L5-S1 Disk Extrusion

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

Author

Posts
doug goldberg
Participant

April 10, 2013 at 7:17 am

Post count: 5

#8388

Dr. Corenman thank you for the what has to be the best resource on the internet for neck and back issues.

Im a 55 year old male, 200lbs, marathon runner. On 24 January I rolled out of bed to what felt like a giant cramp from the top of my left leg to my foot. I could barley walk or stand up. After several days I was able to limp around but had lots of left leg pain and tingling and numbness in my left foot. My Chiro diagnosed piriformis syndrome as the pain and soreness was worst in my left buttocks and hamstring. I also had a very, very sore left calf causing a pretty bad limp. On 2/15 I had an MRI of the low back which resulted in the following findings:

At L5-S1, minor buldge with a small paracentral disk extrusion and early facet arthropathy are noted. The extruded disk material extends 5-6mm caudally, slightly displaces the descending left S1 nerve root posteriorly and results in mild asymmetric effacement of the left lateral recess. There is a 5-6mm caudal extension of disk material into the left lateral recess.

I have been getting steadily better. The numbness and tingling has been gone for few weeks now. As of today I have no constant pain, my hamstring and left leg can be stretched fully without pain. I could not do that at first. Im able to walk without a limp now and I can cycle, swim and use the elliptical without pain. In fact I feel better after I do these exercises. I do have a weak left calf though as I cannot do single leg calf raises without assistance from my upper body. I dont seem to have much heel drop when toe walking. Im worried about my calf though. Do you think this will get better with time as well? Ive started an a regime of calf exercises in the hope of getting the strength back. What actions do you think I should take. Thank you so much for this board.

Donald Corenman, MD, DC
Moderator

April 10, 2013 at 5:41 pm

Post count: 8660

#8390

You have had classic findings for a disc herniation compressing the S1 nerve. For a thorough discussion of this disorder, see “Nerve injuries and recovery” on the website.

Pain, numbness and paresthesias (pins and needles) are all symptoms that can recover fully after a disc herniation without surgery. Motor weakness is another matter. It seems that the motor nerve is “tougher” than the sensory nerves (pain, proprioception, sensation) and takes more compression to make the motor nerve malfunction.

Consequently, recovery is not assured without surgery. Even with surgery, motor strength return is not guaranteed but decompression surgery (microdiscectomy) does allow the motor nerve the best chance for recovery.

No study has been published to my knowledge that indicates a “time period” before surgery will not be helpful but I assume that the more quickly the nerve is decompressed, the better chance it has for recovery.

That being said, there is no “rule” that requires surgery in the presence of motor weakness. However, if this was my leg and weakness was present in a vital motor group, I would have the root decompressed in a timely fashion.

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.

doug goldberg
Participant

April 10, 2013 at 6:48 pm

Post count: 5

#8392

Dr. Corenman thank you for the timely reply. You suggest that I may be well served by considering surgery to decompress the nerve. Although that sounds frightening to me I’m sure to consider your advice. I live in the Chicago area do you know of any reputable neuro surgeons in this area or what may be my best course of action to locate one.

Thank you again.

doug goldberg
Participant

April 11, 2013 at 10:24 am

Post count: 5

#8399

Dr. Corenman one more question is it advisable to consider steroid injections to help the nerve heal?

Donald Corenman, MD, DC
Moderator

April 11, 2013 at 7:26 pm

Post count: 8660

#8400

Steroids do not “help the nerve heal” but reduce symptoms from the sensory side (pain, numbness and paresthesias). This steroid injection makes the symptoms more tolerable but the compression itself is not “removed” so the recovery of motor strength is not affected. This symptom decrease is actually somewhat dangerous as the patient “feels better” thinking there is improvement but the compression of the motor root does not change.

If the patient has made the decision that they do not want surgery to increase the chances of motor strength recovery, then an epidural steroid injection is warranted.

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

April 11, 2013 at 8:07 pm

Post count: 8660

#8404

I do not make physician recommendations at this time. Finding a reputable spine or neurosurgeon takes some investigation. Sometimes a Google search can be effective. Word of mouth is also another way of finding a recommendation.

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 6 total)

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