Nerve damage fears

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Margo
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January 18, 2012 at 8:27 pm

Post count: 12

#5399

Dear Dr Corenman,

Firstly I must say thank you for making yourself available for questions. I live in South Korea and cannot communicate with my doctor and even so through a friend interpreting I guess they just don’t tell the patient too much.

I had a numb pain in my left toe for a long time over two years when it got really bad I finally went to check it out. It is from a hyrniated disc pushing a nerve. Disc 5 and 6 in the lower back. I had this machine with 4 pads put on my back which vibrate on some nerves that helped a lot. After 3 months of that the radiating pain has completely gone but then about 2 weeeks ago I got this horrible numbness down the last fingers and side of palm on my left hand and a weakness down to my elbow. I was so afraid I did nerve damage, maybe by having that machine on a little too high I thought. The orthopedic said not to worry and this from a cervical disc also pushing on another nerve that he saw from xrays on the neck area. Well I tried not to worry but the numbness moved to my right hand again the last two fingers and side of the palm. The doctor seems still calm about it and did that pad machine thing on my neck area. I sleep very carefully on my back now with no pillow and a pillow under my knees. That made the numbeness go away but I’m still worried. Do you think I need to get an MRI. Wow they are so expensive but if you think I had better get one I will. Should I be worried? How serious is this? Now the pain in my toe is gone and also the numbness but I have to be so careful because it’s easy to come back if I bend my neck for reading or something for too long.

I look foward to hearing your advice.

Donald Corenman, MD, DC
Moderator

January 18, 2012 at 11:30 pm

Post count: 8660

#5400

Your leg symptoms were from a herniated disc in the lower back. Without motor weakness, about 70% of patients will be able to avoid surgery with appropriate care. It sounds like you had an electrical muscle stimulator or interferential current device given to you for relief. I’m not sure if the machine itself gave you relief or just time but it seems you had a good outcome from that.

You then apparently developed a disc herniation in your neck with radiculopathy but without a thorough examination and an MRI- this is speculation. The machine did not cause this potential herniation.

You report that bending your neck will cause the toe pain and numbness to return. I am confused. Has your hand pain and numbness disappeared or is that also present?

One of the most important factors is the results of a carefully performed physical examination. Did your doctor perform a thorough physical examination? Do you have any motor weakness? Do you have any long tract signs? (See website under cervical radiculopathy and myelopathy).

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.

Margo
Member

January 20, 2012 at 12:10 am

Post count: 12

#5418

Yes the numbness in my hands is gone. No bending my neck did not cause my toe pain what happened is that I started laying flat to care for my lower back but in doing that I would put two pillows under my head so I could read laying down. That is when my hand pain started. So I realized and I did not bend my neck like that again that is why the numbness stopped.

No my doctor did not give me a physical examination. The doctors here do not seem to be so concerned about being thorough. He seems convinced though that I really should not worry and I’d like to believe him because an MRI is soooo expensive.

How it stands the pain in my toe is very low now and the numbeness and weakness has gone but I am also aware the slightest wrong movement of either my neck or my lower back will bring the radiating pain back. Maybe I will cancel the MRI and if the numbness should come back then I will go ahead and proceed with the MRI. What do you think?

Donald Corenman, MD, DC
Moderator

January 20, 2012 at 12:34 am

Post count: 8660

#5419

The bottom line is that if you can live with your symptoms, you have no significant weakness of any important motor group and there is nothing dangerous about the spine (instability or such)- then you don’t need surgery. Therefore, a full work-up is not necessary.

Now- if you want relief as you can’t live with the symptoms, then a work-up is necessary which includes a complete physical examination and imaging including an MRI. Treatment would be determined based upon the findings.

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.

Margo
Member

January 20, 2012 at 5:27 pm

Post count: 12

#5423

thank you this is very helpful.

It sounds like I don’t need the MRI but I’m still worried about this numbness. I am sleeping the correct way on my back with a pillow underneath my knees and rolled up towel underneath my neck. However at different times I still get this numbness down my last two fingers to the side of the palm on my left hand. I don’t know what this coming from and I don’t know how to find out. This doctor has not suggested anything about a physical examination he just keeps saying not to worry. Do you know what this numbness could be coming from. Today as I was laying on a firm floor I wanted to see something on my computer so I lifted my little netbook computer to see it and held it up for some time when this numbness returned. This morning I slept on my side for an hour and it came back then too. The doctors just say it is from my neck cervical area or stress and not to worry but it feels strange to just ignore this numbness they do not make any suggestions to do a physical examination. I had to ask them to do the MRI but even after I get the results if I do it they will find nothing and just tell me not to worry but the numbness will not go away so I don’t know how to fix it.

Donald Corenman, MD, DC
Moderator

January 20, 2012 at 9:59 pm

Post count: 8660

#5424

You are not being consistent reporting your symptoms. You reported that “Yes the numbness in my hands is gone” and then you just stated that you have numbness in your fingers. Numbness in the fingers could be anything from peripheral nerve compression (carpel tunnel syndrome or cubital tunnel syndrome) to cord compression (myelopathy- see website).

Again, a physical examination is needed and if you see any physician that tells you nothing is wrong without performing a physical examination- find another physician.

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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