Low Back Pain and Severe Bilateral Leg Pain

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axnmom
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January 10, 2014 at 6:32 am

Post count: 1

#10111

Firstly thank you for your time and all you do, maintaining this very informative site as well as taking the time to answer questions on this forum.

I am a 32 y/o female with near constant low back pain for approximately 3 months now. The onset occurred with a slip on the floor while mopping; I didn’t actually make impact with floor, I was able to catch myself prior. The jerking, twisting from the slip led to the pain. The back pain is a pressure, aching type of pain with frequent muscle spasms. The pain is made worse by sitting or standing for longer than a few minutes, lifting anything of significant weight, bending backwards, twisting. The pain also radiates down into bilateral buttocks and backs/sides of legs, as far as the soles of my feet, and occurs nearly constantly. The leg pain is a sharp, shooting, electrical type pain. It is worse at night. Occasionally the skin on the lateral sides of my thighs becomes hypersensitive to touch, though this only occurs at times. I also occasionally will have groin pain, though this to only occurs at times and, when it does occur, it is unilateral. The pain in my back is generally about a 5-6/10. The leg pain can ranges from 5-9 (with the 9 occuring at night).

I have noticed some muscle weakness in my legs. It is harder to go upstairs, and I am relying on the bannister to help pull myself up. Also there have been two occasions where my legs have gone out on me; once where I was getting out of bed and I felt a terrible burning pain in both thighs and knees before falling, and once where I squatted down to pick something up and was unable to rise.

I am currently taking Vicodin 5/325 PRN, Flexeril 5 at HS, Gabapentin 400 TID, and a taper of Prednisone. So far, I have received minimal relief from any of this. I am going to PT currently. I was taken out of work (I am a nurse) after I was kicked by a patient, which exacerbated my pain.

I had an MRI on 12/30/13 of lumbar spine wo contrast. The report indicates a minimal grade 1 posterior listhesis of L5 upon S1 of 1-2mm. There is degenerative disc disease at L5/S1 with narrowing of the disc space and loss of the normally seen bright T2-weighted signal intensity of this disc. The remainder of the lumbar intervertebral discs are normal in height and demonstrate normal signal intensity. The conus terminates at the L1 level and appears unremarkable. There are no prevertebral masses. Axial images reveal no compression of the thecal sac nor the neural foramina. At L5/S1, there is no spinal stenosis. There are mild degenerative changes at the facet joints. The neural foramina are patent.

What are your impressions? Thank you for any information you can give!

Donald Corenman, MD, DC
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January 11, 2014 at 4:09 pm

Post count: 8660

#10128

You have typical L5-S1 degenerative disc disease. The retrolisthesis is also normal as when the disc degenerates, it loses height. The facets are ramp shaped and will pull the upper vertebra backwards (retrolisthesis) when this height is lost.

The radiation of pain down the legs sounds to be sclerotomal pain (not nerve compression pain) unless you have substantial foraminal stenosis bilaterally which is unlikely. Sclerotomal pain is referral pain generated by bone and ligament.

You have delayed onset pain which could be from endplate fractures. When the disc fails fully and there is no shock absorption left, the endplate of the vertebra can fracture. This can cause delayed onset pain due to the inflammatory cascade. This cascade can take time to fully develop which explains the delay in dull achy pain onset.

There are other disorder that can cause these symptoms (inflammatory or metabolic neuralgias) so a good workup is necessary to determine the pain generators.

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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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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