L5-S1 DISC HERNIATION, TWO BACK SURGERIES.

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PFCRANGER
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September 25, 2012 at 3:24 am

Post count: 36

#7010

HELLO DR. CORENMAN, MY NAME IS CHRISTOPHER AND I AM A 29YR OLD POLICE OFFICER FORM NEW YORK CITY. IN MARCH OF THIS YEAR I WAS INVOLVED IN A CAR ACCIDENT WHEN MY POLICE CAR WAS HIT BY A TRACKER TRAILER. I SUFFERED A L5-S1 DISC HERNIATION( NUCLEUS PULPOSUS, COMPRESSED S1 NERVE ROOT AND SPINAL STENOSIS. THE PAIN WAS HORRIBLE RUNNING FROM MY BUTT DOWN MY RIGHT LEG, PARALYZING AT TIMES. NO PAIN MEDS I WAS GIVIEN WORKED. I SEE A NEUROSURGEON HE PREFORMED A LUMBAR LAMINECTOMY WITH DECOMPRESSION AND NEUROLYSIS. THEN ABOUT 2 WEEKS LATER THE PAIN AND ISSUES RETURNED. MRI WAS TAKEN AND SHOWED A RE-HERNIATED DISC, ANOTHER SURGERY WAS PREFORMED SAME TECHNIQUE. ITS NOW 4 WEEKS AFTER 2ND SURGERY AND THE PAIN IS HAPPENING AGAIN. HE PRESCRIBED NEUROTINE AND NOW A LIDOCAIN PATCH STILL NO RELIEF. MY QUESTION TO YOU IS, WHAT COULD THIS BE CAUSED BY? ANOTHER HERNIATED DISC ? IS A FUSION THE NEXT OPTION? AND CAN I RETURN IN YOUR OPINION TO POLICE WORK? IF I WERE TO SEE YOU WHAT WOULD YOU HAVE DONE AND WHAT WOULD YOU DO? I FEEL THAT I SHOULD GET ANOTHER MRI WHEN I SEE THE DR. FOR THE POST APPOINTMENT. THESE SURGERIES WERE PREFORMED IN JUNE AND AUGUST OF THIS YEAR. I THANK YOU FOR TAKING THE TIME TO READ MY CONCERNS TO YOU, I HAVE WATCHED YOU VIDEOS AND READ THE INFORMATION ON THE WEB SITE AND FOUND IT TO VERY INFORMATIVE. HOPE TO SPEAK WITH YOU SOON.

arboc50
Member

October 2, 2012 at 11:30 pm

Post count: 7

#7091

I’m curious about this too. It seems your question might have been missed. Maybe myself replying can bring it to the top of the list.

Thanks Doctor!

Donald Corenman, MD, DC
Moderator

October 3, 2012 at 9:26 am

Post count: 8660

#7095

You are correct. I missed this question- sorry for the delay.

You have unfortunately suffered at least one recurrent herniation and possibly two in a short period of time. I have seen this before in some patients that have come in to ask the same questions. The chance of three disc herniations in a very short period of time is remote but assuming that you have herniated yet again, that does not help you.

Three herniations on the same side at the same level normally requires a fusion of that level. The reason is that the disc can be expected to continue to herniate and the nerve root then becomes battered. These roots are relatively sensitive and repeated compression can damage the nerve permanently.

One question I have is if there is weakness of the muscles attached to this root? In my opinion, motor weakness requires a quicker response to relieve nerve compression as the motor portion of the nerve root does not heal as well as the sensory and pain portions of the nerve do.

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.

PFCRANGER
Member

October 8, 2012 at 11:25 am

Post count: 36

#7123

THANK YOU SO MUCH FOR REPLYING TO MY QUESTION. I GOT WORRIED IT WAS MISSED AS WELL.

PFCRANGER
Member

October 8, 2012 at 11:40 am

Post count: 36

#7124

Thank you very much for getting back to me I can’t really say if i am having muscle weakness, but i do know when i move the pain is paralyzing and sends a jolt of pain that feels like fire running straight down my leg. I have been experiencing other weird sensations and spasms in my foot.There are times when my leg feels weak and that it will give out. When i do my walks it become painful and sitting after awhile as well becomes painful. Usually these pains occur only within 30 min of any activity. Its become a bit discouraging because i think i should be feeling better now but i am only feeling worse then before the second surgery.

Donald Corenman, MD, DC
Moderator

October 8, 2012 at 7:21 pm

Post count: 8660

#7127

Pain with sitting and “jolts” down your leg might signal another disc herniation. There is the chance that there is no new herniation but the nerve root is still so swollen from two compressive injuries in a short period of time.

To check for motor weakness, there is a simple test you can perform yourself. Balance on one foot on the painful leg while steadying yourself on a counter or wall with your hands. Just use your hands for balance and do not support your weight with your hands. Perform ten heel raises on the painful leg. Then do the same on the non-painful leg.

Compare the ability to do these heel raises one side to the other. If you are substantially slower or cannot complete the ten raises with your painful leg, there is most likely motor weakness. Do the same test but this time, raise the ball of your foot off the floor ten time (toe raises). Compare both sides. Again, if one is substantially slower or you cannot complete ten on the painful side, there is motor weakness present.

Either the current intensity of your pain or weakness if present should warrant a new MRI. If the nerve is compressed by another herniation, surgery should be considered. If the nerve is inflamed, an epidural injection or even an oral dose of steroids might be helpful.

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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