L5 S1 extruded disc

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Damcab
Member

November 11, 2012 at 5:16 am

Post count: 4

#7369

First of all i’d like to thank you for the website and this forum.
I’ll try to make my long story short.
I’m 34 years old, 80 kilos and 1.90 mt. I used to play tennis, run and, swim.
4 years ago i had a disc protusion at l5s1 level. On the left side. During this time i’ve made everything my doctor has recomended me. I have always left surgery as a last resort. But in the last 6 months the pain has become unbearable. My last mri said that i have a L5-S1 extruded left disc herniation compressing the left S1 root.
The pain goes to left buttocks and radiate down to the bottom of the foot. The pain increases in my low left back with sitting and bending forward (legs extended) and is relieved by standing and walking. I have not problems pushing my foot down or up. However i do fell it is much more easy to do this excersise with my right leg. My doctor gave me two choices. 1) microdisectomy or 2) lumbar fusion. He told me that my spine shows signs of inestability therefore doing the microdisectomy might not fix the problem. honestly having read a lot about lumbar surgery and all the problems that it could bring in the future i dont want to have a lumbar fusion unless is my last option. Therefore i am considering doing the microdisectoy snd then hope for the best.
I would apprecite if you could give me your opinion about my condition.
Thanks in advance. Damian

Donald Corenman, MD, DC
Moderator

November 11, 2012 at 7:53 am

Post count: 8660

#7371

Your history is classic for a disc herniation that the same level most likely has developed a recurrent disc herniation on top of the preexisting one.

Having a disc herniation for three plus years, most individuals have adapted to the nerve compression and the pain becomes tolerable. If the pain has significantly increased in the last six months, something must have changed. Most likely, another disc herniation had occurred at the same level in that six month period of time.

Remember that the tear in the disc wall (see website) never heals as the disc is avascular and incapable of healing. The same process that dried out the nucleus and allowed it to “flake off” and herniate the first time still occurs over time. Increased pain is most likely from a new hernation that now sits on top of the old one.

Your symptoms are typical for a herniation. The nerve is stretched over the bulge in the front of the canal. Extension (bending backwards) slackens the nerve and with less stretch, there is less pain. Bending forward tensions the nerve so more pain is generated.

You note no lower back pain of significance. Even if there was severe degenerative disc disease present, you have no symptoms from this. If that is the case, a simple microdiscectomy would be all the surgery you would need.

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.

Damcab
Member

November 14, 2012 at 9:56 pm

Post count: 4

#7402

Thanks for your kind answer.

Damcab
Member

November 29, 2012 at 6:54 pm

Post count: 4

#7498

An update on my situation. I had the microdisectomy done a week ago as the pain spread to my leg and them it got mildly numb. A severe cough triggered it. I’m now recovering from the surgery and it seems everything went well, at least is what the doctor have told me. I’m walking as much as i can, aprox 2 miles a day. I do have pain in my leg specially if i try to stretch it while i’m seat. I have read that the nerve takes time to heal and in the process it hurts. Just wondering if the pain i feel with the stretching is normal and if it is advisable to try to stretch it.
Thanks in advance
Damian

Donald Corenman, MD, DC
Moderator

November 30, 2012 at 8:23 pm

Post count: 8660

#7503

The nerve is still inflamed. The surgery removes the compression from the nerve but the nerve has to heal and this takes time. Stretching the nerve to some extent is important but you can stretch the nerve too much and irritate it. This is where the “art” of medicine comes into play.

The nerve does need to be stretched somewhat as adhesions that form during the recovery period will also be stretched, preventing the nerve from being adhered down. Too much stretch will cause increase inflammation and more nerve symptoms.

If the nerve is really “hot” in the post-operative period, I will give my patients oral steroids to reduce the inflammation. For especially symptomatic patients, I occasionally will obtain a new MRI. Hematoma or even rarely, a recurrent herniation can occur and can be dealt with accordingly.

It can take up to six months for a nerve to “calm down”.

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.

Damcab
Member

January 9, 2013 at 1:08 am

Post count: 4

#7698

Just wanted to share my recovery with Dr. Coreman and everyone that follow this forum.

6 weeks after the microdisectomy I’m feeling better every day. The nerve pain in my leg is decreasing continuosly. Sometimes it feels as if it is the same that the day before, but if I mesure it against a week before I can certainly notice the difference.

My doctor recomend me to start doing fisioteraphy to strenght my back/abs and stretch my back. Having search a lot in internet I have found a program called Mat and Upright therapeutic Exercise Program that was specially design to recover from a back micrdisectomy.

I wonder if you ever heard about this Program and the most important, if you would recomend your patiences to follow it.

Thanks in advance.
Damian
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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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