surgery opinion

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lewis123
Participant

January 15, 2021 at 11:29 am

Post count: 4

#33540

hello
12 years ago I had a l4l5 laminectomy, no back pain but feet were falling asleep.
10 days later I bent over and a popping sound and intense pain went down my left leg. I started leaking spinal fluid. I had a 2nd surgery to fix the leak. A month later the pain in the left leg was still unbearable. I felt sick also. 2nd opinion showed an infection. 3rd surgery to clean out the infection. My L4L5 disc was gone and it fused naturally. 2 months of pt helped the pain and I have been pain free until Jan 2019.

I now have pain along my waistline. Sometimes higher but no pain in my legs or feet. Had an ablation of l3l4 l4 l5 and l5 s1. 75 pain relief for about 5 months. Had a epidural shot Dec 2019 and again March 2020 Some relief for a couple of months. Saw a surgeon to see if their was anything I could do besides shots. He did not recommend any more surgeries because of the 3 prior surgeries with spinal leak and infection would be to dangerous for another surgery.

I saw another surgeon In Dec 2020. He recommended a Laminectomy l5 S1 and Lami L3L4. He also wanted to see a ct scan. I met with him this month and he is now reommending a fusion at L5 S1 and leave the L3 L4 alone. My L5 disk was showing black on the ct scan. I still do not have any pain in my legs or butt.
My MRI from June 2020 which I had done at your clinic.

L1 L2
Disc desiccation with annular bulging. A small 2mm left paracentral disc extrusion with slight cephalad migration of the disc maaterial. Slight effacement thecal sac and moderate facet arthropathy. No Appreciable neural element compression or stenosis.

L2 L3

Disc desiccation with annular bulging A 4 mm left postero lateral disc protrusion. Mild facet arthropathy with thickening of ligamentum flavum.
Stable mild 2mm retrolisthesis is demonstrated. There is end plate remodeling. Mild to moderate central canal stenosis and left sided foraminal stenosis. Minor narrowing ofthe right neural foramen.

L3L4
Disc desiccation with annular bulging and endplate remodeling. Moderately advanced facet arthropathy with cartilage loss. thicking of the ligamentum flavum. Moderately severe central canal stenosis with mild to moderate bilateral forminal stenosis.

L4L5

Ankylosis of the disc space. There is endplate remodeling. Posterior laminectomy defect. There is partial ankylosis of the facet joints The central canal and neural foramina without stenosis.

L5 S1
Advance disc degeneration disc space narrowing, disc desiccation, and vacuum cleft. Abnormal annular morphology with posterior bulging of the annulus and a 6 mm broad based porterior disc herniatin. Associated marginal endplate ridgeing. Moderaltely advanced facet arthropathy worse the left with thicking of the lifamentum flavum. Moderately severe to severe left and moderate right foraminal stenosis. The central canal is the the lower limits of normal in size. Moderately left sided subarticualar recess narrowing with mild narrowing to the right.

So would like to know of I should have surgery because of prior surgeries in your opinion. Also since my pain is present more with kayaking, skiing, and hiking. Better with biking. Im a very active 70 year old women.

Thank you.

Donald Corenman, MD, DC
Moderator

January 15, 2021 at 12:05 pm

Post count: 8660

#33543

I am confused, You only have lower back pain and it does not radiate into your buttocks. thighs. later hips or any level below the belt line?

See these two sections to see if these can be helpful in your symptoms description.

https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-lower-back-and-leg-pain/

https://neckandback.com/conditions/isolated-disc-resorption-lumbar-spine-idr/

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.

lewis123
Participant

January 15, 2021 at 12:34 pm

Post count: 4

#33544

Thank you for the quick response.
I have never had leg or butt pain the last 2 years. My pain is in my waistline. If I doing nothing all day my pain is a 2 or 3. If I ski hike or kayak or swim my pain goes to a 6 to 8 after an hour. I’ve been doing pt with stretching.

It feels good but doesn’t ease the pain. Also pain meds to nothing
Occasionally my left toes get tingly. The waistline pain is sharp and stabbing. If I get a hard massage the pain is a 6. So I have given up on that. A heating pad really helps but only for an hour or so. The pain wasn’t constant like it is now. I spent 6 weeks mtn biking last fall and the pain was ok. Now that I’m not biking it has been very day. Maybe it’s just arthritis but the MRI shows alot of things.Hope this helps you.

lewis123
Participant

January 15, 2021 at 12:37 pm

Post count: 4

#33545

I also get pain when standing for less than a hour. About a 6 to an 8.

Donald Corenman, MD, DC
Moderator

January 15, 2021 at 3:47 pm

Post count: 8660

#33546

Do you have low back pain with impact such as running, driving on a bumpy road, impact when jumping off a curb, playing sports (tennis) or bending forward and lifting. Do you have delayed onset pain where you do a heavy activity such as gardening and “pay for it” that night or the next day?

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.

lewis123
Participant

January 15, 2021 at 4:13 pm

Post count: 4

#33547

Yes. I have quit mtn biking on bumpy single track. It helps. But pain also starts if I hike, stand, nordic ski, or swim for more than an hour. Any longer and I have to quit the activity. Usually pain about 6 or 7. I now have pain most of the time if I don’t do anything. But it’s only a 2 or 3 level. Bothersome stabs and aches.
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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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