Leg Pain post L4/L5/S1 spinal fusion

Tagged: Leg Pain, spinal fusion

Viewing 3 posts - 1 through 3 (of 3 total)

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joseamaya4
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November 1, 2019 at 3:35 pm

Post count: 2

#31381

Dear Dr. Corenman,

I am a 67 year old male who recently had a spinal fusion. Pre surgery I had numbness on my right foot for a year, a couple of months ago I fell down the stairs and had an Xray. Results showed a fracture on my L4 although the Dr. told me it wasn’t a result of that fall but it was an old fracture. An MRI showed severe compression of vertebral foramen between L5/S1 and he recommended L5/S1 Spine fusion as well as laminectomy. During surgery he decided to fuse L4 as well. Post surgery my recovery was going well, the numbness was completely gone and I could slowly walk without pain or anything. 15 day after the surgery I started to have pain on the outter side of my right leg near my calf. The pain subsequently got so bad that I was unable to walk sit or even be in bed without pain. My dr prescribed Lyrica at the beginning, but as the pain got worse he prescribed oral steroids. Although the steroid did relieve the pain for a while it came back even stronger so much so that I ended up in the hospital 5 weeks post surgery because of the pain, I wasn’t able to walk or sit. My Dr. then recommended to have an MRI which showed (Translation Spanish to english):

Findings: Accentuation of physiological lordosis of lumbar spine. Artifacts on the vertebral image can be identified on L4-L5-S1 in relationship with recent spinal fusion. Transpendicular rods can be identified in adequate position. Lumbar vertebral bodies have adequate height, form, alignment, with small changes in lipid composition and without evidence of fractures, neoplastic or infectious lesions.
Elements of the posterior arch show a slight facet hyperthrophy, from L1-L2 until L3-L4. L4-L5 and L5-S1 can’t be evaluated because of the surgical material. Intervertebral discs L1-L2, L2-L3 and L4-L5, bulged.
Small protrusion in L3-L4 disc. L5-S1 disc can’t be evaluated because of the surgical material. The average diameter of the medular canal is 18 mm, left intersomatic space has good amplitude. Right intersomatic space can’t be evaluated due to surgical material. Medullary cone, dural sac, cauda equina and filum terminale are normal. No epidural collection can be observed. After administration of contraste material, no abnormal vascular reinforcement can be observed. Paraspinal soft tissue with residual post surgical edema, no collections or evidence of fistula.

Conclusion: Spinal Fusion hardware with transpendicular rods in L4-L5-S1 in adequate position. Surgical material limits evaluation of space, disc and canal in L5-S1. No observed intradural, epidural or soft tissue collections.

My Dr. couldn’t make an assesment because of the surgical material so he ordered a CT scan which showed (translation spanish to english):

Findings: Lumbar vertebrae have conserved height. Spinal fusion hardware with transpendicular rods and bone graft between L4-L5-S1. In L5 the rods are placed adjacent to the lateral corticospinal tract and have small protrusions in the anterior corticospinal tract, 4 mm to the right and 3.5 mm to the left. In S1 the right rod has a protrusion on the anterior corticospinal tract of 8 mm with adjacent small bone fragments. No hernias in discs from T12-L1 to L3-L4 can be observed. Limited evaluation of the canal and discs in L4-L5 and L5-S1 due to reflection of hardware. Paravertebral muscluar plains are conserved.

Conclusion: Hardware, transpendicular rods and intertransverse bone graft in L4-L5-S1. Ventral protrusion of transpendicular right rod in S1 with small adjacent bone fragments. Limited evaluation due to reflection of hardware.

After the MRI and CT scan, I had an epidural steroid injection. The next day I was still feeling lots of pain even in bed. Two days later my pain stopped and I was able to walk and sit using help of course. I was discharged from the hospital a week and a half ago and have been indicated physical therapy. Although I no longer have continuous pain, I am still unable to walk or sit by myself without having pain. I was wondering if the physical therapy is supposed to hurt this bad? I’m also starting to have symmetrical pain in my left leg and my right toe is starting to hurt as well. I called my Dr. today and told him my symptoms, he is recommending the removal of one of the S1 rods. Do you think this is a good option to aleviate pain? Thank you so much.

Best,

JoseA

joseamaya4
Participant

November 8, 2019 at 9:23 am

Post count: 2

#31404

Quick Update: I have been in the hospital for the past 5 days. I am on IV Prednisone (4mg) and a higher dose of lyrica and pain killers. My pain is virtually gone when in bed and when sitting (I couldn’t even sit). Today my Dr. told me to try and stand but I couldn’t handle the pain, it was too much. Again, when sitting or in bed there is no pain. He is thinking of surgery again. Help.

Donald Corenman, MD, DC
Moderator

November 8, 2019 at 8:30 pm

Post count: 8660

#31407

It is hard to understand the translation from Spanish to English as there are terms that don’t make sense. I’m sure this is a maltranslation as there is no corticospinal tract in the lumbar spine. This tract is part of the spinal cord and disappears below T12. “L5 the rods are placed adjacent to the lateral corticospinal tract and have small protrusions in the anterior corticospinal tract, 4 mm to the right and 3.5 mm to the left. In S1 the right rod has a protrusion on the anterior corticospinal tract of 8 mm with adjacent small bone fragments”.

A very liberal translation might indicate compression from one or more of the screws placed in the pedicles which could have breached the bone and are compressing a neve root. This would make sense if your pain is now worse than before. Can you obtain a better translation of the CT scan?

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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