Should I consider an additional surgery?

Viewing 6 posts - 1 through 6 (of 14 total)

1 2 3 Next

Author

Posts
jayd10033
Participant

January 19, 2022 at 6:17 am

Post count: 79

#34752

Hello Doctor,

I had a far-lateral lumbar micro-discectomy earlier in 2021. As a result of that surgery I got discitis (you were very helpful on here!) and have since recovered. The low back was largely OK following that recovery, but for the past month has re-presented with both low back pain + occasional sciatic-ish pain. A new MRI was ordered, below are the results. Based on those, is an additional discectomy something I should consider or does the below not appear severe enough in your opinion? Perhaps a steroid injection first? I am unsure if steroids will do anything for impinging scar tissue. What are your thoughts? MRI results below.

Date of Exam: 01-18-2022
EXAM: MRI LUMBAR SPINE WITHOUT AND WITH CONTRAST
HISTORY: Status post lumbar discectomy 2021. Low back pain since November 2020. History of discitis.
TECHNIQUE: Magnetic resonance imaging was performed with pre and post contrast sagittal and axial Tl -weighted images, fast spin-echo proton density sagittal and axial images and fast spin-echo T2-weighted sagittal images on a 3T MRI unit.
Contrast: 15 ml- gadoterate meglumine from a 15 ml- vial.
COMPARISON: Prior MRI lumbar spine 8/24/2021
FINDINGS: Redemonstrated, moderate 1.3-4 spondylosis with disc space narrowing, chronic appearing endplate Schmorl l s nodes with nearly completely resolved, prior 1.3-4 marrow edema with minimal residual marrow edema/moderate type I degenerative endplate marrow change the posterior inferior 1.3-4 endplates.
There is enhancing fibrosis involving the anterior portion of the right 1.3-4 neural foramen and mild enhancing fibrosis within the anterior 1.3-4 epidural space.
Degree of foraminal enhancement is slightly decreased in degree.
Redemonstrated enhancing fibrosis within the right 1.3-4 neural foramen impinging upon exiting right 1.3 nerve root sheath.
Tiny, nonenhancing, inferior right foraminal 1.3-4 disc herniation is present (sagittal post gadolinium enhanced Tlweighted image 10, series 801). Stable from prior exam.
There is mild thecal sac flattening with mild bilateral facet arthropathy.
Prior, left foraminal 1.3-4 enhancing fibrosis is improved. There is mild left-sided foraminal narrowing without significant change.
There is no spinal stenosis.
Redemonstrated, 0.3 cm, grade 1 retrolisthesis 1.2-3 and 0.2 cm grade 1 retrolisthesis 1.3-4.
There are no compression fractures.
Mild, chronic, Tl 1-12 through 1.2-3 endplate Schmorl’s nodes are redemonstrated. There are no destructive marrow processes.
Conus medullaris is at T 12-1.1
There are no enhancing mass lesions, abnormal signal or abnormal enhancement involving the distal thoracic spinal cord, conus medullaris or cauda equina nerve root sheaths. There are no intraspinal or paraspinal masses.
Partially included, at Tl 2-1.1 , very small central superiorly extruded disc herniation. There is mild thecal sac flattening. There is no spinal stenosis. Stable.
At Ll -2, there are no disc herniations, significant disc bulge, spinal stenosis or foraminal narrowing.
At 1.2-3, there is uncovering of the disc by spondylolisthesis.
There is mild 1.2-3 disc bulging. There is no spinal stenosis or foraminal narrowing. There is no significant change.
At 1.4-5 and 1.5-SI, there are no disc herniations, significant disc bulge, spinal stenosis or foraminal narrowing. Stable findings.

IMPRESSION
1 . Moderate 1.3-4 spondylosis, chronic, 1.3-4 endplate Schmorl l s nodes with near complete resolution of prior 1.3-4 vertebral marrow edema, as above.
2. Slight decrease enhancing fibrosis within the right 1.3-4 neural foramen with tiny, nonenhancing, disc herniation in combination with postoperative fibrosis impinging upon the exiting right 1.3 nerve root sheath.
3. Improved, left foraminal 1.3-4 enhancing fibrosis with mild left-sided foraminal narrowing.
4. 0.3 cm, degenerative grade 1 retrolisthesis L2-3 and 0.2 cm, degenerative grade 1 retrolisthesis L3-4 without significant change.
5. Partially included, very small central Tl 2-1.1 superiorly extruded disc herniation with mild thecal sac flattening. 5 othenNise no significant interval change.

Donald Corenman, MD, DC
Moderator

January 19, 2022 at 12:46 pm

Post count: 8660

#34753

We have to differentiate your symptoms. Are they more central lower back pain or more one-sided back pain that radiates to the hip or buttocks?

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.

jayd10033
Participant

January 19, 2022 at 5:59 pm

Post count: 79

#34754

Thanks for looking.

Lower back, right side. Tingling / ache behind leg, hamstring/calf. Nothing of note on the front. Dull / persistent ache is in the same spot as pre original surgery, low back, right side.

jayd10033
Participant

January 20, 2022 at 5:06 am

Post count: 79

#34756

Just to clarify, MOST of the discomfort is confined to the lower right side of my back. I don’t have painful electric shooting pains, just occasional tingling or ache behind the right leg. The focal point remains the L3-4 area on the right.

jayd10033
Participant

January 20, 2022 at 5:06 am

Post count: 79

#34757

Just to clarify, MOST of the discomfort is confined to the lower right side of my back. I don’t have painful electric shooting pains, just occasional tingling or ache behind the right leg. The focal point remains the L3-4 area on the right.

jayd10033
Participant

January 20, 2022 at 8:54 am

Post count: 79

#34758

UPDATE: Surgeon recommended waiting if possible, but noted there is almost no good disc there following a previous microdiscectomy + discitis. The levels were almost bone on bone. He said I was a good candidate for a “spacer” + small fusion/rod. When asked why not an ADR, he said he didn’t want to perform an ADR at a level where there was an infection, especially recently as there was higher risk of uncovering/activating dormant bacterium with ADR than fusion.

What are your thoughts?
Author

Posts

Viewing 6 posts - 1 through 6 (of 14 total)

1 2 3 Next

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