Minimal Anterolisthesis at L5-S1; Pseudo Bulge indenting thecal sac

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vidhatad
Member

February 8, 2013 at 4:50 pm

Post count: 6

#7944

Hello Dr. Corenman,

I have a particular case with all symptoms at the L5-S1. The MRI report says the following:

1. Minimal Anterolisthesis of L5 over S1 with suspicious spondylolysis on right side (there is very little slip of L5 over S1 as seen on the MRI)
2. Posterior pseudo bulge of L5-S1 disc is seen indenting the thecal sac
3. Rest of intervertebral discs appear normal
4. Mild facetal arthropathy is noted at L5-S1 level
5. Lower end of spinal cord, cauda equina and filum terminale appear normal. No abnormal pre/ paraspinal soft tissue mass seen
6. Screening images of spine reveal mild changes of cervical spine (DDD at C5-C6 and C6-C7; paracentral and lateral herniation at C6-C7 – 3 doctors described this as severe and suggested surgery; 1 suggested traction and rest – after nearly 1 month of rest there is no pain in my shoulders, back or right arm)

After nearly 2 months of rest, I have had continued numbness on the right side of thigh (thing-knee joint). Alternatively, I also get cold feeling and sometimes feelings of an electric shock in the same region. Post the rest period, the doctors asked me to start physiotherapy exercises and try to return to normal life. I have been recommended neck/ shoulder and lower back strengthening exercises. The neck strengthening and back exercises involve some flexion and some expansion exercises.

After doing the exercises for nearly 3 weeks now, lately I have started getting itching sensations in the right leg, as well as the left leg. And sometime when I sit in one place for more than 45 minutes to an hour, I believe I feel numb in my private parts. I also get a tingling sensation at time in the fingers of my left foot. Though both of these sensations go away after standing up and walking about for sometime or lying down. Also, lying down on my back gives me vibrations kind of sensation in areas of my right thigh.

However, I do not have any other problems like major pain. I also keep checking my conditions for ankle movements and foot-drop, and have no problems there as well.

I have a couple of questions:
1. Do these increasing symptoms indicate worsening of my condition, especially at L5-S1 region?
2. If so, what are my next options?
3. Is my condition warranted for a fusion surgery?
4. Does a fusion surgery at L5-S1 lead to degeneration of disc at the L4-L5 level?

My apologies for the longish post – but am quite worried about my condition.

Regards,
Vidhata Deshpande

vidhatad
Member

February 10, 2013 at 12:12 am

Post count: 6

#7953

Hello Dr. Corenman.

Since I wrote to you yesterday, some symptoms have changed/ increased. These are as below:

1. three times since yesterday, I have noticed an electric shock like sensation near my saddle area.
2. Also, I have had electric shock like pain in my left knee lateral side
3. A burning sensation near my gluteal cleft

What I am requesting from you is to understand what symptoms should I be most worried about or what would constitute a medical emergency?

Thanking you in advance.

Regards,
Vidhata

Donald Corenman, MD, DC
Moderator

February 11, 2013 at 12:16 am

Post count: 8660

#7968

There is nothing that you report in symptoms or imaging that appears to be an emergency. Your lower back most likely has an isthmic or degenerative spondylolisthesis at L5-S1 which is low grade and not compressing any neural structures (according to the report).

Your neck has a disc hernation at C6-7 which might have been causing some left arm symptoms in the past but you have recovered from that and have no upper extremity symptoms now.

The symptoms you have could be related to your spondylolisthesis but based upon the imaging report, I would agree that a good rehabilitation program would be beneficial. If these symptoms originate from your back, an epidural steroid injection might also be helpful.

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.

vidhatad
Member

February 11, 2013 at 3:33 pm

Post count: 6

#7975

Thank you for the response Dr. Corenman. It is indeed very helpful. Just a couple more questions:
1. What are the chances that a degenerative spondylisthosis can deteriorate further and become unstable?
2. While I am diligently doing all exercises for the back, from what I understand, flexion is bad for the Spondylisthesis and expansion is bad for the bulge? In any event, I have been given both in moderation. Should I continue with these?
3. How many times, in your experience, does a degenerative Spondylisthesis require a surgery, especially considering a bulge in the disc?
4. Last but not least, can somebody with my conditions remain surgery free for a long-time by just following Physiotherapy?

Thank you for your response once again.

Regards,
Vidhata

Donald Corenman, MD, DC
Moderator

February 11, 2013 at 8:20 pm

Post count: 8660

#7977

Degenerative spondylolistheses can degenerate further and become unstable but worrying about that is somewhat like worrying about getting hit by a meteor when you walk outside. It most likely will not happen but if it does, you will know it. Don’t waste your energy worrying about this possibility.

Actually, the flexion is more of a problem for the disc bulge and extension is more problematic for the slip but again, don’t be too concerned about that. Core strengthening is the key to stabilizing the spine.

I cannot tell you how many times a degenerative spondylolisthesis needs surgery as the population I see has enough symptoms to consider surgery. I have no doubts that there are many more walking around with this diagnosis who don’t even know it.

Most patients with this diagnosis do not need surgery so the answer to your last question is yes.

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.

vidhatad
Member

February 18, 2013 at 8:29 pm

Post count: 6

#8016

Thank you Dr. Corenmon. Sorry for the delayed respopnse.

Had a couple of questions on the L5-S1 bulge. Though this is currently not a major problem – however, if the bulge increases and/ or the symptoms increase, will the only surgey possible be a ‘disectomy and fusion’ or would a microdisectomy suffice? The reason I ask is I have never read any micro-disectomy and/or disectomy study about central disc herniations – most data available online seems to only cover lateral or paracentral and lateral herniations and seem to exclude patients with central disc herniations. Is this because disectomies for central herniations have no or low success?

Also, if micro-disectomies have a low success, what is the success rate (in terms of return to a close to normal life) for disectomy & fusion surgeries for central disc herniations?

Thanking you in advance for your response.

Regards,
Vidhata
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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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