spondylolithesis and disc hernias

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

Author

Posts
Kathy.P
Member

January 27, 2012 at 12:04 am

Post count: 3

#5466

Hi Doctor Corenman,

I have recently been diagnosed with spondylolisthesis 05-L1 approx 50% after CT scan and X-rays . I have constant lower back pain and also pain in my left leg from top to bottom which seems to move around and intensify as the day goes on . The CT scan also showed two disc hernias according to my orthopeadiatrician. He says this is something i have had for a long time and has gradually got to this stage after giving birth 21 months ago , heavy lifting and years of gymnastics in my younger years . I am now 34 years old of British origin but now live in Greece. My doctor has put me on an NSAID but with not much releif so far . I am to return to him in 2 weeks for another consultation .
As i have to pay for all medical treatment here i need to make sure i am making the right decisions as resources are limited here in Corfu and i am considering going back to UK for further advice , i thought i might just ask a top professional like yourself if i am being guided in the right line and for some of your professional advice.

Donald Corenman, MD, DC
Moderator

January 27, 2012 at 12:28 am

Post count: 8660

#5467

Your descriptions indicate you have an isthmic spondylolisthesis of L5-S1 grade II-III. Please see the description of this disorder on the website. This disorder has been present mostly likely since you were a young teenager and has advanced in the amount of slip. The leg pain is from the foraminal stenosis associated with the isthmic spondylolisthesis (also described on the website).

The conservative treatments necessary to give your relief are physical therapy and selective nerve root blocks (again- see website). PT has to be done in the “stenosis position” (pelvis posterior rotation). At your advanced slip level (grade II-III) however, I am not convinced that conservative measures will be successful. You most likely will need surgery in the future so a trip back to England might be beneficial.

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.

Kathy.P
Member

January 29, 2012 at 7:48 pm

Post count: 3

#5473

Hi Dr Corenman,

Many thanks for your swift reply and may i just say what an amazing website you have . I am using it frequently to learn as much as possible regarding my newly found diagnosis.
So far NSAID that i have been perscribed has not offered any releif and i have constant pain from the bottom of my back , right across to my left hip,right down my left leg, from left buttock down to back of left knee and constant varying pain in front of lower left leg which often feels numb and incredibly heavy when walking. Sitting or leaning forward may offer a little releif but not alot. I have also felt the last few days an occasional pain under left arm and a light numbness , does this have anything to do with my condition ? I am eagerly waiting for my next consultation with my orthopedic (in a week and a half) as pain has me close to tears!

Many thanks once again

Kathy

Donald Corenman, MD, DC
Moderator

January 30, 2012 at 1:05 am

Post count: 8660

#5474

First- the arm pain and numbness is not related to your spondylolisthesis.

The “heaviness” of your leg is a bothersome symptom to me. Heaviness can mean motor weakness which is a problem that needs to be addressed sooner than later. The L5 nerve is the one that is compressed in your situation and if it is not generating signals to contract the muscles that your brain is demanding, this can cause permanent damage to the nerve.

The four major muscles that the L5 nerve serves are the tibialis anterior, the extensor hallicus longus (EHL) and the gluteus medius (and occasionally maximus). There are also the peroneal muscles.

To test the tibialis anterior, simply walk on your heels keeping your foot in the air (off the ground) with each step. If you note the foot does not want to stay up, further test by standing next to a counter and balancing your weight on the counter with your hands. Lift one leg up off the ground and perform ten repetitive foot raises with the other leg. Match your “good” leg to your symptomatic leg. Are they the same or is there a significant performance difference? If the symptomatic leg is much weaker, you have foot drop and a neurological motor deficit in your painful leg.

To test the gluteus medius, you need to be undressed in front of a mirror. Lift your painful leg up and watch the level of the pelvis on that side. It should RISE UP. This means the gluteus medius muscle is working on the OPPOSITE side. Then bear weight on your painful side and lift the “good” leg. The pelvis should rise up on the lifted leg side. If it drops instead of lifts- you have a positive Trendelenberg sign and a weak gluteus medius.

The extensor hallicus longus (EHL) is a small muscle on the top of your foot. It truly is important only if you are a karate expert, a soccer player, a football place kicker or a rock climber. It is the “canary in the coal mine” for the L5 nerve root. It is easy to test as it can be overcome even when neurologically intact by a skilled examiner. Simply lift your great toe with your leg crossed in your lap (if you can do that maneuver) and try to push the big toe down with your fingers. You can easily test the strength by comparing the opposite sides.

The peroneal muscles keep the ankle from twisting. Generally, when walking, especially on uneven ground, the ankle wants to twist in. The muscles that prevent this action are the peroneals on the outside of the leg. If you feel like you are always on the verge of spraining your ankle, these muscles may be weak. Testing them during a physical examination requires a skilled examiner.

Generally, if you have EHL weakness, it is not too important but if you have tibialis anterior, peroneal or gluteus medius weakness, it is my opinion that surgery is warranted.

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.

Kathy.P
Member

February 22, 2012 at 8:15 pm

Post count: 3

#5624

Hi Doctor Corenman,

Just tought i’d check in with you. Since the last email i couldn’t wait for my next appointment with my Orthopedic due to constant pain and took myself back for a review . He stopped the oral NSAID and gave me daily injectable NSAID which seemed to offer some releif and then on doctors advice was told to inject every other day ,take paracetamol inbetween and then eventually every two days etc etc . I have so far got to injecting every other day(for just over two weeks now ) but am now back to square one if not worse as the back pain ( slightly to my left of the lower spine) is getting unbearble, sometimes feeling like repeating stabs with a sharp object.Leg pain is still same too .
I have now booked a trip back to the UK at the end of March to take things further so i am now gathering all info possible . As i still have quite some time to bear i thought i might keep a pain diary if you would be so kind to advise how this is done . I have read of these on the forum and would like to know how the pain scale works and if you think this would be of use as i now await to see spinal specialist in England .

Kathy

Donald Corenman, MD, DC
Moderator

February 22, 2012 at 10:58 pm

Post count: 8660

#5625

Keeping a pain diary is really designed for tracking results of a nerve or facet block. None the less, understanding what activities create and relieve pain should be helpful to your surgeon to understand the biomechanics of your disorder. Take mental note of what activities seems to create the most pain and what you do to relieve pain.

Injection of NSAIDs is not recommended on a long term basis. Try to get something else to relieve pain.

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 6 posts - 1 through 6 (of 6 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