Post Op L5 S1 Microdescectomy and Left and Right Decompression

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jonas
Member

October 19, 2012 at 4:19 pm

Post count: 13

#7185

I had my 3 hour Operation on 16th of July 2012 L5 S1 Microdescectomy removal of a Neural Arc and Left and Right Decompression but i now feel things didn’t go to good because i have very severe L5 back pain and alot of muscle spasms in my lowerback and walking is down to very tiny steps which get smaller and smaller until i am almost stopped
i use 2 crutches to try to walk but mostly i use a wheelchair because walking is to painful on my back and legs, my surgeon said my left nerve was almost crushed at the L5 S1 this is probably why i still carnt walk
my bowels and badder are fine thank god i was dreading anything happening to them when i had my operation
Do you think the operation failed like i do or have i got to give it more time to see the results

Donald Corenman, MD, DC
Moderator

October 19, 2012 at 9:27 pm

Post count: 8660

#7186

Please describe why you had surgery and what your initial symptoms were. Also, please describe the disorder that surgery was intended for and what the procedure was.

Removal of the neural arch can have many connotations. Did you have a spondylolisthesis and the surgery was removal of the arch? Was there instability present? Was only a small portion of the arch removed as in a microdiscectomy?

How has the surgery affected you? Were you unable to walk prior to surgery and still cannot walk or is the lack of walking ability new since the surgery? How has your life been affected since 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.

jonas
Member

October 20, 2012 at 1:25 am

Post count: 13

#7195

Thank you Dr Corenman for your speedy response
I had Surgery because my MRI Scans showed the L5/S1 Nerve was really compressed by a very Ugly looking herniated L5 Disc it was also pinching the right side as well
The surgeon wanted to do a L5 Fusion but because i smoke and find it difficult to kick the habit she decided to remove the bulging parts of the disc and decompress both sides not sure what the neural arch removal was designed to do but these were written on the notes i think she said if she removes the neural arch then anymore herniation would not give me problems because it gives the herniation more space but im not really sure if that was linked to the nerual arch removal because when i was talking to my surgeon i was extremely nervous and it was all to much to take in at the time

before surgery i did suffer from severe left side Foraminal Stenosis which you told me i had months ago you were the only one who ever explained foraminal Stenosis and how to detect it,
before surgery my walking went down hill to the point my left leg was so weak and wouldn’t move very good when trying to walk so instead of trying to put up with the slow painful walking i mainly used a wheel chair to get out and about pain free
it seemed silly to me trying to walk and in so much pain it was pointless but if i got in my wheelchair i could go anywhere pain free and faster than ever

after my operation my surgeon did say it was a very busy 3 hour operation and she did alot of work on me and the L5/S1 Nerve was almost crushed
i’m not sure if all of the neural arch was removed all i can say is i am due to see her in November so i will ask her and update you then
My Surgery hasn’t really given me any better quality of life, my mobility is still the same if not worse my left leg pain and throbbing is still the same and my lower back pain is worse than before surgery
the only thing i am happy with is the surgeon tried her best and i am not totally disabled from the waist down

My life was affected about 6 weeks after surgery because i expected so much more mobility and pain relief from this surgery but now i have been put on anti depressants and been given pain relief which blocks a good majority of the pain and i have come to terms with the condition of my back and legs and i understand that there are people out there with worse conditions than me to put up with if i cannot walk then so be it i will carry on using a wheelchair and that solves that problem
the back pain has taken up till now to sort out the best medication which suits me and does the job
so thank you Dr Corenman for all your time and i hope my experience can help other people in some way or other
i would highly recommend surgery even though it hasnt helped me yet
because if i didnt have surgery my L5/S1 Nerve would of got that crushed it would of left my leg in a more worse state i’m sure
i think my poor back and left nerve condition was hard for any surgery to correct but it was worth a try

Regards
and good luck to all future back sufferers

Jonas

Donald Corenman, MD, DC
Moderator

October 21, 2012 at 1:03 am

Post count: 8660

#7203

If you had foraminal stenosis causing nerve compression, the type of surgery does matter for effectiveness. If the foraminal stenosis is due to a disc hernation, a simple microdiscectomy can be effective. If however, the foraminal stenosis is due to angular collapse of the vertebra, a foraminotomy can be effective. However, to be effective, significant amounts of bone have to be removed to free up the nerve.

Unfortunately, most of the time, that bone originally grew into the foramen to stabilize the angular collapse. Removal of the bone to free the nerve root also destabilizes the vertebral segment and allows re-collapse and recurrence of the original symptoms after a time.

If this is the case, a TLIF fusion (see website) may be necessary to stabilize the segments and free the nerve while realigning the vertebral bodies.

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.

jonas
Member

October 21, 2012 at 5:31 pm

Post count: 13

#7209

Thank you Dr Corenman for your valued advice i feel quite reluctant to have another op because i don’t feel confident that it will give me more mobility and less pain, i tried a test which i read in one of your forums where you heel and toe 10 times with each foot my right is very responsive to movement but my left is half the speed and it burns in my hip and buttock area when i heel and toe so i take it my motor nerves are damaged i went for a very short walk to a shop yesterday which was about 100 yards from the car using my 2 crutches to stabilize me but after that i am very much in pain and my walking is back to tiny painful steps around the house
sometimes when im in the kitchen my lowerback and muscles and buttocks contract and both my legs start to shake and i feel my legs bending at the knees and my legs feel so weak i feel ive got to sit down quickly to relieve the pain and muscle contractions
once i sit in my wheelchair the pain and spasms go within 2 to 5 mins and i just finish off whatever i was doing in my wheelchair
i know im going on a bit but i just wanted you to have a clear picture of my symptoms

if i turn down a offer of another operation where do you think my mobility will be in the future will my compressed left leg become worse
over time and is it possible my lowerback could cause any bowl or bladder problems in the future

or is there any hope my symptoms could get better instead of worse
the only thing what really concerns me is bowel or bladder problems
mobility is something i can learn to adapt to

Kinds Regards
Jonas

Donald Corenman, MD, DC
Moderator

October 21, 2012 at 8:29 pm

Post count: 8660

#7213

Those tests I described for motor weakness have a caveat. If the pain prevents you from performing the tests, that may not indicate weakness as pain can inhibit the completion of the tests. A physical examination by a skilled examiner can reveal weakness that is nerve induced.

Your description of your pain leaves me to believe that you are incapacitated due to your symptoms; “i went for a very short walk to a shop yesterday which was about 100 yards from the car using my 2 crutches to stabilize me but after that i am very much in pain and my walking is back to tiny painful steps around the house”.

Bowel and bladder dysfunction due to nerve compression is very rare. The nerve that must be compressed for dysfunction is the Nervi Eregantes, a filamentous nerve in the center of the canal. It takes a very large disc herniation or severe spinal canal stenosis to injure the nerve. Foraminal stenosis should not cause this nerve injury.

Can symptoms get better without surgery? I have seen cases where the unexpected does happen but that is not the typical result. By your symptom description, you most likely will need 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.
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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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