New L4 L5 herniation Post op L5 s1

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dawney 1
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August 17, 2013 at 11:07 pm

Post count: 10

#9237

I am post op L5 S1 herniation with Microdisectomy, 6 weeks later L4 herniation 2 days after L5 surgery I began to have right back pain right foot pain buttocks and burning and the left leg never got better after this L5 surgery still numb, burning etc… I also had a discogram during the L5 surgery, and also had an L4 moderate disk Bulge, is it possible maybe that the disco-gram putting that needle and injecting the dye in the L4 because the Doctor checked both disks, during surgery. with the pressure of the dye in the disk could have caused the disk to push out, I had this MRI last week because of the pain on the right side which the ER doctors said was Lg amount of Inflammation on right side, since my left side of leg foot saddle pelvic is numb and pain still shoots down, I would not know the difference if it got better or not because of the new herniation now it is pressing on the L5 nerve, is it possible the pressure of this dye in an already bulging disk could cause it to blow I just cant figure how it just went 6 weeks after surgery, I walk with a limp now it has not changed I see no improvement in left leg but now right leg is acting up. surgeon says after looking at new Mri it is not herniated it is only fluid, went for another MRI at ER they say it is herniated 2 Radiologists say it is and I will need surgery who do you believe.

Donald Corenman, MD, DC
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August 18, 2013 at 8:10 pm

Post count: 8660

#9238

Your reported history is unclear. From my understanding, your initial test was a discogram of L4-5 and L5-S1 or was it a discogram during the L5-S1 microdiscectomy? A discogram requires the patient to be awake during the test so the second possibility does not make sense

You report that the leg pain did not improve after the surgery. You do not make clear but I assume you had a left sided surgery. Do I understand that you now have right sided leg pain after the surgery as well as continued left sided pain and that this right sided pain is new?

You then had a new MRI which demonstrated right sided inflammation in the canal at L4-5. If this is true, a discogram will not cause inflammation in the canal. This could either be from a prior surgical approach or even possibly an infection.

Where is the new herniation you note? Is it at the previously operated level at left L5-S1 or is it at the L4-5 level?

After surgery, it is not uncommon to have a “fluid” buildup as surgery causes temporary fluids to form (hematoma, seroma) but a recurrent disc herniation is one of the possibilities if you did not gain initial relief from surgery.

What does your surgeon say about your new onset right leg pain and why there is inflammation in the canal at a level (L4-5 right) that was not reported to have prior surgery?

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.

dawney 1
Member

August 20, 2013 at 9:56 pm

Post count: 10

#9251

Ok I had microdisectomy at left L5 s1 on July 20th for Herniation, while the surgeon was in my back he did the discogram checking level l4 and L5 s1, 2 days later I had severe low back pain on the right I still had the pain on the left side with no change to leg and numbness on the left, the right side pain got so bad with toes tingling buttocks burning I could not walk hardly, I called the surgeon he said on phone it was just inflammation and referred pain I did not get better, so I went to pain management he ordered MRI it showed a left L4 herniation it was sent to surgeon he said it was fluid he said he did not see a herniation, so I said I would call radiologist and ask him to look again he said it is a herniation, so I got worse and went to ER just the other day and there diagnosis was Degenerative disc and joint disease of lumbar spine involving L4-L5 with prominent left subarticular zone protrusion containing and enhancing annular tear which abuts the traversing left L5 nerve root correlate for left L5 Raduculopathy. The ER doctor told me there was a lot of inflammation on the right side of disc and told me to take motrin I still have pain on the right side and left leg still numb and I still have pain on the right side with leg and buttocks that is all I can tell you I never had a herniation on right but have symptoms on right side now, The hospital told me to find another surgeon, My concern was he put the dicogram dye in both levels L4 and L5 s1 did it cause my already disc bulge at L4 to herniate and by fixing the L5 s1 level did it cause the new herniation, I did not get blood work done, and the radiologist did not mention infection possibility just inflammation on right side, I had to increase my Neurontin and taking 800mg of motrin it helps a little but without it I am in severe pain

dawney 1
Member

August 20, 2013 at 10:00 pm

Post count: 10

#9252

also the L5 s1 appears to be ok on on New MRI its the L4 that is new right after this surgery I never had a herniation at the L4 only a bulge and an annular tear at L4
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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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