MRI report of my l4-l5 Disc herniation. Thoughts?

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Jelet
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January 20, 2013 at 10:29 am

Post count: 2

#7780

Hello Doctor Corenman. First of all I am very blessed to be able to get your opinion for free online especially in this economy. I really do appreciate it. God bless you.

My question is basically, what would you guess be for most of my pain to go away to be able to sit in class in college without any pain and generally be pain free…

My current doctor thinks most of my pain will go away in a month and i can return to the gym in a month but this doesnt seem right.

here is my mri report and some photos from my mri that i took at the doctors office.

http://i271.photobucket.com/albums/jj123/Jelet1/MRI.jpg

http://i271.photobucket.com/albums/jj123/Jelet1/21AF225D-E6F7-471B-B89B-179B92B7206B-301-000000254F5D2D74.jpg

http://i271.photobucket.com/albums/jj123/Jelet1/FCD19EB9-EC60-49DC-9B30-F8E91F82E510-301-00000025553E96DB.jpg

I receive no leg pain, just a 24/7 weak lower back pain. But just recently, this morning and right now i am receiving a burning sensation in my foot. And I am now getting worried and wanted a second opinion because its hard for me to believe that in just a month i will be pain free when my back has made only a little bit of progress in healing these past 3 weeks…

I injured it on december 11th squatting in the gym and i couldnt get up. I had to call an ambulance to pick me up. But then the next day i could walk fine.

What are your thoughts, how bad does it look? When do you think most of my pain should go away ? just a guess would be appreciated.

^ actual mri pic

Donald Corenman, MD, DC
Moderator

January 20, 2013 at 8:04 pm

Post count: 8660

#7782

I have suspicion that there might be more to the MRI than what was noted. Not uncommonly, a pars or facet fracture (new or old) can be missed. The images you sent were not complete or useful for that rule-out.

Let us assume that there is nothing missed and your pain developed from this posterior annular tear and bulge. Your history is typical for this tear as squats in the gym place more stress on the annulus than just about any other gym exercise and these tears are common.

Will the tear in the back wall of the disc heal. The answer is no. However, the tear can become much less painful over time. Many professional athletes develop these tears and recover to continue with professional sports.

Don’t worry about the burning in the foot. At least based upon the two images you sent, there is no significant nerve root compression that was noted.

How long will it take before you back is not abjectly painful? Hard to say but normally it takes between one to three months. The symptoms slowly will abate but your back might seem fragile for some time. I would consider eliminating squats from your routine and when you are ready, start with much lower weights and rehab your back appropriately.

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.

Jelet
Member

January 21, 2013 at 6:32 am

Post count: 2

#7784

Thank you Doctor Corenman. I wont be squatting or deadlifting again, just not worth the risk. Also just to add, my hands feel like they are burning now.

I woke up and i had no burning for 2 hours but then i went on the couch and burning started to slowly build up. im laying flat on my back. My friend that also had a herniated disc says that its normal and actually a good thing/sign? he says it the blow flowing/circulating/healing throughout my body. but i dont think he knows what he is talking about. cant be a good thing, can it?

I will update you when most of my pain goes away when that time comes just for your curiosity purposes…

also here is the ct scan report that i got at the emergency room on the night of the accident. in case your curious

http://148bcec7bb334341cd98-2fb779bd12ec72d4612275342f2c9187.r31.cf1.rackcdn.com/b747ef205a9ba0eadacf042a574f01f2.jpg

thanks again.

Donald Corenman, MD, DC
Moderator

January 21, 2013 at 11:01 am

Post count: 8660

#7785

Your friend as you suspected is incorrect. The burning is most likely referral pain from the symptomatic annulus tear. Please let us know how long your symptoms take to abate.

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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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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