Symptom question

Tagged: Unusual leg symptoms possibly from cord compression or neuropathythce

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thebird
Participant

March 24, 2018 at 3:24 pm

Post count: 24

#27950

Thanks for taking the time to give me some info Dr Corenman.

My NS mentioned there is no cord swelling yet which means 2 things. Either it’s subtle and we have caught it early or it’s an exception. He also mentions this can explain why my protein is elevated in CSF.

I still have to get the angiogram and go from there however I assume once confirmed I’ll be taken in for surgery. My research shows these are treatable and via surgery have the best success and symptoms are often seen improved following surgery. Is my research correct?

Also, it is a myelopathy so I am suffering now with weakness and balance issues below the level but as I understand it, when normal blood flow comes back then things improve but there is still some damage done. I guess mine was caught in under a year so hopefully this is better for me I hope. Reading articles, people usually get diagnosed late due to the rareness and mimicking other conditions.

While I am waiting, is it best to just rest or try do what I can so I have the best chance of recovery? I notice my legs are strong sometimes, but weak other times. Walking can be challenging but still achievable. Comes and goes.

Donald Corenman, MD, DC
Moderator

March 25, 2018 at 3:44 am

Post count: 8660

#27956

AV malformations are treatable. I don’t do surgery on these malformations so I cannot comment on what is surgical and what is not. I think you should continue to keep your legs as strong as possible.

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

April 5, 2018 at 9:01 pm

Post count: 24

#28028

Hi Dr Corenman,

The saga continues, and not in my favour.

I had the angiogram which was clear of AVM or fistula.

The Neurosurgeon gave me the option of 2 level ACDF as we had no where to go. I proceeded. Surgery was performed last night, I notice the neuropathy May have reduced but other symptoms remain. I have little to no post-operative pain and surgery was very smooth. The NS mentioned during surgery he noticed my thyroid to be right and possibly enlarged and ordered bloods on me today for thyroid function. Looking at google, this can cause neurological symptoms? He also said my cord definitely had more pressure on it than the MRIs showed and he was very surprised.

I understand it is not the desired outcome for me, but after the extensive testing this was the direction it came to. I just have a couple of questions if you don’t mind.

Symptoms that remain

1. Weakness in lower limbs
2. Unsteadiness
3. Lose contact with feet/legs every few steps and sometimes don’t feel them hit the ground
4. Postural instability when standing/sitting

Also still have the elevated protein in CSF to no explanation.

Actually only one question, can the decompression take time to improve symptoms? My NS has mentioned usually you have instant relief when pressure is relieved. What are you thoughts on this?

If you have any info or insight to add I would appreciate it but pretty much back to neurologist for me to try find the cause linking the elevated protein as I assume that is my problem now the neck is ruled out?

Thanks for your valued time, as always

thebird
Participant

April 6, 2018 at 3:46 am

Post count: 24

#28029

Further update:

Have spoken to NS again and he advised we need to give it at least 6 weeks to see if there is improvement, due to the amount of time I’ve had symptoms. Also said based on the damage he saw in there, he would be surprised if it was not responsible for some of my issues but still indicated the thyroid results are coming which can explain some too, if found causing an issue.

thebird
Participant

April 17, 2019 at 7:12 am

Post count: 24

#30373

Hi Dr Corenman,

Not sure if you still have any interest in my case, however symptoms persisted.

It was finally found after many lumbar punctures that I have some male version of benign intracranial hypertension with opening pressure of around 30cm on a few occasions but no headache present and no weight issues or vision problems. I was started on diamox and symptoms dramatically reduced however neuropathy in legs still remain, some unsteadiness/transmission issues when walking but able to work full time again.

Elevated protein is still not explained, and unable to identify if pressure is still causing symptoms or the issue that is raising protein is causing symptoms.

No cause has been found for the pressure besides narrowed transverse sinus line, but it is not confirmed and can’t do anything until elevated protein is explained.

Kind regards

Donald Corenman, MD, DC
Moderator

April 21, 2019 at 12:40 pm

Post count: 8660

#30388

I think that a well regarded neurologist would be a good next step. The combination of higher CSF pressure along with protein in the CSF indicates a disorder yet to be named. It does not seem to be myelopathy.

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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