Pain Management Specialist suggests a Neuro Stimulator

Tagged: spinal stimulator

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Greg
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February 13, 2016 at 8:25 am

Post count: 29

#21326

This is my site for back problem questions and reading others issues. I have Isolated Disk Reabsorption at L5,S1. I can have one flare up one year and three the next year. I went from 2008-13 with none. Either way when I get a flare up everything stops until I get an epidural. This last one my PM doctor was unavailable for a month as he was in another state. Therefore I took three doses of Toradol per day for three days and then switched to Naproxen 600mg a day for the next seven days. Torodal is a surgical anti inflammatory prescription for pain. The strongest one available with no narcotic effect. I went through my back spasm in about the same amount of time as an epidural, just slower out of the gate. Toradol can only be taken for five days maximum as it can cause kidney damage as has happened to NFL football players that took it after games like it was candy. I also have Inguinal nerve flare ups from a mesh related Inguinal hernia repair that I had in 1997. I have to wear baggy pants with suspenders and XXL underwear if I can even wear them at times to manage the trigger points involved in that issue. Yesterday my PM doctor suggested I consider a Neurostimulator placed in the buttocks area that not only could address my IDR issue but also my Inguinal Nerves at the same time. I am assuming that somehow the Inguinal nerves are indirectly attached to the spinal nerves. He said we would start with temporary electrodes to check for placement and once the electrode placement was considered in the correct location/locations then he would place all the parts under the skin. A small electronic chip according to him. I said at this time it did not make sense as I have episodic flare ups that are not yet chronic on a day to day basis. Next year I enter the MediCare marketplace and with supplemental insurance there would be no cost. I was wondering what you thought about this Dr. Corenman? There is a mad scientist surgeon in Las Vegas that removes surgical mesh not covered by any insurance as it is considered experimental. It reads like he is “selling” the procedure and therefore I am out on that. He seems to be the surgeon for those that are at the end of their rope due to non stop chronic pain in the groin. There are only a handful of surgeons in the USA that will tackle mesh removal as the mesh has become integrated into the tissue. Some of it has to be left because it is fully sutured into the Inguinal Ligament. Damaging that Ligament would be worse than the repair.

Greg
Participant

February 13, 2016 at 8:51 am

Post count: 29

#21328

btw: Others with uncontrollable pain have had 100% success in controlling their pain in any part of the body with these modulators according to clinical phase testing. One has a communication device that allows one to control the amount of stimulation created by the electrodes in order to block the pain signals to the brain. Jerry Lewis was the first person of recognition to have one placed in his body for chronic back pain decades ago. Apparently the under skin devices have gotten much smaller to the size of a chip.

Donald Corenman, MD, DC
Moderator

February 13, 2016 at 9:53 am

Post count: 8660

#21329

We have to dissect out the two different problems and discuss them separately.

Your lower back pain, if from the IDR at L5-S1 should initially be treated with activity modification and a therapy program to focus on core strength and understanding the biomechanics of your lower back. See the section https://neckandback.com/treatments/conservative-treatment-mechanical-lower-back-disorders/ to understand that subject.

If therapy is ineffective, the next step should be consideration of a work-up to determine if you are a surgical candidate. This might include SNRBs or/and lumbar discograms. For lower back pain (LBP), the stimulators can be effective on occasion but these devices are really not designed for LBP. The stimulators are effective for nerve pain (leg pain).

The only nerve that traverses the groin (superficially) is the lateral femoral cutaneous nerve, a pure sensory nerve that when irritated causes meralgia paresthetica. I have not written about this condition yet but you can look it up on the internet. If the repair caused irritation to the deep nerves (the femoral plexus), that would be highly unusual. In either case, the nerves that enter the groin are from L1-L2 way up in the back so a stimulator would not be effective if placed in the lower back (where the L5-S1 nerves are located).

The stimulator generator is about 1/3 the size of a pack of cigarettes and would be implanted under the skin, normally around the buttocks area. It is adjustable by an external box that is place over the skin in the area of the generator.

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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