physiotherapy or surgery ?

Tagged: MRI report findings leg pain

Viewing 6 posts - 1 through 6 (of 6 total)

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afnan
Participant

May 31, 2019 at 4:23 pm

Post count: 4

#30492

im a 20 yrs old student and i am suffering from sciatic nerve pain for more than 3 yrs
i fell from a swing and that was when i first felt the pain.got checkup,Dr said its just muscle damage nothing to worry about
3 years later i cannot work normally i feel pain every time i walk or sit or even lie down without body pillow
i got MRI it shows disc bulge at L5 S1 .my pain goes from my left hip thru the back of my thigh into the knees and ankle till down to my toes .i cannot even walk around the university for more than 3 minutes , i cannot sit in the class ( we have wooden furniture) without changing my posture every min and still i find it very painful getting up after class and i limp for a min or two before i walk like normal again but of-course with pain
im getting physiotherapy and needling ( i will admit that i m not getting it regularly ..sometimes i have to give it some 3-4 days gap or sometime even more)and i take a gap in therapy ..say after just 2 days of the session im back to the starting point in pain level
should i continue therapy or go for surgery?

i went to 6 doctors they all said i need surgery but physiotherapists say otherwise
should i go for surgery at this age and acc. to the symptoms i described ?
also i would like to know how long will be the duration of the rest? aftwr how many weeks can i go back to university to attend classes ( 50 mins each ..aprrox 5 classes a day..can reduce the classes if thats better)or should i take 6 months of university?

i will be really thankful for your reply ! thank you sir !

Donald Corenman, MD, DC
Moderator

June 1, 2019 at 12:21 am

Post count: 8660

#30494

Your appropriateness for surgery really depends upon your disorder that is compressing the nerve root. It would be helpful to copy and paste your MRI findings so we can discuss them here.

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.

afnan
Participant

June 2, 2019 at 12:43 pm

Post count: 4

#30498

thank you Dr for your reply

here is the MRI report :

Only T2 weighted axial and sagittal images through lumbar spine were acquired according to
departmental protocol

Clinical Indication:
Back pain

Findings

Straightening of lumbar spine noted likely due to spasm
Multilevel disc degeneration with ligamentum flavum thickening and facet arthrosis noted
Disc dehydration is seen at L5-S1 level. There is central and left paracentral disc protrusion
superimposed on diffuse disc bulge noted. The disc protrusion along with ligamentum fiavum thickening
and facet arthrosis resulting in ventral thecal indentation , mild right sided and severe left sided neural
foraminal narrowing causing compression over exiting nerve roots on left side
Patchy hyperintense signals seen in visualized osseous structures likely fatty marrow replacement
Rest of the intervertebral disc spaces are preserved
No significant disc bulge or protrusion noted at any other level causing thecal or foraminal narrowing
Vertebral bodies have normal height and alignment.
Distal spinal cord have normal morphology and signals.
Conus medullaris terminate normally at L1 level
No pre or paravertebral soft tissue abnormality seen.
owing.

Donald Corenman, MD, DC
Moderator

June 4, 2019 at 10:34 am

Post count: 8660

#30504

Your radiologist noted at L5-S1; “severe left sided neural foraminal narrowing causing compression over exiting nerve roots on left side” and “hyperintense signals seen in visualized osseous structures”. This indicates discal failure (isolated disc resorption and foraminal stenosis). I can’t teell what surgery you might need without seeing images myself. You can try a selective nerve root block to see if you can get longer term relief. See these threads for more information.

https://neckandback.com/conditions/lumbar-foraminal-stenosis-collapse/ and
https://neckandback.com/conditions/isolated-disc-resorption-lumbar-spine-idr/
https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic/

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.

afnan
Participant

June 5, 2019 at 6:38 pm

Post count: 4

#30519

i read all of the links you provided in your reply.they really helped me in understanding all the available options
i have decided to get Microdiscectomy
i was confused and scared of the surgery but after i read your article about it
i understood the procedure alot better and in depth
i am now confident with my decision

thank you so much !

Donald Corenman, MD, DC
Moderator

June 6, 2019 at 9:32 am

Post count: 8660

#30528

Keep us posted of your progress.

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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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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