popping in back after PT for L4-L5-S-1 fusion and decompression

Viewing 2 posts - 1 through 2 (of 2 total)

Author

Posts
lynn
Member

March 25, 2013 at 12:34 am

Post count: 1

#8248

HiDoctor,
Thank you for your site. I had surgery Dec 4. AnteriorL4-L5, S1 fusion with decompression. I have several issues with my that includes a very deformed facet joint on the left side of my lumbar spine, rapid degen disk disease, and neurological problems. I have had some nerves burned, and steroid injections. As far as my recovery from surgery, my back looked to be healing well. However, I did have agonizing nerve pain that was treated by steroid injection. This worked well, except I have almost constant pain in my left ankle..and crushing feeling. My left foot swells, burns and goes numb. This has become worse since surgery. My doctor tested for CRPS – negative after seeing how swollen my foot has been since surgery. I went of Lyrica and the symptoms seemed to resolve some, but now the swelling has come back and I also have swelling just below my knee and a lot of swelling on my low back.

Additionally, my back spasms and my spine is extremely tight, and locks at times. The PT has been working on this.

The main issue and question I have is this: Last week, after PT I got home and was in unbearable back pain. I was hunched over again (this was corrected post surgery). I called the pt office in the morning. My back was popping, I believe in the center just above my rear and maybe in the lower thoracic area. I was still hunched over. When I arrived, they worked to get some of the fluid moving up from my foot and lower leg and rubbed softly. I could not stand the back pain and had to go to the ER. Naturally my back was in spasm and very tight. I really don’t know the difference between tight and locked. I just know that I can not bend but an inch or so to the right or left.

The next day my pain doctor looked me over and suggested I call my neurosurgeon. It was now late in the afternoon on Friday. The office staff paged him. I knew popping must be something of concern by then. I got an x-ray, and my neuro doc’s asst was leaving as I was coming with the x ray. He said the radiologist would call if something was wrong. I have not heard from him this weekend…I presume nothing by not hearing from him, except that it is not life threatening.

I did not have popping on Sat. Today, I tried to slightly bend to the right and my back popped in the lower thoracic area. A minute later, I bend slightly forward, and my back popped in the center of my lower back. I am 95 percent certain it wasn’t in the deformed facet joint area. I am also still hunched over, but not as bad. I can pick up something off the ground by mid day and if I had my pain meds. Up to now, I couldn’t bend any further forward than to lay something on the bed (for example).

I was wondering, of course, what could be going on? Can one get a popping sound after an annular tear? I had three-stage threes in my lumbar that weren’t picked up on mri but by discogram only. Maybe my mid back is doing just what it always does…pain, spasm and locking. But the one pop was just above the lumbar area, and a minute later, another in the lumbar center.

If you could give me any thoughts….I would so appreciate it. My neurosurgeon is awesome and very busy in surgery. He sees pts just two days per week, and even if the x ray looks ok…I am certain something is wrong.

thank you for your time. I was a teacher until last year. I have met so many great medical personnel and I reflect in gratitude that many of us have chosen human compassion professions.

Sincerely,

Lynn

Donald Corenman, MD, DC
Moderator

March 25, 2013 at 4:07 am

Post count: 8660

#8254

Your symptoms of “constant pain in my left ankle..and crushing feeling. My left foot swells, burns and goes numb. This has become worse since surgery” fits with nerve compression or injury. An anterior surgery (ALIF) is designed to indirectly decompress any compressed nerve. It does so by “lifting up” the disc space from the front and hopefully reducing compression on the nerves in back.

This “lifting” works a large part of the time but is not fool-proof and failures of this indirect decompression are well known. The way to tell if there is or is not residual compression of the roots is with a new MRI scan.

You are still in the post-operative three month period for your back pain. The pain should be diminishing now but some patients will still have back pain at this point. Popping sounds should not be emanating from your fused areas as these areas should be immobile. Popping can originate from your sacroiliac joints or the facets above your fusion levels.

Your neurosurgeon or his assistants should have the time to go over these issues with you.

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.
Author

Posts

Viewing 2 posts - 1 through 2 (of 2 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