pain after spinal stenosis op.

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[email protected]
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June 24, 2011 at 11:44 pm

Post count: 5

#4664

Thank you very much for your answer. From your answer and your website it is obvious that you are a highly trustworthy and professional specialist.
I live in Norway and therefore it is difficult to consult you live but if I lived in US i would surely consult you.
Your advise has been very helpful to me in my decision for further operation. I will let you know the outcome.

Donald Corenman, MD, DC
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June 27, 2011 at 3:43 am

Post count: 8660

#4666

Good Luck! Please let me know how you do with the outcome of the 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.

[email protected]
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August 19, 2011 at 9:30 pm

Post count: 5

#4790

Hello again.
6 weeks ago I was at my neurosurgeon. I had had no relief in the L5 pain on the right side after injection with cortisone. I had S1 pain on the left side from the regenerated cyst.
It was decided that I should do foraminal decompression on the right L5 by removing a minor part of the facet joint. On the left side where the cyst was regenerated and irritated the S1 root it was planned to obliterate the facet joint.
Before operation a CT myelografi was performed. The myelografi showed no filling of the L5 root sheet on the right side and no filling of the L5 root sheet on the left side. On the left side the L5 root was dislocated.
Operation was planned on the 15. of august. The last week before operation I had some relief of my pain. I was able to walk 30 min. with little pain.
On the 15. of august the operation was cancelled because I was better in my pain.
My neurosurgeon would only operate if the pain is intolerable or in case of paresis.
My situation is now somewhat frustrating. I have numbness from L5 both sides and some from S1 left side. If I stand more than 5-10 min or walk I expire reduced strength in the right quadriceps.
I was very disappointed when the operation was cancelled because I had hoped to bee”cured” for my symptoms.
Would your advise concerning operation bee the same as my neurosurgeon?

Donald Corenman, MD, DC
Moderator

August 19, 2011 at 9:55 pm

Post count: 8660

#4791

You note you had an injection “with cortisone” of the L5 root on the right. We had previously discussed what sounded like foraminal stenosis of the L5-S1 level on the right. First- was this injection performed under fluoroscopy (with real time X-ray)? Fluoroscopy makes sure the medication is placed in the exact correct area.

There are normally two medications injected at the same time- a numbing medication like lidocaine as well as a steroid. If so, were you asked to determine if you obtained relief in the first three hours after the injection? This is the diagnostic window and if you did obtain relief in this three hour window, this diagnostically confirms the foraminal stenosis can be causing your pain.

The improvement in your pain prior to surgery is most likely from the effects of the steroid injection. Unfortunately, the injection was only temporarily effective and your pain returned. Your surgery was cancelled because of pain relief and if the pain has returned- most likely needs to be rescheduled.

The myelogram is somewhat confusing. The root cutoff at L5 right could be from foraminal stenosis but normally the dye won’t trace beyond the dorsal root ganglia which is in the foramen. The foraminal stenosis itself should be visible as a significant bony narrowing of the foramen. The L5 root on the left is confusing as the ganglion cyst has to be more superior to compress the L5 root. Normally, the ganglion cyst on the left will compress the S1 root only but if big enough, will compress both roots.

The planned surgery was to perform a foraminotomy on the right and a “facet obliteration” on the left. I am not sure what the surgeon means when he states a “facet obliteration”. Was he going to remove the entire facet or attempt a fusion of this facet?

The right quadriceps weakness is also confusing. The quadriceps muscle is normally innervated from L3 and occasionally L4. Both nerves are not near the L5-S1 level. Does you quad muscle become weak from a burst of pain? This would not be neurological weakness but weakness from pain inhibition and might fit with your presumed diagnosis.

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.

bnj2201
Member

August 24, 2011 at 10:37 am

Post count: 3

#4810

I have been having numbness, tingling, hurting in my legs. It used to only be my left leg but has now went to the right leg also. This has been going on for about 2 – 3 years now. More recently within the last 4 months my left arm and hand have started to become tingling numb and it feels like I have electric running through it, and now my right hand is starting to do the same. I also have periods where I get an extremely bad headache and get dizzy, and sometimes I get flushed and hot along with the headache. I had been seeing my pcp and she performed xrays, ct scans, blood work and several physicals and she couldn’t come up with much more then multiple sclerosis and wanted a lumber spine mri and refered me to a neurologist. I started seeing him in july. He ordered a brain mri w wo contrast, that came back normal then he wanted a cspine mri too which also came back normal. He said he was looking for syrinx or chiari. But never found anything. My pcp said that if it was MS the lesions would be in my lumbar spine not in the brain or cspine? I just feel as if I’m not getting any answers would love to know what you think. Keep in mind I’m 19. And I work in healthcare. And I have copies of all the mri’s
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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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