L5 s1 degenerative disc

Tagged: Groin pain and leg pain with an L5-S1 disc tear

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Mcnab
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August 7, 2018 at 3:46 am

Post count: 7

#28899

Thanks again for sharing your expertise with me.
I totally follow you with the neuropathy explanation. The only thing that bothers me is that after a night of rest i feel 70% better. It is only when i stand up that my symptoms begin again.
Also when i go swimming i have almost no pain in the mentioned areas. From the moment i get out of the swimming pool and gravity increases i start having more pain again.
Also when resting and lying down my symptoms get better and i have almost no pain during nightime as you would expect with a neuropathy. It seems like something is wrong at L5 S1 or in that area.

When talking long walks my symptoms get beter and my pelvic floor starts to itch and i feel the nerve next to my tailbone ‘loosening’.
Can an si joint cause these problems because i have lots of tenderness over the l5 s1 and the si joint.
Can the psoas be causing si joint problems or is it the other way around?

Donald Corenman, MD, DC
Moderator

August 7, 2018 at 6:09 pm

Post count: 8660

#28903

Standing up aggravating symptoms could be mechanical but every other symptom fits with neuropathy. The notation “When talking long walks my symptoms get better” does not fit with ‘standing causing symptoms aggravation’.

SI joints should not cause these symptoms. Psoas disorders cause hip flexor weakness and groin 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.

Mcnab
Participant

August 7, 2018 at 10:54 pm

Post count: 7

#28907

Thanks for your explanation dr.
Maybe i expressed myself incorrect.
When standing still or sitting down my symptoms get worse, when i stay mobile my symptoms get better. When walking, first i start to get worser pain, but when walking long distances, like let say 10miles, my pains do get better.

It feels like the pain starts in the l5 s1 region but lets say about half an inch left to the spine. When twisting my torso left and right i get the shooting rectal nerve pain. At first i only had that pain, it is only later the burning feet came round.
3 days before this pains started i hurt my back by bending backwards trying to get a heavy object of me.

I will get some tests done for neuropathy and see wat comes out of that.

Thank you for your time dr.

Donald Corenman, MD, DC
Moderator

August 9, 2018 at 5:02 am

Post count: 8660

#28928

You might have a typical L5-Si disc injury with a highly sensitive nervous system but as I said before, I would be very careful in assuming that as I think there is some nerve inflammation here not explained by your lower disc injury.

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.

mcalamassi
Participant

February 24, 2021 at 2:55 pm

Post count: 1

#33650

hello doctor,
this is a very old thread but I’d like to ask something related to it.

You stated that an annular tear or disc degeneration at L5-S1 is not compatible with pain in the perineum, anus, testicles etc…..as the Pudendal nerve comes out from the sacral (s2) not the lumbar

BUT

can’t a protrusion at l5-s1….irritate (either mechanically or chemically) ALL the nerves in the cauda equina and indeed also the sacral nerves like the Pudendal ?

I have heard of people suffering from Pudendal symptoms…having annular tears in L5-S1

thanks a lot

Mcnab
Participant

February 25, 2021 at 3:10 pm

Post count: 7

#33654

Hello,

After al these years i still have the same problems. I recently had another mri and i have degenerarive disc and annular tear at l5-s1 and also a major hernia at l4-l5.

My neurosurgeon told me that in 30% of people the s2 nerve runs through S1 so to answer your question my neurosurgeon says it is possible.

I also would like to know your opinion dr. corenman.

I also have very stiff muscles in my lower back and around the back and left front of my ribs wich radiates to the si joint region and my front hip, testicles and causes penile pain when i stretch that region. Can this be related to thoracolumbar junction syndrome wich makes the quadratus lumborum and psoas verry stiff and causes my left pelvis to lock up and cause pudendal nerve symptoms? Or can this be related to my l4 l5 hernia?
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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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