to have severe right pain in low back and leg with tingles and foot pain he said it was inflammation it got worse I could hardly walk the Left side never got better after the surgery, I demanded an MRI I went for an MRI the radiologist said I have a L4 L5 Large herniation on the left side, and new symptoms on right, My Doctor said it was only fluid he saw no herniation with the CD well I was having severe constipation for 6 days no BM and urine problems I went to ER they did a MRI thinking I had caudia Equina but it showed a large heriniation on the left side with a posterior tear and radial tear, I have continoius sharp pain down both legs now the Doctor still says its fluid and wants to do injections and I am not keen on that as the last injections cause me bladder paralysis, the radiologist also said a lot of inflammation is on the right side so I am on inflammatory meds I am on Neurontin 600mg TID I have been on this for a year now since this accident the surgery was an L5 S1 6 weeks ago I had a large buldge of the L4 with annular tear before this L5 surgery I believe this ne herniation happened after the surgery because I know the pain started right away they brushed it off as inflammation I know my body it is a stabbing pain on the right side when I move around the left side is pretty much numb in different areas on the left but I am getting sharp pain in left thigh to now, so you dont think this discogram could have caused to much pressure in the L4 because he checked that one he said the L5 filled up with the dye and caused pain but L4 did not show it was only a Bulge when he checked it 6 weeks ago on the surgery table I was out then they woke me up he did say I had a severe anxiety attack on the table and they had to give me ativan so maybe I went nuts when they woke me up and it herniated then who knows when I had my EMG done last year it showed radiculpathy on L5 S1, I dont know what to do here this doctor still says it is fluid on both CDs and 2 radiologists say it is a herniation very large but contained maybe I should get a second opinion this is a lawsuit on going for a year my body is a mess since all this surgery I went to PT it made all worse this last route and injections well it messed up my bladder and gave me severe cramps in both legs it did not help Im worried about having another surgery I had a cervical fusion done this past Jan of the c6 c7 for herniation had left arm nerve problem but now my right fingers the last three get numbness and my neck hurts all the time now, I am so tired of all this I have been a nurse for 28 years and now I am messed up I fell into a dock that was missing a plank with my left leg I have pelvic numbness now I feel nothing in my vagina and buttocks numbness I walk with a limp have to pick my legs up to get in a car from weak legs back pain had a labrum tear left hip fixed the clicking is gone but still have hip pain I still have a rotator cuff to repair from all this should I just leave this new herniation alone, will it go away, I am 107 lbs very thin 54 year old I have some muscle wasting mostly left leg and left shoulder from all this I feel like this is never going to end, after I had my cervical fusion I got horners syndrome right eye it has gotten a little better but still have weak eye lid and blurred vision

Donald Corenman, MD, DC
Moderator

August 20, 2013 at 8:32 pm

Post count: 8660

#9250

So to make sure I am not confused, you had a microdiscetomy surgery at left L5-S1 for what I presume was a herniated disc. During this surgery, you also underwent a discogram.

This chain of events is hard for me to understand as a discogram procedure requires you to be awake and to be able to answer questions. The microdiscectomy surgery requires you to be asleep and intubated which by definition means you cannot answer questions.

In addition, a discogram is a presurgical procedure designed to determine what potential future surgeries could be helpful. Doing this procedure at the time of a planned surgery is confusing as to the surgeon’s thinking for diagnosis.

Let us continue but ignore the discogram for the time being.

Your history is somewhat confusing. You have new onset right leg pain as well as left leg pain that did not improve from the surgery. A new MRI was performed and indicates a potential recurrent herniation at L5-S1 and a new herniation at L4-5, both on the left. Is that correct?

Is there any indication of compression of the right nerve root at either level that would help to explain why you have new right leg pain? Did you undergo laboratory tests to indicate you do not have an infection and did the radiologists indicate that there is no evidence of infection?

Yes, I think you could be well benefitted if you decide to have a second opinion. Another set of eyes in your case would be helpful.

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.

dawney 1
Member

August 21, 2013 at 4:50 am

Post count: 10

#9254

ok during the microdesectomy I was told I was awakened to ask the question I was medicated before I went in and I think I was out not sure to that I dont remember I remember they gave me versed before i went in but they also said when I awake I had a severe anxiety attack and they had to give me ativan to calm me down and then my Bp went very low and when it was over they had a hard time waking me up and i couldnt catch my breath it sounds a mess but if they have you on the table he said he shot the dye in both levels that tells me I must have been opened up already who knows what really happenend on the table it concerns me the whole ordeal, my understanding was he was going to do the discogram while I was on the table and if it showed possitive he would proceed with Micro which he did but only did the one level L5 s1
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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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