New back/leg pain

Tagged: Meralgia Paresthetica- inflammation of the lateral femoral cutaneous nerve

Viewing 6 posts - 7 through 12 (of 17 total)

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RenCurtis
Participant

December 1, 2019 at 4:02 pm

Post count: 8

#31604

Hello, Dr. Corenman. I was checking my medical records to see if there may have been more to my pre- surgery MRI concerning my L5-S1 fusion. I came across something I was not aware of and I’m wondering if it could have/did contribute to what is going on with my back now and what you think in regards to my MRI results. Granted, this test took place before my fusion surgery in April 2017. I will send this part of my record to you if I may.

Donald Corenman, MD, DC
Moderator

December 4, 2019 at 11:39 am

Post count: 8660

#31620

Very good.

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.

RenCurtis
Participant

December 30, 2019 at 9:09 pm

Post count: 8

#31836

Hello Doc, I am finally getting in for an MRI on January 2. That appointment I had was with one of the office PA-Cs. They did a 3 view X-ray and he said it looks as if the L4 had been working harder and picking up the slack from of the L5-S1 area not being able to work as hard. He suggested the spinal injections again and if I have no relief then surgery again but in the L4-L5 section. He said he doesn’t have a lot of hope with the injections working because they were not successful prior to my previous fusion but says we will still give it a try.

Donald Corenman, MD, DC
Moderator

December 30, 2019 at 11:42 pm

Post count: 8660

#31837

Injection results are inconsistent but if they work, the injection can be quite beneficial.

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.

RenCurtis
Participant

January 17, 2020 at 6:19 pm

Post count: 8

#31928

Hello Dr.Corenman,
I reviewed my MRI from January 2 with my surgeon’s PA. He said he has never seen deterioration as bad as in my spine at the L4-5 level. He said the fusion from 2 years ago looks wonderful but that the other vertebrae have deteriorated greatly. He said for the upcoming appointment for the injection, I will be receiving 2 instead of just 1. He then proceeded to tell me that I cannot go 4-6 longer without another fusion. We will be scheduling that second surgery at the end of this month.
I have my medical chart and found notes from a previous CT (dated April 2017 and my fusion was in Sept 2017) that states….. Intervertebral discs are mildly narrowed and desiccated throughout the lumbar spine. The conus ends normally at the L2 level. The conus medullaris is of normal morphology and signal intensity. Cauda equina are also of normal signal intensity and morphology with the exception of crowding due to canal stenosis as described in further detail below. T12-L1: Mild facet arthropathy, without significant narrowing. L1-L2: Mild facet arthropathy, without significant narrowing. L2-L3: Moderate facet arthropathy, without significant narrowing. L3-L4: Moderate facet arthropathy, without significant narrowing. L4-L5: Bulging annulus eccentric towards the left with moderate facet arthropathy/ligamentum flava thickening, which creates mild canal stenosis, mild right foraminal narrowing, and moderate left foraminal narrowing. L5-S1: Bulging annulus with superimposed central extrusion which migrates 1 cm below the level of the disc, and moderate facet arthropathy/ligamentum flava thickening. Constellation of findings together with above described retrolisthesis creates severe canal stenosis with pronounced crowding of the cauda equina, posterior displacement of both descending S1 nerve roots, and moderate foraminal narrowing. So now, my question…. Reading this regarding the L4-L5 and hearing how badly my back has deteriorated regarding L4-L5, would there be a significant reason why that area would not have been taken care of at the same time as the fusion of my L5-S1? I’m quite confused. It sounds to me as if that whole section needed to be fused.

Donald Corenman, MD, DC
Moderator

January 18, 2020 at 3:14 am

Post count: 8660

#31929

Unfortunately, you have the genetic version of CBS (crappy back syndrome). By the remarks of this radiologist, the L5-S1 level was very degenerative and compressive of the nerve roots (“Constellation of findings together with above described retrolisthesis creates severe canal stenosis with pronounced crowding of the cauda equina, posterior displacement of both descending S1 nerve roots, and moderate foraminal narrowing”).

Your L4-5 level was degenerative as well (“L4-L5: Bulging annulus eccentric towards the left with moderate facet arthropathy/ligamentum flava thickening, which creates mild canal stenosis, mild right foraminal narrowing, and moderate left foraminal narrowing”) but not half as bad as L5-S1.

The argument that L4-5 should have been included could have been somewhat valid but then you have to account for the degenerative changes of L2-3 and L3-4 (both “Moderate facet arthropathy, without significant narrowing”) which are already degenerative.

I don’t think it was a mistake to only initially do L5-S1 but your lower back has degenerative changes throughout the lumbar spine and you might have need to reduce stress activities to your lumbar spine due to your genetic predisposition. See https://neckandback.com/treatments/conservative-treatment-mechanical-lower-back-disorders/

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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