Symptom question

Tagged: Unusual leg symptoms possibly from cord compression or neuropathythce

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Donald Corenman, MD, DC
Moderator

February 15, 2018 at 11:12 am

Post count: 8660

#27573

I wish I could add to your information but I do not know what your disorder is either. Please keep the forum involved with your future treatment so we can all learn a thing or two.

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.

thebird
Participant

February 16, 2018 at 1:27 am

Post count: 24

#27580

That’s ok, I appreciate you following my progression and more than happy to share my experience. I understand that a lot of threads here are unusual, because if we had answers we would not resort to this. Plus, you seem to be the only spine expert offering such a service. I wonder if you can help with a few questions as I am determined not to give up and try get a diagnosis that can hopefully lead to treatment.

Further to the lower legs stinging (not in feet), and what seems like vestibular dysfunction, neurologist labelled it possibly ataxia that I briefly feel off balance or delayed signal of my leg movements when walking. I have started having stinging in my right arm, not in hands but my under arm from elbow to hand, however it is intermittent. The neurologist is still of the opinion my symptoms are very much of spinal pathology. So here is a few questions, if you may answer as best you can I would appreciate it.

1. Can elevated protein in the lower spine build up from CSF disruption by my protruding discs as we have found no cause of inflammation or any trace of MS?

2. Should I start looking for a Neurologist that specialises in unique situations such as mine? My current neurologist is very good but I understand he is more so special interest in MS etc and not as much as spine. However I don’t doubt his knowledge at all.

3. Is there any further imaging or tests that could be done around my symptoms, to see if the cervical level is responsible? Taking in mind I’ve had full spine mri, 2 brain mri, ct of cervical spine. All enhanced with dye etc.

The only findings identified are elevated protein, and 2 disc protrusions flattening the cord with CSF present posteriorly.

tine01
Participant

February 16, 2018 at 8:33 am

Post count: 11

#27582

I am 3 weeks post laminectomy/discectomy of L5-S1. after 1 week post-op I developed dull pain on my buttocks down to my calf. Pain is around 1-2 in the whole day and gets worst in the evening 4-5 pain scale, This week I feel pain on my groin about 1-2 pain scale. My surgeon told me to be patient and do physiotherapy for 2 weeks then he will re-assess. Taking pregabalin 150mg twice a day and celecoxib 200mg twice a day. Immediately post-op I developed numbness on my 2-5th small toes and side of my sole (s1 nerve? I guess). But it is seemingly decreased, but is still there, I have slight weakness during toe raises as per my rehab doctor. My only concern is my pain on my buttocks and calf (which if pressed is very painful). My calf is also cramping. Is this still inflamed nerves post surgery?

Donald Corenman, MD, DC
Moderator

February 17, 2018 at 1:24 pm

Post count: 8660

#27587

Probably still some root inflammation continues. The calf tenderness might very well be from the previously compressed nerve root but also a blood clot (DVT) has to be in the differential. Your calves should measure the same diameter. Make sure you have no previous risk factors for DVT.

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.

Donald Corenman, MD, DC
Moderator

February 17, 2018 at 1:31 pm

Post count: 8660

#27588

To “thebird”. Increased protein in the CSF is not related to mechanical disorders such as degenerative disc disease or herniations.

Another set of eyes can always be helpful (with an experienced and meticulous neurologist).

Further studies are probably not indicated. You could consider a diagnostic epidural to look for symptom reduction. This is not a perfect test in your case but might lead to some insight. See https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/.

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.

thebird
Participant

February 26, 2018 at 1:34 am

Post count: 24

#27706

Thanks Dr Corenman.

Have had further review by immunologist to no answers.

Back at the original neurologist today and after discussions he is now suspicious of electricial issues causing my symptoms and raised protein. Has scheduled me for an EEG and prescribed Epilim to trial after the EEG.

Has also ordered T3 MRI imaging of brain and c-spine again to give up any other clue. He advises T3 imaging can show more around blood vessels that could be bleeding to try help explain raised protein.

The discs bulges are still at the end of the list. The new information I received today makes good sense, hopefully this might be the right track!
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Donald Corenman, MD, DC

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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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