new injury, same disc?

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mikul515
Member

January 18, 2013 at 9:04 pm

Post count: 4

#7773

I had l4-5 lamenectomy/discectomy in 2003, after surgery everything was ok, except for mild pain and some discomfort..
10 yrs. later i wake up one morning with that same lightning bolt type shooting pain down the left leg..i knew something was not right.

i just got mri results whch i will not list because im not a good typist,
but there is a SEVERE BULGE L4-5, and from what it says there is alot of compression on this thecal nerve…i just started pain mgt.and discussing ways to ease the pain right now… since this has been the most informative site on the web ive come across, and to get a professionals opinion…lets start off by saying “im scared doc”..im 40 y.o. now, and not very happy about this surgery again..mostly because im not under the same insurance i had 10 yrs. ago. im in a managed care system, in ny, and im so afraid im going to get a surgeon without experience.(paranoia??)
#1) re herniated?? i thought surgery took care of this yrs. ago??
#2) anything to ease my mind, that may help with this surgery, or make the recovery time faster?

respectfully,
Michael
Staten island,N.Y

Donald Corenman, MD, DC
Moderator

January 19, 2013 at 1:11 am

Post count: 8660

#7776

You have a recurrent herniation at L4-5. This is not uncommon as the chance of recurrent herniation is about 10% in the general public.

A large recurrent herniation can create some problems that need to be addressed. Makw sure you have no motor weakness as this is the one problem that needs surgery sooner than later. If no motor weakness and no cauda equina syndrome (see website for description), then therapy, epidurals and medications can be used.

If the pain to too intense and surgery is called for, a managed care system does limit your choices of surgeons. Pick the one that has more experience, compassion and seems to “understand” what you are going through. The technical ability of the surgeon is very difficult to judge unfortunately.

It is nice to know that redo surgery is still not that difficult in good hands.

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.

mikul515
Member

January 19, 2013 at 11:25 pm

Post count: 4

#7777

thanks for the reply doctor,
i think this thing will be ok, since i dont think motor skills have been lost, i was able to walk on my heels, while pivoting my left toes in and out..so thats good, i guess..
the tough part is dealing with the pain, and im not too wild about starting the painkillers again…
Do you think this re-do surgery will be the same as my last one?(lamenectomy/discectomy)?,
ive read that the microdiscectomy pushes the muscles to the side, instead of cutting through them..maybe could be a better choice to get quicker healing time?
I do realize you are busy with everything you do, and want to thank you for you input with this, and helping so many with your experience

Donald Corenman, MD, DC
Moderator

January 20, 2013 at 8:22 am

Post count: 8660

#7778

The redo surgery should be similar to the last one. There is slightly more scar tissue and a very slight increase of the potential for a dural leak but the outcome should be as good as your first surgery.

The microdiscectomy can be performed many ways but the outcome should be the same with any technique amd the healing time should be about the same.

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.

mikul515
Member

February 10, 2013 at 3:49 am

Post count: 4

#7956

Hello again,
I finally was seen by a neurosurgeon, in which he was leaning toward screws, and rods . but first he wants another mri with gadolinium to make sure it is a re-herniated disc.(and not scar tissue)

My concerns are;
1.)can i get another discectomy to avoid such a big surgery?
2.)if the spinal fusion is necessary, is there a test to see how strong the bone is ,to make sure the screws will hold? Im a little freaked out to think the bone can crumble when putting in these screws

Donald Corenman, MD, DC
Moderator

February 10, 2013 at 5:20 am

Post count: 8660

#7957

The neurosurgeon is talking about a fusion along with the microdiscectomy. Fusion is reserved for a third time disc herniation, instability of the vertebra (degenerative or isthmic spondylolisthesis), collapse of the foramen (angulation of one vertebra on the other that causes the foramen to narrow substantially), significant lower back pain that can be determined to originate from the disc level and deformity (scoliosis).

If you have one of those, a fusion might be needed. If you do not, in my opinion, you do not need a fusion.

Even if you had osteoporosis, there are techniques to prevent the bone from “crumbling”. Bone is more resilient than you think.

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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