L5S2 Back Pain

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l5s2
Member

June 11, 2012 at 6:11 pm

Post count: 4

#6349

Hello Doc,
I am suffering on back pain since May 2011 and live in Germany, Duesseldorf. I am 36 years old and my L5S2 intervertebral disk is broken.

I have attached some MRT pictures.
Do you think a DiscoGel threatment could relief me from having pains.
Especially the sciatica on the left side hurts and when I wake up from bed it always takes time to relief me from my pains. I do back swimming and physiotherapy. Especially abdominal muscles training and distension of my sciatica are my current treatments. I also had four injections on my nervs under MRT injections and serveral normal injections from my orthopredic doc.

l5s2
Member

June 11, 2012 at 6:13 pm

Post count: 4

#6350

ww.azfar.de/images/phocagallery/1_azfar-l5-s2.jpg

ww.azfar.de/images/phocagallery/2_azfar-l5-s2.jpg

ww.azfar.de/images/phocagallery/4_azfar-l5-s2.jpg
ww.azfar.de/images/phocagallery/5_azfar-l5-s2.jpg

Donald Corenman, MD, DC
Moderator

June 12, 2012 at 3:37 am

Post count: 8660

#6354

You first have to identify what your symptoms are and how these symptoms have affected your life. See the thread “How to describe symptoms” under “Conditions” to allow an accurate description of your symptoms.

You note “sciatica” but on your MRI images (which are incomplete), there is no obvious disc herniation. You might have lateral recess stenosis or foraminal stenosis but these images are not included in the ones that you had sent.

The discogel treatment is one that I have not personally investigated but I have read the manufacturers write-up. This “injection” includes a material that breaks down the nuclear proteins and this causes me some concern. Also, the mixture injected has to withstand the forces of shear, rotation and compression. What is the data to understand how this substance will respond to these forces?

Remember that the annulus has to be intact for this substance to work and most times, there are substantial tears in the annulus. I am also uncertain of the longevity of this material. Finally, what is the toxicity of this substance to nerves?

With so many questions regarding discogel, my decision is that I will not consider it on one my patients until peer reviewed longer term studies have come out.

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.

l5s2
Member

June 12, 2012 at 6:36 am

Post count: 4

#6356

What is the quality of the pain?
–> I have nerv pains in the buttocks and pain in the left leg. I feel a prickling in left calf and shinebone. I also have pain which goes to the left side of the groin.
Sometime I also have buttlocks pain on the right side but this is very irregular.

Is the pain burning, stabbing, sharp, shooting, dull, aching, electrical, gnawing or pins and needles?

–> Pain in groin is like stabbing or pins, buttlock pains are aching especially when I do special movements such as streching myl legs while lying on my back.

Does the quality of pain change with activity?

–> yes, sometime when I stand, sometimes when I sit, sometime when I lie in bed. pain increases if I sit too much at my office desk or stand too much.

Is the skin hypersensitive to touch? No

Are there associated skin changes like thickening, color change or nail changes? not to foot or lower leg

Percentage of Pain by Location:
8 to buttlocks
6 groin
4 back

How did the pain start?
I complained because of back pain last year before that I had intermittent pain at my back
Was it a gradual onset over years or was there one specific activity or injury that caused it? No really.
When did that injury occur? May 2011
Describe the activity or action that brought on the pain. Was it a lifting injury, a bike accident or did the pain onset come on gradually?

How long have the symptoms been present and have they changed in quality or intensity? For nearly one year. They are always present but sometimes I can not stand the pain or can not sit on my desk.

I hope this helps you. I am planning to create new pictures with the MRI. As soon as I have them I will post new ones.

Best,
Saad

Donald Corenman, MD, DC
Moderator

June 12, 2012 at 9:26 pm

Post count: 8660

#6360

Based upon your complaints, you have more radiculopathy (nerve pain) than lower back pain. The images you sent did not demonstrate severe nerve compression (but the images were incomplete). More complete images might lend a clue to your disorder but you also may have a neuropathy which does not originate from the lower back.

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.

l5s2
Member

June 13, 2012 at 8:05 am

Post count: 4

#6368

Hello Dr. Coreman,

please visit this site
ww.azfar.de/index.php/fotoalbum/category/4-spinal-disc

there you will find new updated pictures from my MRT diagnostics from today.

Are these new pictures better?
Regards from Germany
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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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