Persistent Bilateral Leg Pain for 8 mos ..Dr's at a loss as to why

Viewing 3 posts - 1 through 3 (of 3 total)

Author

Posts
newpak
Member

July 20, 2013 at 11:06 pm

Post count: 1

#9067

Hello Dr. Corenman,

I’m hoping you can shed some light on to why I am experiencing these symptoms as my doctors are baffled as to why I am having this pain. I have categorized as per your suggestions.

Location and Quality of Pain

Bilateral upper and lower, predominantly back of legs and some cramping in front of thighs and buttock pain
Primarily a constant, tight, aching pain or soreness in both legs. Standing or sitting exacerbates pain. Sensation of fatigue.
Occasional mid to low back pain.
No skin sensitivity.
No change in colour or thickening of skin.

Percentage of Pain by Location

Currently 60% lower leg vs. 40% upper leg. Varies in location (outside of leg and back)
Nov – Feb 50% upper vs. 50% lower

Intensity of Pain

Currently on a scale of 1-10, while taking Cymbalta – 5-6
At worst – 8 without medication

Weakness

Muscles feel weakened. Tired much of the time.

Onset and Length of Time Symptoms Have Been Present

Onset of pain – November 2012
No injury. Was walking more than usual just before onset of pain
Intensity of pain has not changed but location of pain seems to vary (back to sides of legs, buttock, cramping in front of thighs)

Activities

Activity mostly limited to short walks or bike rides (20 minutes or less). Movement helps to reduce pain.
Currently pain more intense when standing vs. sitting
Not pain free during different times of day – intensity differs
Lying down with pillows under/in between knees is most comfortable position. Does not keep me up at night.
Pain intensifies when squatting, walking up stairs (do not feel discomfort going up, but when reaching top of stairs, muscles feel exhausted).

Previous Consultation & Treatment

Massage – no change
Physiotherapy – helpful with buttock pain/tightness
Acupuncture – no change
Chiropractor – Active Release – limited – some relief for buttock pain
Ice/heat (temporary 5-15 min relief), Walking, stretching
Jun 28 – Cymbalta 30 mg – Numbed pain to level of about 3-4. Could not tolerate 60 mg dosage – 3 weeks on medication pain returning to level 5-6
MRI (03/2013)– There is minimal disc degeneration of the lumbar spine. No significant disc herniations. No spinal or neuroforaminal stenosis. There is a small focal left posterolateral annular disc tear at the L5-S1 level. No neural impingement evident.
X-Ray – Lumbar vertebral body alignment and disc spaces are normal. The facet joints are normal. No fracture, dislocation or significant degenerative change is identified.
EMG & Nerve Conduction – Study is slightly abnormal and there is clear evidence of very mild peroneal compressive neuropathy at the fibular head on both sides of almost a symmetrical degree with drop in the conduction velocity on the right side from 54.3 m/s to 43.8 and on the left side from 54.7 to 41.2 m/s. These findings are consistent with compressive type peroneal neuropathy of a mild degree.

Thank you for your time. I look forward to your response.

Li

Donald Corenman, MD, DC
Moderator

July 22, 2013 at 6:42 pm

Post count: 8660

#9072

Your symptoms may not originate from the lower back. There are many other origins of these type of symptoms including peripheral neuropathy (see website), inflammatory conditions (myalgias and arthropathies) and tendonopathies (like tennis elbow).

Your slowing of the peroneal nerve signals at the knee suggest an entrapment neuropathy. The peroneal nerve goes through a tunnel at the outside of the knee and the nerve can be compressed here. Some of your symptoms could be attributable to this compression.

Contact my partner, Dr. LaPrade at my clinic for further information at (970) 476-1100.

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.

Rkhett
Member

October 9, 2013 at 3:44 am

Post count: 1

#9547

Were you able to get a diagnosis and ease your pain?
Author

Posts

Viewing 3 posts - 1 through 3 (of 3 total)

You must be logged in to reply to this topic.

Donald Corenman, MD, DC

Average rating:

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel