L5 nerve root recovery

Tagged: far-lateral herniation at L5-S1 with foraminal stenosis, recovery of motor strength after years of compression

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rypz79
Participant

March 21, 2020 at 3:57 am

Post count: 33

#32340

If the nerve root is inflamed, pushing and pulling it (walking and flexing the hip) will aggravate it.

In general taking strong NSAIDs (e.g Etodolac 400-800mg) as needed can slow / can increase / doesn’t affect the nerve healing process or in other words does inflammation can slow / can increase / doesn’t affect the nerve healing process?

When you mention dermatome, you are talking about pain and sensation (numbness). This is different that a “myotome” which indicates muscle strength…

So essentially every remote (more then 18 inch away from the disc herniation) motor loss, even partial (weakness) is unrecoverable even if the decompression surgery occurs at the time of the herniation?

I’m a little confused and probably don’t fully understand this. Assuming this in not Functional Compression Nerve Block does sensory loss (pain, numbness, burning sensation, pins and needls) falls into the Functional Myelin Injury Nerve Block which recovers between 4-12 weeks from the decompression surgery even if the sensory tissue is remote? or the 12 months recovery time applies also for remote sensory tissues?

(PS in the nerve damage & healing article
it’s named Injury to the Myelin Sheath Only with 8-14 weeks of recovery time not 4-12 weeks but again I might be mixing things)

Thank you very much Dr. Corenman
rypz79
Participant

March 21, 2020 at 6:42 am

Post count: 33
#32341
Correction:
So essentially every remote (18 inch or more away from the disc herniation) motor loss, even partial (weakness)
is unrecoverable even if the decompression surgery occurs at the time of the herniation?

Sorry
Donald Corenman, MD, DC
Moderator

March 21, 2020 at 10:04 am

Post count: 8660

#32342

“In general taking strong NSAIDs (e.g Etodolac 400-800mg) as needed can slow / can increase / doesn’t affect the nerve healing process or in other words does inflammation can slow / can increase / doesn’t affect the nerve healing process”?

Inflammation occurs with tissue injury. Inflammation is essential for healing but it does the exact wrong action for nerve healing as inflammation increases nerve cell dysfunction. Thats why corticosteroids are so effective for this type of treatment. I think that anything that reduces pain such as NSAIDs are helpful but for “healing” of the nerve root due to compression, it is only the decompression that is effective to return motor function.

“So essentially every remote (more then 18 inch away from the disc herniation) motor loss, even partial (weakness) is unrecoverable even if the decompression surgery occurs at the time of the herniation”?

According to my studies, the chance of full motor recovery with surgery performed in a timely fashion has about an 80% (approximate) chance of full recovery. This means that the injury at time of herniation could have permanently injured the nerve root no matter how fast the decompression surgery occurred

“I’m a little confused and probably don’t fully understand this. Assuming this in not Functional Compression Nerve Block does sensory loss (pain, numbness, burning sensation, pins and needls) falls into the Functional Myelin Injury Nerve Block which recovers between 4-12 weeks from the decompression surgery even if the sensory tissue is remote? or the 12 months recovery time applies also for remote sensory tissues”?

The sensory injury has not been studied as well as motor loss as sensory loss is not as dysfunctional. It seems like sensory loss has a better chance of recovery but there still can be spots on the skin that are not normally sensate.

“So essentially every remote (18 inch or more away from the disc herniation) motor loss, even partial (weakness) due to damage to nerve cell itself which requires axonal regeneration is unrecoverable even if the decompression surgery occurs at the time of the herniation”?

Possibly. See above.

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.

rypz79
Participant

March 22, 2020 at 2:37 pm

Post count: 33

#32347

Hello Dr. Corenman,

Well since my month post-op visit this coming Wednesday have been canceled due to the covid-19 closure here and since EMG/NCV tests are not very useful for sensory/pain I did some testing on my own.

It turns out that my L5 dermatome area on my right foot (inner and outer surface) is not numb per say there is a little loss of sensation compared to my left foot so when I pinch it with a nail or when standing on a cold floor or with feeling of hot water in the shower they feel the same.

I also found out that when I sit on my knees “choking” the blood supply for both legs the left one takes 10-15 seconds to “wake up” with the normal sensation of an awakening limb while in my right feet there is no such sensation.

It feels like one foot is getting less electrical charge then the other and when both at rest feels a bit colder.

Can I conclude something from these findings about my nerve damage and my recovery chances from this radiculopathy?

Thank you very much Dr. Corenman

Donald Corenman, MD, DC
Moderator

March 23, 2020 at 10:50 am

Post count: 8660

#32351

Those symptoms do not help to conclude anything about recovery.

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.

rypz79
Participant

March 23, 2020 at 2:01 pm

Post count: 33

#32358

Hello Dr. Corenman,

I’ve read in this blog
http://www.huffpost.com/entry/nerve-injury-types-and-re_b_13008678
That fibrillation is only seen when there is an axonal injury. Thus when there is no indication of fibrillation on the EMG test it’s likely to be damage to the myelin sheath only.

1) Is that correct? Couldn’t find any reference for that in your article https://neckandback.com/treatments/emgncv-electromyograms-and-nerve-conduction-studies

2) Is Neurapraxia essentially an interruption in the conduction of the impulse down the nerve fiber due to myelin sheath damage only with no axonal damage involved?

3) Can / is it common for Neurapraxia to occur due to a compression from disc herniation with symptoms of radiculopathy?

4) With almost no motor loss do you recommend me doing an EMG/NCV test (the surgeon told me couple of days after the surgery that it’s irrelevant)?

Thank you very much Dr. Corenman
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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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