L5 / S1 Surgery 4 years ago MicroDisc

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arshad80
Member

August 6, 2012 at 7:26 pm

Post count: 3

#6664

Hello Dr Corenman,

Thanks for creating and maintaining this spine encyclopedia, it is definitely helping people like me living in pain.
My question, I am 32 years old i had a MicroDiscectomy surgery done in 2008 because of Sciatica L5/S1 on right leg and weakness
main reason i was over weight 232 pounds and i had very stiff muscles with undiagnosed Hypothyroid.
by the time i started taking thyroid medication it was too late and i was suffering pain for over 8 months and couldn’t work and i had to go for surgery. the surgery went successful and rehab was done for next 6 months using exercises
i changed my life style and started gym and lost my weight to 185 pounds with 6ft height and i was doing elliptical for 40 minutes every day
just 2 months ago i started weights training and on 5th of july i lift some weights around 80 pounds and i felt some thing in my back and now it has been almost a month i am on bed. I can not sit and walk for more than 10 minutes or go on elliptical for longer period then 8 minutes.
I feel wound like feeling in my lower back if i sit for more than 30 minutes
and when i walk i feel pain in my back and thighs.
if i dont take pain anti inflammatory drugs given by family doctor i have burning sensation in my both thighs more on the right side.
My MRI is on 20th of this month.
The good part is that after the 21st of july i started my lower back exercises again and i spend 30 minutes twice every day stretching and strengthening the core
and inversion 15 minutes twice every day
but this doesn’t help reduce my pain in sitting or walking or the burning sensation. The pain goes maximum to my thighs / right knee. and on the left thigh middle. I am stretching thigh front / back muscle but doesn’t help

I would like to get your advise and help?

Thanks in advance

Donald Corenman, MD, DC
Moderator

August 6, 2012 at 9:13 pm

Post count: 8660

#6665

Congratulations on your weight loss and fitness gain! This will be better for you in function and longevity over time.

In regards to your new symptoms. more likely than not you have a new tear of a disc or a recurrent disc herniation. The MRI will be revealing and then you can make decisions regarding the treatment.

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.

arshad80
Member

September 22, 2012 at 12:39 pm

Post count: 3

#6988

Hello Doctor, Thanks for your reply.
It has been almost month and half I am posting question for regarding my back.
This is my MRI Finding

L5-S1
there is an evidence of previous surgery but no evidence of recurrent disc herniation or spinal stenosis.
L4-L5
there is a degenerative disc disease with some mild disc space narrowing. there is some mild facet arthropathy. there is mild posterior vertebral spurring. there is a large posterior central disc herniation a little bit more prominent on the left than right. due to technical factors this is little bit difficult to assess but there is no obvious enhancement at this level. there does appear to be severe compression of the thecal sac and compromising of the left lateral recess and to lesser extent compromise of the right lateral recess. there is a severe spinal stenosis. the neural foramen are patent.
This is my MRI Impression
“L4-L5” there is a posterior disc herniation causing severe compromise of the spinal canal and a severe spinal stenosis.

I have been told by the NS to go for L4/l5 left Microdisectomy

PAIN:- I have pain on the left but now its gradually moving more towards the right side then left .but pain exist on both side, I have tingling sensation in both left and right but more on the right side . from front of my thigh + right big toe and heel

My question will a left Disectomy will improve the conditions on right or it is only good for left side. or what can be done to make it fix on both sides in one surgery. my NS is on vacations for three weeks i would really appreciate your suggestions.
I have started going back to Gym walking or elliptical 35 minutes and then i perform back exercises and stretches but still have pain sitting in my back and buttocks and right thigh and tingling in my legs more on the right feet while sitting and more when i lay down flat on bed.

Thanks in advance for your reply. and please also tell me how can i see you with my MRI . I live in Canada

Thanks

Donald Corenman, MD, DC
Moderator

September 22, 2012 at 8:01 pm

Post count: 8660

#6992

You have a large herniation at L4-5 that causes canal compression (stenosis) as well as nerve root compression. Your neurosurgeon has recommended a left sided microdisectomy at L4-5. Obviously, without a physical examination or reviewing the films, my information is conjecture.

If this is a standard large central disc herniation, the left sided microdiscetomy is a good choice for surgery. There are two variations of this herniation; sub-ligamentous and extruded/sequestered. The sub ligamentous variety is typical. The herniation fragments are located under the posterior longitudinal ligament. During surgery, the ligament is opened and most if not all of the herniation fragment can be removed from both sides from the left sided approach.

If the fragments are in the canal (extruded/sequestered), I still think this surgery is a good choice but there are some potential problems. Most of the time, there are two to three large fragments in the canal and these are generally visible or reachable by the left sided approach. There are rare times that these fragments are multiple and small and cannot be fully reached from the left side. Nonetheless, removing most of the fragments will debulk the nerve root compression and any small fragments “left over” are generally not symptomatic.

You can send your MRI to my office. Please call the 888 number and talk to my nurse Margaret.

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.

arshad80
Member

November 20, 2012 at 12:37 am

Post count: 3

#7456

Hi Doctor,

I spoke to Margaret on friday regarding sending my MRI, But she has asked me to get an XRAY as well for my spine, It’s going to be hard to get an XRAY now as I have already got 2 MRI’s with in last 3 months.
and my family doctor wont write it any more because it’s all Government paid in Ontario Canada. Is there any way you can look at the MRI only? and when i come over to see you in person i will get my XRAY done from there.

Thanks
Arshad

Donald Corenman, MD, DC
Moderator

November 20, 2012 at 1:36 am

Post count: 8660

#7460

I understand your dilemma with Canada’s National Health Care Service. The MRI images will be enough.

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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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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