L5 - S1 DIsc Degeneration

Viewing 6 posts - 1 through 6 (of 7 total)

1 2 Next

Author

Posts
kenireland
Member

July 23, 2011 at 8:31 pm

Post count: 3

#4718

Hi Doctor,
I am a 41 year old male who has over the last year being suffering from sciatic nerve pain which was worsened to include lumbar back pain and most recently pain in the ball of the right foot. I had an MRI in March 2011, of which I have a copy on disc and can see that the L5, S1 disc looks very narrow and appears to be bulging into the nerve space. Following unsuccessful results of a long course of anti-inflammatory and nerve related drugs my consultant is now recommending an epidural injection. From my own reading about such steroid injections they are a short term fix? I have since being visiting a Chiropractor who following treatments has asked me to ice my foot and has ordered orthotics. Apart from this I have recently added stretching exercises.
I used to be a keen middle distance runner and tennis player and I have not been able to properly exercise for the past 4 months. My question is, if the orthotics help with my alignment and I get to the stage through stretching and core strengthening exercises were the pain is alleviated, should I go back running and is the disc able to repair its self over time?

Many thanks for your time.

Donald Corenman, MD, DC
Moderator

July 23, 2011 at 9:55 pm

Post count: 8660

#4719

According to your report, you have significant degenerative disc disease at L5-S1 with a “bulge” that compresses the nerve root- most likely S1. Your symptoms are lower back pain and leg pain.

In general, the symptoms of degenerative disc disease are pain in the center of the back (axial back pain) and symptoms of nerve compression are buttocks and leg pain. Pain in the sacroiliac region (off midline and slightly lower than the belt line) can originate from either cause. The percentage of back vs. leg pain is important to determine which problem needs more treatment attention. For example, if a patient had 80% low back pain and 20% leg pain, more focus would be given to the disc and if reversed (80% leg pain)- more focus would be to the nerve root compression. This is important with the focus of surgery also.

An epidural steroid injection can be very helpful. In some patients, this injection will yield some permanent relief but in others, only temporary relief. It is certainly worth a try. The injection should be used in conjuntion with further physical therapy as a breakthough can occasionally be made.

Orthotics will help the foot and the knee alignment but most likely be ineffective with lower back pain. The disc is avascular, so there is no chance of healing the degeneration but even so, can become less painful with treatment over time. Think in terms of management and not cure.

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.

kenireland
Member

July 25, 2011 at 7:20 am

Post count: 3

#4723

Dear Dr Coreman,

Thank you for your response, the pain in my lower back is as you describe, but has lessened considerably since I stoped running and commenced treatment. The back pain is at its worst first thing in the morning and when I am sitting for long periods of time. There is no pain in the buttocks or leg anymore, but the pain in the ball of my right foot continues and is the more severe most constant pain. So, I understand that nerve root compression is causing this and would hope that the Orthotics will help with this foot pain?

As there is no chance of healing the degeneration of the disc,should I discontinue running, even on grass? Is playing tennis likelly to make it worse over time? Would swiming and gym work using light weights and a back support be a better alternative?

I would like to continue with some kind of long term exercise regime. I would assume losing weight, may also help and think regular exercise of some kind is important.

Many thanks.

Donald Corenman, MD, DC
Moderator

July 25, 2011 at 10:19 am

Post count: 8660

#4724

Severe constant pain in the ball of the foot could be from a number of sources. If the pain does not change with position of the spine, it may not be generated from the spine. However, if you get an epidural and the toe pain is relieved for three hours, then most likely the pain is generated by the spine. If the pain is constant and spine generated, it might be chronic radiculopathy (see website).

Toe pain could also be from compression of a peripheral nerve in the knee or foot or even arthritis of the toe.

The disc pain can get better with therapy and activity modification. You may have to give up running if the pain is spine generated however it is hard to say without knowing your situation personally. Cycling, hiking and swimming would be better activities for the spine with less force generated to the discs.

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.

kenireland
Member

July 25, 2011 at 6:20 pm

Post count: 3

#4726

Dear Dr. Coreman

Thank you again for this information. A feww final questions, if I manage to relieve the disc pain with treatment, will the disc at L5, S1 continue to degenerate over time regardless? degenerative disc disease would suggest this to me! “The disc is avascular”so does this mean it has no blood supply to heal? Do discs receive any fluids ot nutrients through movement? Do the cells of discs not regenerate? Are there procedures to artificcially repair a disc?

Many thanks

Donald Corenman, MD, DC
Moderator

July 25, 2011 at 9:20 pm

Post count: 8660

#4727

Yes, the disc will continue to degenerate over time but that does not mean the symptoms will continue. There are many patients with degenerative disc disease that have no pain. Remember that degeneration does not always equal pain. Yes, without blood supply, the disc will not heal. The key to disc pain is management. There are some activities that will aggrevate the back pain and need to be modified or avoided.

There are surgeries used to fuse or replace the disc. If one disc is problematic only, a fusion is a great solution. The artificial disc replacement for the lumbar spine is not ready for prime time (see website for comments) although the cervical disc replacement does have some use.

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.
Author

Posts

Viewing 6 posts - 1 through 6 (of 7 total)

1 2 Next

You must be logged in to reply to this topic.

Donald Corenman, MD, DC

Average rating:

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel

L5 – S1 DIsc Degeneration