ozone therapy effectiveness in L5-S1 compression Vs surgery like disce

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Jyotirmai
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September 14, 2011 at 3:22 am

Post count: 15

#4889

This is to get your kind and super specialized opinion for my case which is said to be because of disc protrusion and compression.

History: My pain on back which radiates to right leg– thig, calf and heels , first time this triggered on 2007, which was than relieved in due course of time (about two to three months) without much of the treatment treatment like exercise, physiotherapy etc. Since then I got three-four “attacks” in these 4 years which generally lasts for a month or two and get relieved by rest and little bit of exercises. Exercises were not regular….

Present issue: This time, pain is troubling me from last two months with somewhat more intensity, I have tried with some physiotherapy for two weeks and exercise but not returned normal routine life. Even in the days when there is no pain, I feel difficulty in walking and standing for more than 10-15 minutes…
O/E: SLR: R —700 ;L — 800

MRI REVEALS: MR findings are suggestive of mild retrolisthesis of L5 on S1 vertebral body with degenerative changes in L5-S1 disc with a broad-based right paracentral and foraminal protrusion. On comparison with the last MRI scan of Feb, 18,2008 there is significant interval increase in the degree of disc protrusion and compression of right lateral nerve roots.

Kindly suggest the best suitable treatment (surgical and non-surgical) for this, also please let us know if ozone therapy will be suitable for this case.

Donald Corenman, MD, DC
Moderator

September 14, 2011 at 11:15 pm

Post count: 8660

#4895

You report back and right leg pain that radiates to the heel, onset in 2007 that faded away without treatment in about three months. For the last four years you have had four “attacks” that have lasted about one to two months each.

You apparently have had another “attack” that has lasted more than two months with more intense symptoms.

The MRI was read as significant degenerative changes at L5-S1 which have advanced in the last two to three years. There is either a disc herniation or bone spur protruding into the lateral recess and foramen on the right. (Look up lateral recess stenosis and foraminal stenosis on the web site).

I assume your leg pain is worse with standing and walking and improved with sitting and bending forward. You need to identify whether your back pain or your leg pain is worse and what actions cause increased pain. If you can identify that differentiation, I can give you more information.

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.

Jyotirmai
Member

September 15, 2011 at 2:58 am

Post count: 15

#4897

Thanks for your prompt response!! You are absolutely correct my leg pain become worse when I stand or walk. I cannot stang for more than 15 minutes and walking above 70-80 Mtrs is tough.The action which causes the pain is driving car and climbing stairs. one of the reasons- this time it is aggravated becasue of climbing of stairs to 3rd floor for 15-20 days At times i get some releif when I sit. But now a days during that also i need to change posture and need to sit in curved posture. Also i can not sit for 20- 25 minutes at a strecth, without support at back. I have sent you some MRI snapshot in e-mail, i am not aware how to attach them in this forum…Also can u please throw some light on ozone therapy…Thanks!!!

Donald Corenman, MD, DC
Moderator

September 15, 2011 at 7:53 am

Post count: 8660

#4898

Most likely, you have foraminal stenosis. The foramen is the location where the nerve exits the spinal canal. Stenosis is a narrowing of this opening. The foramen narrows with spinal extension (extension occurs with standing and walking) and widens with flexion (bending forward or sitting). What most likely happened is that the herniation or bone spur that was compressing the nerve enlarged slightly and the nerve root became momentarily severely compressed. This will cause the nerve to swell and have a tighter fit within the foramen. Now, when you stand and walk, the nerve root becomes more irritated and pain results.

The treatment is a physical therapy program to start and a selective nerve root block to medicate the nerve. If that treatment is ineffective, surgery might be warranted if your pain or impairment is significant enough. Surgery might be as little as a foraminotomy or as much as a TLIF (see website).

Ozone is oxygen gas that instead of the state O2- has an extra molecule of oxygen and is O3. Ozone is highly corrosive. The extra oxygen molecule will attach to many tissues and oxidize that tissue. It is also found in a gas state. Injecting this into the body is fraught with complications and it is hard to think where this injected gas would be necessary. Injection of any gas into the body could cause an embolism which could cut off blood flow to the embolized blood vessel.

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.

Jyotirmai
Member

September 15, 2011 at 6:17 pm

Post count: 15

#4899

Thank you very much,once again for honest and accurate information!!! I was planing for ozone treatment, but now I will drop this option…
Kindly,refer my e-mail to mail ID: [email protected] with MRI film snapshot attached.
I am looking for long term solution as my age is 31 yrs.
In case of surgery, I wish this is done with expert and safe hand, I would be highly obliged if you can suggest some doctors in INDIA for this…
Thanks for your precious time !!!

Donald Corenman, MD, DC
Moderator

September 15, 2011 at 11:13 pm

Post count: 8660

#4900

I reviewed your MRI images you sent to me and you have a large right sided herniation with an extruded fragment at L5-S1 which is compressing the S1 nerve root. This nerve innervates the calf muscles among other motor groups. Please check to see if you have gastrocnemius/soleus weakness by tiptoeing across the room. If you find you cannot hold your body weight up well on your right foot, you have weakness of that muscle group.

If you have weakness, in my opinion, you need surgery. If you don’t have weakness and have tried and failed standard therapy (epidural injections and physical therapy), you would also be a candidate for surgery.

The surgery is a discectomy of the right L5-S1 level. I prefer the microdiscectomy technique but there are different techniques to perform this surgery. In the hands of a skilled surgeon, it should be a simple operation with a 90 to 95% success rate. There is a video on the web site of this operation that you can view. The recovery is generally relatively quick.

I cannot tell you what surgeon to choose in India as I do not have contacts there at this time. Word of mouth can be helpful and looking at any writings or papers that this surgeon has produced may give some insight into his thought processes.

Good luck!

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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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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