Mild sciatica/ ache in legs

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BlackSwan
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May 28, 2013 at 5:12 am

Post count: 10

#8753

Hi Doctor Corenman,

2 years ago I had emergency Micro D, due to left foot drop . I had a L4/L5 left fragment pinching nerve. Surgery corrected that and fragment was removed. But I still have a residua broad based 5mm disc bulge posteriorly slightly abutting thecal sac. An MRI reveals that there is extreme facet arthritis from l4-S1. Also I have scar tissue attach to left L5 nerve root which has thickened. I have full range of motion, and I have done straight leg raises (on myself) and can do them fine.

My main issue is I have a chronic low level sciatica(mostly left leg) in calf. Not much back pain. When I wake up I am fine for many hours and as day progresses it may get a bit stronger. Sometimes I only have a calf itch. Other times my legs may both ache a bit, or even my opposite right leg aching. like a deep muscular ache in legs. i rarely take meds for these issues. I try to stay active and do treadmill 5 times a week.Lying in bed will cause calf pain and if I walk on an incline it aggravates leg worse. A pillow under knees for some reason will also cause left leg pain. I was in physio for 4 months but did not get stronger or better so I stopped. It comes and goes during the week and some days I am perfectly fine. I am wondering if I should be worried or just adapt to it. Is it permanent now? Will it get worse? What do you think may be causing it? Is the ache in legs a different etiology than the calf pain and neurogenic itch in calf? Do I need more physio? Any advice please. I am fit and normal weight, age 40.

Thank you very much!!!

Donald Corenman, MD, DC
Moderator

May 28, 2013 at 9:41 am

Post count: 8660

#8754

Residual disc bulge after a microdisc surgery is not too uncommon. Either the annulus which originally tore is bulging (see anatomy to understand this concept) or a bone spur has developed (again-not uncommon) after a disc herniation.

This residual bulge can still irritate the nerve root. There is another finding which can be possibly linked to continued leg pain. “Extreme facet arthrosis” can be associated with a condition called degenerative spondylolisthesis (wee website for details). This disorder is best diagnosed with standing X-rays including flexion/extension views.

Scar tissue can also be associated with continued leg pain if this scar tethers the nerve root. Finally, there is the possibility of chronic radiculopathy (see website for description) as the cause of your pain.

In my practice, an epidural injection would be the next step. You might also try membrane stabilizers like Lyrica or Neurontin. Make sure that you keep a pain diary if you have an epidural (see website for details). If you get great but short-lived relief, you might be a candidate for another decompression.

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.

BlackSwan
Participant

May 29, 2013 at 5:35 am

Post count: 10

#8761

I am grateful for reply. This was actually my 2nd Micro D on L4/5. First was in 2000. This disc extrusion had a left sided Free fragment, and also a 14 mm x 5 mm bulge posteriorly .My surgeon calls it a bulge but both radioligists refer to it as a protrusion.The surgeon removed fragment due to foot drop, but left the residual bulge alone. I asked him and he said that I needed my disc and it wasn’t necessary to address posterior bulge and cause extra trauma. Not sure if bulge has moved over last 2 years since operation due to physical activity. I spent 4 days in hospital and when I went home I resumed light activities and went back to work within 4 weeks. Though it took me a while to feel well again.

The MRI done a few months after operation state that there is mild bilateral foramen narrowing with contact but without compression of L4 nerve roots and narrowing of lateral recess. Although now I have not had an MRI in close to 2. 5 years, I had one twice after my surgery because I thought I was In bad shape and both times my orthopaedic sent me home as he did not feel that I needed anything more than voltaren.My biggest problem is the bilateral leg aches and mild sciatica in both legs. This worries me. As I mentioned I am 40 but quite fit and exercise regularly. Physio did not make me any better after 4 months.

My GP will not allow me to have epidural injections for fear of arachnoiditis I live in Oz and we do not have spine clinics here. We have public health system and the gatekeeper is the GP.

I am wondering if it is wise just to leave things alone for time being since my sciatica is mild with little back pain. and I have full range of motion, or am I doing more harm than good?

Lastly, I am arthritic in my sacrum area. I feel things niggling around in there so I just try to be careful. I was wondering if my 5mm posterior disc protrusion was something from your perspective that I should concern myself with in terms of continuous monitoring?

Thank you.
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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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