lumbar puncture, hernia L5-S1,

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

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hanzi84
Participant

February 24, 2016 at 8:20 am

Post count: 5

#21413

Dear Dr.Corenman!

Thank you for your answer. Because it started after lumbar puncture, I think something wrong at L3/L4 and the hernia was seen accidentally because they did a mri L spine after lumbar puncture because the symptoms started. My case is a little bit complex because the first mri shows left L5 nerve compress but i have started bilateral symptoms. Other MRI 3 months after shows disc extrusion at L5-S1 and a surgery done. The muscles are stronger but other symptoms not changed. They did a control mri this year in january and a hernia can be seen at L5 like in the first mri and it is not clear for me it is press nerves or not and the radiologist only wrote that it is a left nerve root scar and a 5mm central protrusio and a little left dura dislocation but not wrote if there is a nerve compression or not.
I did some screenshot abot that 3 mri. I very appreciate that if you are able to see this few pictures (each is in different folder to separate) and help me to interpret my situation because neither the surgeons nor the radiologist could not decide if i need another surgery or not. OR I might have a CSF leak because of the lumbar puncture (it is hardly seen on mri I was told and to check it need a radioisotope cysternogram, or do a blood patch) and it cause a nerve root tethering. Is it passible that a CSF leak put a pressure or tether the nerves and the cauda equina nerves cannot float properly inside the dura?

The MRI screenshots can be reached here this link:

https://www.dropbox.com/sh/jezg7aqbk4u9dae/AADsw5ueY1gaxdVObxpFDMNKa?dl=0

Thank you very much Dr. Corenman.

Donald Corenman, MD, DC
Moderator

February 24, 2016 at 9:42 am

Post count: 8660

#21415

Sorry but I do not review images on this site currently but will be happy to read the radiological report and comment on this. I do review images in a consultation for a fee. You would have to contact the office if you have any interest in the consultation.

Bilateral symptoms can occur with unilateral pathology (herniation only on one side) as long as the symptoms are more intense on the herniation side.

It is possible that you developed arachnoiditis after this lumbar puncture but this would be unlikely. It is possible that you have a chronic leak but this is highly unlikely. A radioisotope cysternogram is in my opinion an unnecessary test in your case. This is a radioactive myelogram where the needle puncture is in the base of your skull-the same injection that you had in the lower back that you think started much of this but in this case, in the top of the neck.

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 24, 2016 at 10:03 am

Post count: 5

#21416

Thank you for your answer. I am interested in the consultation but I am not a USA citizen, I live in the EU, Hungary. So the only I am able now to give you dropbox link where my MRI scans are, and I pay for your review and consult via email. Is it acceptable for you?

If I have an arahcnoiditis it can be seen on MRI isnt it? I hope I have not got this because it is uncureable as I know. The problem is radiologist are not familiar with arachnoiditis and post lumbar puncture leak.

I read that (Prof. Schievink. Cedar-Sinai, L.A) 95% of the lumbar puncture leak cannot seen on normal MRI but might be cached up with MRI myelography or inversely diagnose with epidural blood patch treatment.

I forget to meantioned that they can also see a left side Bertolotti syndrome too but they dont think it can be a problem now.

What is very strange for me, if I press the punctured site and the nearby areas on my back with my fingers, my legs and genitals go numb and burning, and have hot and cold flashes. And when I sit or turn I can provoke these symptoms. Can chronic CSF leak cause that?

Donald Corenman, MD, DC
Moderator

February 24, 2016 at 11:03 am

Post count: 8660

#21418

A CSF leak that has fluid near the surface of the skin can cause the symptoms you note; “if I press the punctured site and the nearby areas on my back with my fingers, my legs and genitals go numb and burning”. However, since there was no surgery but a needle stick instead, it would be next to impossible to have such a large leak that you would have a pocket of fluid next to your skin.

I would disagree with the individual at Cedar-Sinai regarding leaks that cannot be seen. A small pinpoint leak can be seen as a pseudomeningeocele (a fluid patch above the dura-called an epidural fluid collection). Non-Visible ones are highly unusual. I would agree that a blood patch giving relief would be helpful in diagnosis.

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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