Post Op L5 S1 Microdescectomy and Left and Right Decompression

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jonas
Member

October 21, 2012 at 9:17 pm

Post count: 13

#7217

Dr Corenman
Please accept a huge thank you for giving me more information about my condition and reassuring me of the bladder and bowl dysfunction i feel more confident now and don’t think fingers crossed i will get problems in that area
i will wait until November to see what the surgeon has to say about any more future operations to the Lumbar Spine area
just one more question please do you think i am doing the right thing by using a wheelchair to get about pain free or do you think i should walk as much as possible even if its so painful and slow
its extremely hard to walk even 10 steps then and after 10 steps my legs just don’t want to move my brain is telling them to move but they just slowly grind to a halt,and if there is a slight incline i have very little chance of walking up that
so thats why i stopped battling with the pain and it was taking 100 times longer to get anywhere if i stopped then rested i could walk alittle more but it was getting me so frustrated and i felt its just not practical and so physically demanding and i was puffing and panting with just trying to walk a short distance

i don’t want to give up on walking i walk as much as i can around the house but thats as much as i can cope with

what is your professional view on this Wheelchair or no Wheelchair ?

Kind Regards
Jonas

Donald Corenman, MD, DC
Moderator

October 22, 2012 at 8:11 am

Post count: 8660

#7222

The normal though about exercise is “no pain- no gain”. Your situation however is the exact opposite. The leg pain generated by standing is nerve compression pain. This should be avoided as the more time the nerve is compressed and the more severe the compression, the greater the chance of permanent injury.

You can stay cardiovascularily fit by riding a stationary bicycle. The body position for the bike is forward flexion, the exact position that opens up the nerve hole and reduces the pressure on the nerve root.

Let us know how you do with your 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 22, 2012 at 4:17 pm

Post count: 13

#7228

Dr Corenman
Once again a big thank you for your professional advise i will carry on using the wheelchair if i’m out and about this gives me my mobility back to go where ever i want pain free
i will get a exercise bike as i really want to keep my fitness up ive always been a very active person before this injury and haven’t had any problems with my weight which i might start to get if i don’t keep exercising many thanks for all your advise i will keep in touch to let you know how my talk went with the surgeon in November

Kind Regards
Jonas

jonas
Member

November 16, 2012 at 10:12 pm

Post count: 13

#7413

Hi Dr Corenman
Just a quick update ,i went to see my spinal surgeon yesterday and she said she carn’t do anything else for the lower back pain because when i had my surgery she said my lower back was in a really damaged state and no more future operations would make it any more better
i had a xray while i was there because she said i shouldn’t of had any type of physio after the operation but there was a mix up and i had several sessions of physio doing back lower back exercises
so she checked on the xrays to make sure the physio hadn’t undone anything she had put in place
i could see on the xray a big gap at the L5 area this is where she said she had decompressed and removed the neural arch
she said she could see a further slippage on the L5 which is why my leg pain has probably come back
but she said come back in 3 months time and lets see where we are at
i was in my wheelchair when i saw her and said i only use it when i have to but in the house i try to stay on my feet
so i will just after see what i’m like in the next 3 months

Thanks for all your advise in your forum it’s been a real help to understand my condition

Donald Corenman, MD, DC
Moderator

November 17, 2012 at 9:32 pm

Post count: 8660

#7423

I am confused. Lower back pain is typically generated by the discs and facets, not the nerve roots. Your surgeon decompressed the nerve but did not stabilize the vertebral segments (fusion) due to your “smoking”. The surgeon then repeated the X-rays and noted “she could see a further slippage on the L5 which is why my leg pain has probably come back”.

“Further slippage” to me means continued instability of this motion segment. This very likely could be the source of your back pain. In addition, return of your leg pain more likely than not means that this continued slip has caused further foraminal stenosis which could be the source of your leg pain.

It might be valuable to get another set of eyes to look at your images and perform a thorough evaluation. Find an experienced spine surgeon who will take the time 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.

jonas
Member

November 18, 2012 at 6:05 pm

Post count: 13

#7445

Dr Corenman,
Many Thanks for your speedy reply and experience in this field i do agree with your thoughts i felt my lower back slip 3 times in 1 day about 6 weeks after the operation i really think she should of put rods in to support that weak area on L5 but for now i will have to live with things how they are until i can get assessed i believe my surgeon is one of the best spinal surgeons in Wales UK but she does Private and NHS Surgeries but maybe because i’m not paying private i am not getting the best of her services i don’t know really it’s just my opinion
i will wait to see how i am in 3 months time and see if she comes up with any more solutions to my problem but i’m not holding out much hope because she said there was nothing more she could do to my lower spine because there is no core foundation she said

many thanks for all your advise and i will contact you in 3 months

take care and keep up your great work helping all us back sufferers

Regards
Jonas
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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.

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