L5-S1

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gu2002
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June 2, 2011 at 11:04 pm

Post count: 5

#4611

hello doctor, I Say That I Had two years ago for a herniated disc surgery
L5-S1 discectomy, laminectomy, That is the reality after the operation, pain Disappeared, But The Doctor Said May Have Been the nerve resent by the surgery, pero, and Spent two years and much pain Sometimes strong grabs me in the right buttock, no branching leg (right) I inject vitamin B12 and passes, pero entumese leg, it hurts to move and bend and stretch, I CAN NOT spend much time sitting, etc, etc.
my question is Which Is Probably a good solution to this, the Humid climate of Buenos Aires (average 70%) Affects Inflammation in the area? Physical activity relieves the pain? What kind of activity? Would think or at Some point in some kind of surgery again?
is good in a disc replacement.
I have 43 years I am Physically active, or WAS, (athlete), But now the truth, I put an end to the Activities out of fear or anything living!
I hope Not to bother with this Consultation and I thank you!

Donald Corenman, MD, DC
Moderator

June 7, 2011 at 11:39 am

Post count: 8660

#4618

By your history, it appears that you have had a discectomy at L5-S1 two years ago and surgery was a success as the pain disappeared initially. I am unclear when the pain returned, but apparently it did at some time. The pain now is intermittant in your right buttocks. The pain is aggrevated by bending and sitting. You do not report any back pain.

This is speculation but by the sounds of your symptoms, you may have a recurrent disc herniation at the same location as your first herniation. The chance of that occurance is 10% in the active population.

Without significant back pain, you don’t need to think of a disc replacement or a fusion. What you need is a diagnosis. Either go back to your original surgeon or find a spine surgeon with a good reputation and ask to be looked at. You most likely need a new MRI with gadolinium (the dye that lights up scar tissue) to determine what the next step is.

Good Luck

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.

gu2002
Member

June 7, 2011 at 9:36 pm

Post count: 5

#4620

ok, thanks for the reply,
This week I will authorize an MRI to see if the problem is in the L5-S1 or elsewhere, I think it is in the same place where they performed the discectomy (L5-S1)
the pain is intermittent, and started a week ago, not down the leg, only the right buttock, I entumesimiento and burning, but intermittent, I am taking anti-inflammatory painkillers and icing I do not know if this well but it calms me.
to you, it seems if I perform, eg. swimming?
from already adradezco your time and response.
I weigh 77 kilos and my height is 1.76 meters. osea I’m at my ideal weight

thanks!!

Donald Corenman, MD, DC
Moderator

June 7, 2011 at 11:05 pm

Post count: 8660

#4622

If there is no motor weakness (calf muscles- try tip toe walking- if OK- most likely no weakness) and the pain is only a week old, there is a very good chance that physical therapy, medications and epidural injections will relieve your symptoms.

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.

gu2002
Member

August 3, 2011 at 5:32 am

Post count: 5

#4745

OK, doc, tell him that they delivered me the results of the latest NMR dated June 24, and reads as follows:
a lumbosacral spine MRI had been cut at the levels of profile and transversus. They used techniques to study tissue T1 and T2 relaxation times
the review shows:
* Tracks surgical at the level of the lower lumbar segment to correlate with a history of the patient.
* There is dehydration of the L4 – L5 disc
* Decrease in altitude and dehydration of the L5-S1 disc
* Hernia occurs posterocentral with predominantly clockwise at the L5-S1 level.
* It descends to flow occupying the right lateral recess and making contact with the nerve root on the right side
* Morphology and sign of the vertebral bodies is preserved.
* Medullary Cone and horsetail without specificities.

This is the summary of the report of the MRI and let me know if you, also believes that this can be absorbed over time, and that kind of activity can I do? According to my doctor neurologist, I have two options, wait for it to absorb or to operate on me again. you view on the subject?

Donald Corenman, MD, DC
Moderator

August 4, 2011 at 1:26 am

Post count: 8660

#4747

This MRI report was written very poetically. This indicates that the “tracks” are the surgical scar tract that is always visualized after a lumbar spine surgery. The L4-5 disc has some degenerative changes. The L5-S1 disc where the previous surgery occurred obviously has some degenerative changes and the “altitude” changes are the narrowing of the disc space after the herniation.

There apparently is a recurrent herniation at that level that causes some compression of the S1 nerve root in the lateral recess.

Your doctor is correct. Without motor weakness, you have two options: to wait or to have surgery. This is a value judgement that only you can address. Benefits of waiting are that you avoid another surgery and the benefits of surgery are that a direct decompression of the nerve root has a good chance to give you relief of your buttocks pain.

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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