L5-S1 again Update MRI

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SarahMay
Participant

May 22, 2014 at 3:18 am

Post count: 19

#10882

Dear Dr Corenman,
I posted here a month ago about a searing pain in my lower lumbar spine which is aggravated by vibration. You suggested that it may be IDR.I have since had an MRI.
L4-L5 Shows mild disc degeneration with an annular bulging and tear.Not compressing L5 nerve root. Mild to moderate bilateral foraminal stenosis with partial effacement of the epidural fat around L4 nerve roots but no compression.
At L5/S1 meoderate disc degeneration and endplate changes. Broad based central disc protrusion without mass effect on thecal sac or S1 roots. Lateral small disc osteophyte complexes causing moderately severe bilateral exit foraminal stenosis with near complete effacement of epidural fat around the L5 roots.

Still having PT. Back sore when sitting. Also standing or walking for a long time. It seems to tighten up. Feel like my stride is shorter when walking. Have annoying pain around sacroiliac joints and can go into top of thighs.Nerve pain into inner thigh at front on right.Get darts of nerve pain when bend to either side and having trouble squatting down.Sciatica going to ankle on and off in left hip. Pain in pubic bone also. Have scheuremans and vertebrae at cervico thoracic junction frequently flares up.
Where to next?. Three months of PT and trying to keep active and not feeling great.Persist with this?.

Donald Corenman, MD, DC
Moderator

May 27, 2014 at 9:49 pm

Post count: 8660

#10893

Most likely, you do have IDR of L5-S1 (“At L5/S1 moderate disc degeneration and endplate changes”). I have just written IDR as a new topic. Look at the website for lumbar IDR to more fully understand this disorder.

Hopefully, your physician has also discussed medications (NSAIDs and membrane stabilizers). An epidural steroid injection can sometimes be very helpful.

Finally, if nothing is helping and your impairment is not acceptable, a work-up to determine if you are a surgical candidate would be in order.

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.

SarahMay
Participant

May 29, 2014 at 4:08 am

Post count: 19

#10904

Dear Dr Corenman,
Many thanks for your reply. I read the IDR topic and found it very informative. It certainly strikes a chord with me. I have mostly been walking-an hour a day and stationary biking every second day. I have been doing water aerobic classes and have noticed my pain intensifies after these. I went to bed about four hours after the class and the pain in my hips just ignited and I had two hours of it before I could sleep. I tend to flare my sciatica too.
I am trying to stay active but is this doing more harm than good?.
Also from what I read about foraminal stenosis people get this age 50-60 years, I’m 35 and wondering if this is just going to get worse or can it settle?.
Should I see a specialist about this and if so should it be orthopaedics or neurosurgery?.
I don’t have any medications sorted yet.
I sincerely appreciate your advice.

Donald Corenman, MD, DC
Moderator

May 30, 2014 at 10:34 pm

Post count: 8660

#10911

Based upon your complaints of lower back pain, this sounds like IDR. Foraminal stenosis causes buttocks and leg pain generally with standing and walking that is relieved with sitting and forward flexion. IDR is treated with a fusion.

If you need a fusion, either a spine surgeon (an orthopedist with a fellowship in spine surgery) or a neurosurgeon should do. Just make sure you do your research and read up on this individual. All surgeons are not the same.

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.

SarahMay
Participant

July 12, 2014 at 5:49 am

Post count: 19

#11174

Hi Dr Corenman,
I went to see a neurosurgeon this week. I’m not a surgical candidate. Just said I had wear and tear-an expression I despise as it seems to belittle the fact that it is painful. I did have different sensation on the left side compared to the right. I was just told I was lucky not to be a surgical candidate and to lose weight and excercise both of which I have been doing in earnest.And that was it. Zero help to me and I’m still in pain.

Donald Corenman, MD, DC
Moderator

July 14, 2014 at 1:13 am

Post count: 8660

#11177

You might consider a second opinion from a spine surgeon-not a neurosurgeon. There are some neurosurgeons, especially “old school” types that do not consider significant back pain or severe degenerative disc disorders as surgically appropriate.

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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