New symptoms, L5 stenosis

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Libby
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December 11, 2018 at 12:02 am

Post count: 3

#29867

Dr. Corenman,
Thank you for all the information on your website. I’m so glad I found you!
I hope you can offer me some direction.
I’m a 44 year old female, 5′ 7″, 160 lbs. I have a lumber scoliosis and a history of chronic lumbar back pain (>20 years). I have done PT in the past, no meds or surgeries.
This past week I had been in bed for 3 days straight and just beginning to improve from an Influenza-like illness. I was finally able to sit upright. I sat crosslegged for about 90 minutes painting my daughters nails. When I stood up I nearly fell to the floor because my left foot was asleep. That was two days ago. It is still numb (the lateral aspect from calf to fourth and fifth digits, maybe third too). I also have left medial calf pain. I went to ED and was r/o for DVT. I was told I irritated the tibial or peroneal nerve. I returned the next day with no improvement. My back wasn’t any worse than normal but I insisted on a MRI, knowing a previous one four years ago reported a severe L5-S1 left ganglion nerve root compression. (I have had numbness of the medial half of my left great toe for >10 years).
They would not give me my new MRI report, but told me I have a L5 stenosis. I was consulted by a general surgeon (who has been moonlighting with the Neurosurgical group for 6 months). He consulted with his staff MD. I was discharged with Prednisone, Gabapentin, referrals marked “urgent” to be seen in Neurosurgical clinic, PT, and an injection (the general surgeon wasn’t sure if it was a steroid or not, just a referral to pain clinic for the injection). The plan was I should feel better in a few days and would need surgery in 4-6 weeks. MD did not know the name of the surgery. (I’m guessing Laminotomy after reading your site). I was told if there is no improvement or there is worsening in a few days they would do the surgery sooner.
In addition to the numbness, my symptoms are a left limp, I have difficulty walking on my Left toes, and have left calf pain with every step (and now even with palpating my calf). I have difficulty walking up stairs and more difficult descending. All symptoms for the past two days. I was seen in the ED Sunday. Today (Monday) I attempted to set up my f/u appointments. My work will not let me return until I have a workability note from Neurosurgery. I’m not sure if I even can work (I am an IR and an ER Nurse). First available appointment for Neurosurgery was Dec 21st, and the injection Consult was two weeks out. With much resistance, I was able to schedule with a PA at Neurosurgery for the the 14th, and the injection Consult for the 12th. Today my lumbar back has become miserable. (no gluteal or thigh pain). Pain constant, but worse with sitting.
When trying to get these appointments moved sooner I was told “The Dr. read you MRI and you aren’t urgent”.
What I would like to know (I know it may be difficult without the MRI), based on my symptoms am I doing the right thing in advocating being seen sooner. How serious is this? Should I be going back to the ED? I’m frustrating with not knowing and the increasing back pain. I feel like this is more serious than it is being treated. Everything I read on your site sounds consistent with an S1 nerve injury. I would appreciate any of your thoughts
Thank you!

Libby
Participant

December 11, 2018 at 12:28 am

Post count: 3

#29869

I also want to add that the bottom of my foot is numb, also more lateral

MRI from four years ago (They tell me the new one is very similar):
L5-S1: Severe degenerative disc space narrowing, severe left L5 ganglion compression with foraminal disc herniation extending outwards to the level of the iliolumbar ligament. No central stenosis and patent right nerve root canal. United compete lateral pars defects and grade 1 spondylolytic spondylolisthesis.
L4-L: No bulge, herniation or stenosis and patent nerve root canals. Facet joints are unremarkable.
L2-L3: Right facet degeneration herniation or central stenosis, mild right foramina encroachment by osteophyte and bulge and no neural compression or stenosis.
L1-L2: No disc herniation or central stenosis and patent nerve root canals, facet joints are normal,
T12-L1and T11-12 levels are unremarkable.

Conclusion: Left convex scoliosis with no acute fractures. Significant findings are as follows:
1. chronic grade I L5-S1 spondylolytic spondylolisthesis with large extruded left foramina herniation.
2. No central stenosis at any level
3. Mild right foraminal encroachment at L3-L4 with right -sided facet hypertrophy at L2-3 and L3-4. No exiting ganglion compression.

Libby
Participant

December 12, 2018 at 9:42 pm

Post count: 3

#29876

Update: Yesterday I received a Epidural Steroid Injection. I saw a medical spine MD today. He said I most likely will not need any surgery. The plan is PT, gabapentin, prednisone, plus the steroid injection. So far my symptoms are unchanged, and I now have radiating back pain which wasn’t there initially. The doctor said he was encouraged by the strong strength I have in my legs/feet. He did find weakness in my left foot fourth and fifth digits. Paresthesias and limp are unchanged.
My MRI report showed:

Findings: Nomenclature is based on 5 lumbar type vertebral bodies. Levoscoliosis of the lower thoracic and lumbar spine measures 30 degrees, measured from superior endplate of T11 through the inferior endplate of L4. 3 mm left lateral subluxation of L2 on L3 and 4 mm left lateral subluxation L3 on L4. Lumbar spine lordosis is maintained. Vertebral body heights are maintained Modic type II degenerative endplate changes laterally on the left at L5-S1. Bilateral pars L5 defect. No bone marrow edema. The conus tip is identified at L2. No extra spinal abnormality. The visualized portions of the bony pelvis are normal for age.

(T-12 to L5 doesn’t appear to have significant findings so I left them out)

L5-S1: Disc desiccation and moderate loss of disc space height. Bilateral pars defect and grade I anterolisthesis of L5 on S1.There is unroofing of the disc and a left foraminal disc protrusion. Mild facet arthropathy. No spinal canal stenosis. No right neural formanial stenosis. Moderate to severe left neural foraminal stenosis with deformity of the exiting L5 nerve root.
Conclusion: Bilateral pars defect and grade I anterolisthesis of L5 on S1. There is a left foraminal disc protrusion at this level contributing to moderate to severe left neural stenosis with deformity of the exiting L5 nerve root.

Does it sound like I’m on the right track with plan of care? I’d appreciate any thoughts you have.
Thank You!
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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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