L5 nerve pain what are my options ?

Tagged: disc herniation, infection, L5 nerve, PAIN, scar tissue, sciatica

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Stepha62
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January 28, 2017 at 1:24 am

Post count: 1

#24230

Thank you so much for taking the time to listen . So I herniated my L4-L5 herniation surgery til I started to lose function in my right foot. First surgery felt awesome . Fast results . Unfortunately I am sure that’s when I got infected . Lots and lots of leaking . Once it stopped leaking I felt as if I had a speed bump in my back . It reherniated . So I had my second surgery . At this point I was told I had very little disc left and if it happened again I would need a fusion and disc . Well unfortunately … I got septic softly after this . Large abscess ( 6 inches long deep as a grapefruit ) up my spine . Weeks later I was released only to return in five days with yet another type of infection . This time they left my back open to drain til it healed on it’s on . I did eventually get back to work after a few months on light duty as an office RN . It didn’t last long . Suddenly I was being hit by lightening I would say with severe 10/10 pain down my leg . Was informed my disc was protruding but obviously I didn’t want the surgeon to operate on me again ( workers Comp nightmare) (got a second opinion which stated due to all my scar tissue he would suggest avoiding surgery until I just have to have it . I agree . But since this event my nerve pain is only getting worse . Now my leg goes dead on me . Literally fell down stairs a couple weeks ago .got an MRI . This time it doesn’t mention any protruding disc but states no change in that dept . Does speak of my L5 nerve root being surrounded by scar tissue . My neurologist ( I am not longer with workers Comp so I don’t have a back doctor at the moment , again it’s a mess ) states this scar tissue is what is doing it . My nerve pain that runs from my buttocks behind leg down the right side of my calf lands in my ankle or bottom of foot is beyond painful . I feel like I have a large knife in my ankle at all times . Sitting causes electrical bolt like feelings . Certain positions make it extremely worse . Rest doesn’t help but it does allow me to get out of the ” killer ” positions . Today just letting my foot to put it on the brake made me nearly lose it . I cannot sit on my right buttcheek. I can pin point the pain area and if I put pressure it shoots down my leg . I haven’t ever had that before . Does scar tissue if surrounding the nerve really cause this ( obviously I know you speak in general as you cannot see me online ) .also what can be done ? )3 wants to refer me to a spine specialist / surgeon . The pain is bad and literally makes me contemplate cutting it off lol . But with my luck I would have phantom pain . Plus that still wouldn’t help me sit . Cause you release the nerve by removing the scar tissue ? I get scar tissue can grow back … but if that’s the case is there some sort of sheath they can put around it ? At this point they could kill that nerve for all I care . ‘Y quality of life is not good . Plus I am a single mom of twins (9). Oh and every since the second time I had surgery I have had urinary leakage . Not bad but thought I would throw that in there . I am fine with accepting my new limitations but also praying to god there is a fix that could even just get my pain down a little . I have had blocks without help . I also now have periodic limb movement disorder , my legs kick 97 times a minute in my sleep when I do sleep . It’s clinic in nature . Neurologist thinks it’s due to my pain and scar tissue . Regardless I will try to get into pain management asap as I am barely handling it now .
Sorry so long . Any advice would be greatly appreciated

Donald Corenman, MD, DC
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January 28, 2017 at 7:05 am

Post count: 8660

#24231

Scar tissue can be a pain generator as the nerve root is designed to move in the foramen like a cable on a pulley. If you fix the root to the pulley, it will not move but “pull” and that can be painful. However, if the scar is just a “bystander” and the root is damaged (the all-so-important nerve membrane or the vasonervorum blood vessels that nourish the membrane), this leads to chronic radiculopathy. In chronic radiculopathy, the pain is generated not by the tethering of the root by scar but by internal damage of the root. This is why neurolysis surgery (freeing the root surgically) may not be effective to relieve pain.

Now, there are other disorders that can cause pain but the pain can be blamed on the scar. These are foraminal stenosis and foraminal collapse as well as lateral recess stenosis. Look these up on this site to see if any of your symptoms fit.

Finally, if nothing else works, a spinal cord stimulator can be effective. Look this up on the site too.

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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