L5-S1 DISC HERNIATION, TWO BACK SURGERIES.

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Donald Corenman, MD, DC
Moderator

February 11, 2013 at 12:27 am

Post count: 8660

#7970

It sounds like you have a significantly irritable L5 or S1 nerve. It has been some time since the initial surgery and you might inquire as to the utility of a CT scan. This might help with the identification of the interbody cage (has it migrated?), the position of the pedicle screws (are they impinging on the root?) or heterotopic bone formation (bone growing where it does not belong). This scan will also define the status of the fusion at this level. If the fusion is solid at this early stage (unlikely), the screws can be removed and the nerve explored.

No reflexes in the patella or achilles tendon (knee and ankle jerk) does not concern me as long as they are uniformly equally missing.

Hopefully, the Lyrica is working for 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.

PFCRANGER
Member

February 12, 2013 at 7:50 am

Post count: 36

#7987

I will inquire about the CT scan, as far as the bone growth the newest X Ray shows non at this time. The pedicle screws are still well placed. So I will play it out for now with the PT and lyrica which is not doing to much for me. I will keep the forum up to date.

catmadni
Member

March 14, 2013 at 8:12 am

Post count: 25

#8195

Doc

Since my last post, I have had the epidural steroid injection. It has helped relieve quite a bit of the burning, stinging, twinges, etc. Lyrica also helps with these symptoms.

I am now nearly 5 months post op. My foot and calf weakness is not improved. Is it hopeless yet? You previously told me that the six month milestone would be revealing. However I assume it is a gradual recovery building up to this milestone. Would I not see some incremental improvement by now if I was on some path to recovering strength?

Thanks again for your generosity.

Thomas Flood
Member

March 15, 2013 at 3:30 am

Post count: 2

#8201

Good Afternoon Sir,
My name is SPC Thomas X, 28 years old of the US Army and I wanted to get your advice on the chronic lower back pain ive had for
about 4 years now and is progressivly getting worse. I am Currently seeing a Universal Pain management in Victorville CA and recieving several methods that arnt seeming to work. Ive done the nerve blocks, the epidural steriod injections, and therapy for 6 months, all without any relief. The only thing that concerns me is that my MRI only shows 4 penetrating disc’s in the L5-S1 i believe…(about 3 CM long-and it seems like its not a very important thing to them). And obviously DDD. Im sure some of this is Genetic because my dad had to have surgery, and my brother is going through the same thing i am right now. I know that jumping out of Airplanes, getting blown up ect ect from being a soldier has done somthing severerly wrong to my back, because i have to walk on a cane now …and there’s times were i can barely move, if at all. (Even with the medication im on). I just want to know what would you do, or how i can go about getting a treatment that works, because im honostly ready to try anything. I have to turn to you because all of the military doctor’s say its nothing, or deal with it, or “if you were in the navy Id tell you to live with it or kick you out…cause everyone has back pain”-Naval Sergeon- Or Im too young for Surgury. I just want some sound advise that’s not taking medication for the rest of my life. Thank you so much for your time Sir. I hope to hear from you soon.

Donald Corenman, MD, DC
Moderator

March 15, 2013 at 5:35 pm

Post count: 8660

#8202

I am unclear regarding your disorder. “My MRI only shows 4 penetrating disc’s in the L5-S1 i believe…(about 3 CM long” Maybe you can copy the radiologist’s report for the L5-S1 level on the forum for clarity.

You hit the nail on the head with genetics. Unfortunately, the collagen fibers that make up your annular wall (the donut wall of the jelly-filled donut) are most likely similar to your father and brother and probably contain tears that are painful. You are also correct that occupation plays a role. Getting blown up certainly would place more stress on the disc wall leading to more tears.

Normally annular tears and degenerative disc disease can be quite painful (as you are aware) but not dangerous. The standard treatment for these disorders is therapy, chiropractic, injections, medications and activity alteration. Of course in the military you cannot alter your activities but hopefully you have utilized all the other therapeutics.

You might be at a crossroads if you have had long standing lower back pain that is incapacitating and have failed the noted treatments above. Surgery can help reduce or eliminate your lower back pain but does not change your original genetic disorder. Let us say that you had a complete workup and we found that only the L5-S1 disc is the pain generator. You underwent a fusion and your pain resolved.

Now you go back to military activities and do well for some period of time. You then had another bad landing after a parachute accident and tear your L4-L5 disc wall. Your pain starts anew and you go through all the conservative measures and again are confronted with a surgical procedure. While this scenario is not highly common, it is not rare either.

I have special forces patients that return to full active duty and have no further problems but the chance is there for recurrent back injury. They have to make a decision whether to stay on full active duty, take another position in the military or retire.

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.

Donald Corenman, MD, DC
Moderator

March 15, 2013 at 5:50 pm

Post count: 8660

#8205

At least a full six months is required to understand the possibilities of regeneration of the nerve and sometimes as much as a year. Unfortunately, there is the law of declining returns. That is, the longer you go without any signs of recovery, the less chance of recovery. This does not mean that the root can still not recover but the chances are less.

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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