L5-S1 Posterior Foraminotomy Surgery 5 Weeks ago

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jcmc27281
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November 1, 2013 at 10:54 am

Post count: 4

#9737

Hello Dr. Corenman,

I recently had a L5-S1 Posterior Foraminotomy Surgery (left sided) to remove a bone spur that was compressing the L5 nerve about 5 weeks ago. I also had a C6-C7 Posterior Foraminotomy surgery at the same time. While my neck and arm pain seems to be improving, however, to this day, the only relief I’ve had from the lumbar surgery so far is the numbness/pain in my left upper outer thigh area is gone. But I still have significant numbness/tingling/pain near the left Big Toe, some of it in the plantar area. If I tap my left foot near the ankle, I can replicate a shooting electric like pain on the sole of the foot, with the pain radiating towards the Big Toe. I think they call that a positive Tinel’s Sign. My question is, can L5 nerve impingement problems display signs/symptoms similar to Tarsal Tunnel Syndrome. I feel as though I’m one of those unlucky people to have a L5 pinched nerve and a pinched nerve in the ankle/foot area at the same time. If it means anything, my foot MRI showed Tenosynovitis of the following: peroneal brevis, longus tendons, posterior tibial tendon sheath and the flexor digitorum tendon sheath.
I’ve read that tenosynovitis in the above areas can lead to Tarsal Tunnel Syndrome.

My surgeon advised me to be patient that it’s only been 5 weeks post-op and that it takes time for recovery. I feel as though I have a secondary problem of Tarsal Tunnel Syndrome that has been overlooked because of the competing symptoms from the L5 nerve impingement. To be fair, since the surgery my numbness/pain in the left upper/outer thigh has diminished.

Do you think I might have Tarsal Tunnel Syndrome as well as L5 nerve impingement? When I treat my ankle/foot with ICE and HEAT, the pain/numbness in the foot greatly diminishes, but the relief is only temporary, and there lies my frustration. Do I need to seek out a Foot Specialist or wait a bit longer as suggested by my neurosurgeon.

Thank you very much.

Donald Corenman, MD, DC
Moderator

November 13, 2013 at 10:29 pm

Post count: 8660

#9787

Tarsal tunnel syndrome (compression of the tibial nerve in the tarsal tunnel-medial side of the back of the foot-similar to carpel tunnel syndrome in the wrist) can coexist with L5 radiculopathy but would be unusual.

A positive tinel sign does indicate a possible compression at the tibila tunnel but I would still think that there is a great possibility of continued radiculopathy.

An EMG test would be useful to rule in or out tarsal tunnel syndrome but a selective nerve root block of L5 would also be helpful. As your neurosurgeon if he or she would consent to a neurological consultation with an EMG/NCV test.

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.

jcmc27281
Member

November 13, 2013 at 10:39 pm

Post count: 4

#9788

Thank you Dr. Corenman.
My neurosurgeon indicated he would order an EMG/NCV test if my foot symptoms do not improve in approx. 3 months post surgery. You indicated that Tarsal Tunnel Syndrome could co-exist with L5 radiculopathy but it would be unusual. I’m just wondering why that would be. Just curious. Thank you.

Donald Corenman, MD, DC
Moderator

November 13, 2013 at 10:46 pm

Post count: 8660

#9790

Normally, there is one overriding diagnosis that causes most of the patient’s symptoms. I would say that 90% of the time, one disorder causes all the symptoms that bring a patient into my office. You might be in the other 10%

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.

jcmc27281
Member

November 13, 2013 at 10:51 pm

Post count: 4

#9791

thank you so much……..i know how busy you are

jcmc27281
Member

December 2, 2013 at 5:30 am

Post count: 4

#9884

Hello Dr. Corenman,
Hope you’ve had a great Thanksgiving. I am approximately 10 weeks Post-OP (L5-S1 and C6-C7 Foraminotomy) now and I noticed the other day that I can’t even do one single push-up / pull-up due to pain in the left shoulder area. Prior to this, however, I was very fit and the push-ups/pull-ups were not a problem, e.g. 100 pushups was not a problem. I still have numbness and pain in my left Big Toe area still.

I’ve also started physical therapy two weeks ago. My PT and neurosurgeon both have informed me that it will take time. I’m just wondering when that TIME will be. When can I expect to be fully recovered? Is 10 weeks too soon to expect such recovery? My neurosurgeon also told me that full recovery can take up to a year or more???……I guess my question is, as a surgeon, when would you personally start considering other reasons/diagnosis for the patient’s continued symptoms.

Patience is not one of my stronger virtues, I have to admit. LOL.

Thank you.
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Donald Corenman, MD, DC

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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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