Need Help Understanding for BACK situation.

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asalafif
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September 6, 2014 at 5:13 am

Post count: 1

#11388

Hello Dr. Corenman,

First, I’d like to thank you for all you’re help in providing us the information you have. I have watched some of your videos on YouTube and I like them very much.

My name is Ali Alafif and I am 24 years old.

I have a back situation like no other I have experienced in my life. Before this back pain, I had two sore back pain’s before and they have heal in a couple of days. However, on February of 2013, I went to work after school at a store, and I lifted heavy boxes most of the day. The next day, I felt a lot of pain and couldn’t bend over to pick-up a pencil if I needed to.

At the time, I thought the pain would go away like before when I have a sore back. This did not happen, so I visited a local chiropractor for about 10 session. He helped a lot. But the back spasms would come and go. Something I did which was foolish was wrestle with my friend in July and he grabbed me in a reverse headlock and I tried to pull my head out and I strained neck and had to ice it for the next few days because it swelled up.

In August, (six months after the work injury) I decided to go to the ER, because my entire back was tender to the touch. The slightest back touch would cause me pain. They did an x-ray, and diagnosed me with muscle spasms, prescribed methocarbomal (which didn’t help), naproxen, and physical therapy, then sent me home.

The physical therapy worked in terms of me regaining my strength, and I could do push-ups, sit-up, and I have a good amount of strength in my back. However, every 2 to 3 weeks, I get bouts of back pain that are like no other pain I can describe. It lasts about 3 days. It takes a toll on me. Another problem is if I play basketball, I will be in back pain for at least 3days to 5 days. I cannot do any sport besides walking.

My life revolves on how my back feels. On May 2014, I went to get two MRIs, cervical and lumbar. the cervical Impression reads,

1. Multilevel mild spondylotic change
2. Shallow, broad-based central/left paracentral disc protrusion at C5-6 contributing to mild to moderate spinal stenosis with mild ventral cord flattening.
3. Additional multilevel mild foraminal narrowing and mild, early central canal narrowing, as detailed above.

Lumbar Impressions

Minor bulging of the L4-5 disc (1mm or less)

My current Pain medicine doctor recommends to do the epidural injections and if the doesn’t work, surgery would be consider.

My question is, do you think the epidural injection will work? From my research I have read it mostly helps those with radiating arm and/or leg pain. I have neither. Secondly, why do you think my pain has lasted a year and a half? Is it common for those like myself to heal without surgery or is surgery necessary to have a better quality of life? My quality of life is pretty bad, I can’t sit too long, stand too long, exercise too long. I think this is causing me depression to be honest, and a feeling of no relief in sight. I know I should wait until I get the epidural before considering surgery but it leaves me wondering what if the epidural injection does not work. Please provide me insight, anything will be helpful. It will be greatly appreciated. Thank you doctor for taking the time to read this, and I will keep you updated.

Best,
Ali Alafif

Donald Corenman, MD, DC
Moderator

September 8, 2014 at 12:42 am

Post count: 8660

#11393

You have provided some confusing information as it appears you have neck and lower back pain but mix these two symptoms up when you describe your pain.

I assume that your lower back is the main pain generator. Your symptoms could possibly be from the “Minor bulging of the L4-5 disc (1mm or less)” but that would be unusual. You might have a pars or facet fracture that might have been missed. I would ask the radiologist to reevaluate the films to look for this possibility. A CT scan might be necessary.

I am a fan of epidural injections. The steroid works well to reduce the inflammation of the nerve roots and this might last for some time. You would need a thorough surgical work-up before any surgical plan would be advised. Your pain generator in your lumbar spine is yet to be discovered.

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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