Surgery for Severe Left Leg Nerve Pain L5 S1 with disc space narrowing

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randrews
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April 26, 2013 at 2:16 am

Post count: 1

#8507

Thank you so much for this forum! I feel so much more informed after reading through many of the other questions and reviewing your educational resources.

I am a very athletic 36 year old mom of 3 with a desk job. I have always had back pain here and there but nothing that could not be taken care of with a visit to the chiropractor. This started with a running injury when I was 16 or 17 and seemed to resolve itself with a few weeks of visits to the chiropractor.

Approx three weeks ago I irritated my back doing double unders (jump roping) and a couple of days later had severe pain 10 of 10 that started in my left buttocks and ran all the way down through my calf which was bad enough to send me to the er. I started oral steroids and pain control and the pain reduced but certain movements would cause the pain to increase.

I had an lumbar spine xray five views. Impression was 1. Lumbosacral spondylosis 2. 4mm left retroperitoneal calcification.

I then had an MRI that said Sigittal images show loss of the normal bright signal in this pulposus at the l4-5 and l5 S1 level measuring 1.2×1.8×1.2 and transverse AP and cranial caudal dimension. This contacts and displaces the nerve roots posteriorly vertically the S1 nerve root on the left side. No compression fracture or subluxation is seen. Axial images through the L5 S1 level reveals a large extruded disc fragment extending to the posterior portion of the left side the canal and displacing the nerve roots posteriorly. The foramen appear patent bilaterally At the L4-5 level of the canal and foramen are widely patent L3-4 and L2-3 the canal and foramen are patent.

A week ago I went in for a epidural cortisone injection. That morning prior to I was again having severe (8 of 10) pain in left leg more so focused in the lower leg and calf. After the epidural injection it was unbearable (10 of 10) and they admitted me overnight for pain management. The pain subsided after about 48 hours but my foot is still numb, has pins and needles and significant weakness in my left leg. It is also a struggle to fully empty my bladder.

When I wake up in the morning the pins and needles and numbness is less severe but as I get up and start the day it gets more and more irritated as the day goes on.

Do you think based on my symptoms that the nerve is damaged?

I have an appointment with a neurosurgeon tomorrow to discuss surgery options. I would really appreciate any direction or suggestions that you can provide.

I would really like to continue to be very active for a long time.

Thanks so much!

Donald Corenman, MD, DC
Moderator

April 29, 2013 at 12:31 am

Post count: 8660

#8528

You have developed a disc hernation at L5-S1 with significant compression of the S1 nerve root. Unfortunately, it sounds like you had a volume phenomenon from the epidural injection. There was precious little root for the nerve and the volume of the injection compressed the nerve root even more.

You have failed an injection and have extreme pain. This is enough to indicate a microdiscectomy (see website for description of this surgery). Even more, you have motor weakness. In my opinion, this is a significant indication for surgery sooner than later as these motor nerves do not recover completely in many cases. Surgery allows a much better chance for recovery (see section under nerve injury and recovery).

Surgery will allow you to return to your normal activity in most cases (see “recovery information by surgery”-“microdiscectomy” under “Pre and Post Op”)

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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