lumbar puncture, hernia L5-S1,

Tagged: bilateral legs and arms numbness, spine pain, weakness

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hanzi84
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February 2, 2016 at 6:03 am

Post count: 5

#21240

I had a lumbar puncture Aug 2015. to rule out headache and dizziness. After lumbar puncture next day started totally numbness both legs and burning pain, pins needles, muscle weakness, the pain radiates to genitals, gluteal, penis, glands, buttocks. BUT my headache and light sensitivity much worse and the punctured site is painful (L3-4) and that pain is in all spine not just lumbar but up to cervical. And in my arms also have pins and needles and in the entire spine and back. The symptoms change when i walking, sitting etc. I have muscle twitching mostly in legs but in back also. The urinating started to getting weak and hard to start but not everytime. When stretch my spine or bending all the spine going to burn and legs and arms go weak and numb or pins and needles. ENG normal. Plantar reflex is hyperactive but ankle reflex is hypoactive. If I stretching my legs and arms they go totally numb and hard to move. They did an MRI and found an 5mm disc hernia centrally without nerve root compression. As symptoms went worse they did another mri 3 months after it Nov 2015. and an extruded L5-S1 disc found and totally compress the canal. After I had a surgery. Not much changed. After they do mri in Jan 2016. The mri shows a 5mm left sided scar like hernia after lumbar puncture. In Barcelona they think i have overly tense filum terminale but no tethered cord or chiari 1. Please help me to find out what is going on. I am able to send you my MRI scans via dropbox or other way too.

Donald Corenman, MD, DC
Moderator

February 2, 2016 at 10:04 am

Post count: 8660

#21241

Lumbar punctures can cause a dural leak. This is a pinhole in the membrane that keeps the CSF (cerebral spinal fluid) in with the nerves of the spine. A leak can cause a pressure drop when you stand up and cause a headache that improves with lying down. There are very rare occasions that the spinal tap can cause a sterile meningitis. This condition is diagnosed by an MRI with gadolinium and can be treated with steroids.

Other disorders can also cause this condition. You can either type in the MRI report here and I can help interpret for free or I have a service fee to read the actual MRI if you choose with a consulting phone call.

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.

hanzi84
Participant

February 2, 2016 at 12:16 pm

Post count: 5

#21244

Thank you for your quick answer. As I think in my case the mri report not enough I would like to send you my MRIs.
1. MRI: Post lumbar puncture MRI C-TH-L spine when symptoms started, Aug. 2015.
2. MRI: Control MRI when found extruded disc L5-S1, Nov. 2015
3. Post operation MRI w/ gadolinium L spine Jan 2016.
If it is good for you I prefer Dropbox or other cloud server to share dicom files. (I live in Hungary, so it can be the quickest). It is enough for me to give opinion via email, if need few screenshots.

My personal questions: Arachnoiditis? CSF leak? Epidural collections? Disc problems? Nerve root injury? Stenosis? Tight filum terminale?

How much does it cost and how can I pay?
Thank you very much, appreciate your help.

Donald Corenman, MD, DC
Moderator

February 6, 2016 at 9:35 am

Post count: 8660

#21265

I am always happy to review reports of MRIs or other imaging when posted here for free. If you want a personal review and phone consultation, I do provide this service for a fee. You can simply post the radiologist’s report of the MRI here or you can call the office to schedule a personal review.

Arachnoiditis is generally seen obviously on an MRI. CSF leak can be seen on MRI but is uncommon. Epidural collections could be the result of a CSF leak or a hematoma (a small collection of blood after the injection) which generally will resorb and disappear. Nerve root injury takes a history, physical examination and review of images to diagnose (with an occasional EMG/NCV test necessary). Stenosis is generally obvious on MRI plus X-rays. Tight filum terminale is very rare (I have seen two cases in 30 years).

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.

hanzi84
Participant

February 21, 2016 at 7:00 am

Post count: 5

#21382

Dear Dr Corenmann!

I had an mri in august last year due to bilateral leg weakness and numbness, vegetativ functional disturbation after lumbar puncutre. They found an L5-S1 disc extrusio paracentralis et posterio lateralis L5-S1, L. S. cum stenosis recessus lateralis. (Left S1 nerve root disclocated).

After 3 month they did another mri because i had bilateral patella hyperreflex, weak bilateral achilles reflex and weak bilateral dorsalflexion and Brudzinski positive, positive Laseque. They did a microdiscectomy on November, i still have burning pain in genitals, legs buttock, but in spine also. And a strange constant pressure like feeling in my left leg. Muscle twitching bilaterally my legs.

They did a post surgery mri 2 months after surgery and the almost the same disc extrusio i have and a left side scar tissue. I think the scar tissue is the cause the constant pressure in my left leg. And nothing changed. :( What do you advice Dr. Corenman? New surgery? Is the scar dangerous? Is physiotherapy enough? But I think something wrong due to lumbar puncture and not just from disc. I have the same bilateral burning feet also as before surgery but after lumbar puncture. puncture was at L3-L4. Thank you

Donald Corenman, MD, DC
Moderator

February 21, 2016 at 10:15 am

Post count: 8660

#21390

If you have the symptoms you note (“still have burning pain in genitals, legs buttock, but in spine also. And a strange constant pressure like feeling in my left leg. Muscle twitching bilaterally my legs”), you need to consider another microdiscectomy. Compression of the roots causing your symptoms is concerning. Yes-scar can cause these symptoms but your report (“almost the same disc extrusion i have”) indicates recurrent or residual herniation that is still compressing the nerves.

It is always possible that the needle caused some injury at L3-4 but that is rare. I think your nerve compression needs to be addressed.

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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