Time for surgery?

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firecasey
Participant

November 25, 2011 at 7:34 am

Post count: 6

#5154

Hello,

First off – Happy Thanksgiving! I am very excited to have found your forum where you provide advice… thank you. I am not looking for a diagnosis by any means, just some expert advice. I will try and provide you a detailed history, please forgive me if I am long winded.

History –

27 / M. Active lifestyle, full time structural firefighter for 9 years. I am a tall individual, 6’8 but in good physical shape.

When I was a senior in High School (approx 10 years ago) I suffered a weight lifting accident doing power clean lifts (280lbs). I felt immediate pop in my lower back. I never seeked treatment as the serious pain subsided after a couple of weeks. Over the past 10 years, I have had CONSTANT lower back pain and discomfort from this incident (the pain is everyday, literally).

I lived on and “just dealt” with it as the pain would come and go, sometimes lasting a few weeks and then okay for a week or two. But it has always been constant. The pain radiates mostly in what I believe to be my left SI joint, and middle of lower back (just above butt crack) with pain mainly radiating in my left butt cheek and lower back. It is a constant ache. Over the past 10 years I have been able to easily ‘adjust’ my left SI joint about 10-15 times a day. I cannot avoid doing it, it just happens and ‘pops’ very easily.

I have been living with this for the last 10 years…it is every day but really flares up when I sit (driving) or in a chair, and in the morning and night time. I toss and turn constantly having to adjust my sitting position. Being I am in a very physically (firefighter) demanding profession, some days are better than worst.

——Fast forward to now——

About 5 months ago I was working a house fire and was doing alot of heavy lifting. My back was sore and I was dealing with the pain as I always had done. After a couple of hours I went home and literally had to drag myself out of my car. I was bed ridden to two days and nearly called an ambulance due to the pain and inability to stand or walk. I called my doc (workers comp due to the pain associated with the fire) and was evaluated. I could not raise my left leg out without pain, and I could not bend to right side (right hand touch right side of knee) without pain. I had an MRI and the findings are as follows, from the

Radiologist report findings:

—–
– Broad based disc buldges at L2/L3, L3/L4, L5/S1.
– High signal annular tear at L3/L4
– Moderate Disc Degeneration at L2/L3, L3/L4, L5/S1.
– No nerve root impingement (I somewhat dispute this after obtaining copies of the MRI CD…I am not Doctor by any stretch but it appears evident that I have it at my L5/S1).
– SI Joints appear normal (Again, ?)
—–

My follow up Occ Health appointment was with a Physicans Assistant, and he basically said “Looks like you got some Arthritis, but you’ll be fine”. That was the end of it, and the workers comp accepted the claim as strained back.

My pain from this instance has pretty much subsided completely and am back to work, however, I am still having the Chronic Pain and discomfort that I have always had since my high school incident (Pain in left SI Joint, muscle spasms, low back pain, etc).

My concern is about the MRI report. For being young, I am surprised that I have the Degenerative Disc Disease. I am worried that if I am living in constant pain as it is right now, how will I be when I am 60 years old? Should I try and schedule an appointment with a Spine MD, since I have a feeling the PA who told me I just had arthritis may not have been accurate. I am also concerned about how loose my left SI joint is, since it literally pops 10-15 times a day. This has been ongoing since my High School incident.

Again, thank you and I apologize for the long winded-ness of this posting. Respectfully, Casey

firecasey
Participant

November 25, 2011 at 7:53 am

Post count: 6

#5155

Also, I forgot to mention. For the last year and a half I have been having discomfort in my left lower abdomen. I consulted with my Dr who sent me to a Surgeon for eval. I had a CT scan done which showed nothing wrong. The pain is like a sore muscle, in the area of where my colon is. The surgeon said that the muscle is fatigued and essentially just sore.

I was happy to hear that it wasn’t something to be concerned about. Is is possible that it could be attributed to my back issues? Can it affect an abdominal muscle like that?

Please also don’t think I am a cry baby, I have literally only been to the doctor a handful of times in my life! Its just this chronic low back issue is really starting to irritate me.

Thanks again

Donald Corenman, MD, DC
Moderator

November 26, 2011 at 3:24 am

Post count: 8660

#5157

Happy belated Thanksgiving!

Now to your questions.

Degenerative disc disease which appears to be causing the pain is related to both occupation, advocation and genetics. I believe that genetics plays a large role.

The pain in the central back most likely is related to the degenerative disc disease in the lowest portion of the lower back- most likely at L5-S1 but the symptoms could even originate from L4-5. Sacroiliac pain almost always is not from the sacroiliac joint but from the disc itself or from mild irritation to the adjacent nerve root.

These disc will not heal and the treatment is core strengthening and medications. Non-steroidal anti-inflammatories (Aleve) can be very effective in some patients to relieve pain. Epidural steroid injections can also be very effective. A consult to a spine surgeon or a physical medicine doctor may be very helpful.

The good new is that even though the symptoms are painful, they are not dangerous. That doesn’t help you when the pain can be incapacitating but at least you know that you are really not doing any more significant damage.

There is occasionally surgery for your symptoms, but you would need a good surgical work-up and you may not be a candidate for surgery depending upon the results.

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.

firecasey
Participant

November 26, 2011 at 3:46 am

Post count: 6

#5158

Thank you Dr. Corenman for this reply! It is so nice to be able to speak to an actual Doctor, not to mention an expert in this specific field, via an online forum. Please know that the service you provide is very much appreciated.

Thanks again,

Casey
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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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