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  • michael
    Member
    Post count: 7

    Dr. Corenman

    I have been dealing with DDD at L4/L5 and L5/S1 for well over a year now. I have low central back pain right about where L5/S1 disc is and I have sciatica in both legs. Most of the leg pain is in my feet but I do get some pain in the tighs and buttocks as well. The sciatica pain in both legs is 90% of the time when I sit and the remaining 10% of the time it’s when I stand or lie down (standing and lying down are completely tolerable) Sitting is the issue. I am an airline pilot and sitting is my lively hood and career. I have had and MRI, 6 weeks of PT, and 3 rounds of steriod shots at the L4/L5 and L5/S1 levels. The shots gave some relief but only for about a week or so at a time.

    When I sit, it is NOT instant sciatica. It’s gradually comes on after about 5-10 minutes and then becomes gradually more uncomfortable. Soemtimes it’s tolerable and soemtimes it’s unbearable. It is affecting my job and I need to get this resolved if at all posslbe.

    I had an MRI and it shows disc dengeration at L4/L5 and L5/S1. There is no herniation. L4/L5 has a small posterior central bulge. It doesn’t appear to be touching the nerves (but I understand that the MRI is taken while lying down, so sitting that may be different?) What is the success rate with the TLIF, at least, in your exprience? Have you ever worked on any pilots? I would love to get this issue solved as I sit for 5-9 hours a day without the ability to get up and move around to get relief. I would be willing to travel to you for diagnosis if you are able to accept a new patient. I have seen a couple of nuerosurgeons in the Houston area, but just don’t feel too comfortable with them.

    Any info is greatly appreciated. Thank you.

    texasspondy
    Member
    Post count: 25

    Maybe Doctor Corenman will give us an airline discount, ha. Kidding aside, I also am in the Houston area, and have conversed over the forum that is with Dr Corenman. Also in the airline biz, however, I don’t fly them, I maintain them.
    Anyrate, I have found a neuorsurgeon in the area that I felt comfortable with his knowledge, experience, patience, and bedside manners. However, I am very impressed with the website literature that Dr. Corenman has here, including explanations, video’s, pictures, and the time he takes to respond to questions that the general public has on back problems.

    It is my intention to follow up as to what procedures, one would have to go through being an “out of towner”, to see Dr. Corenman and possibly have a TLIF performed on me as well. From what I see, Dr. Corenman will suffiice very well as my second opinion and depending on cost/circumstances, might be the primary surgeon.

    Not to hijack your thread, just wanted to chime in, was interested in your decision.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    You note your pain is both lower back pain and leg pain (sciatica). You have minimal to no leg pain while standing but develop leg pain when sitting. The pain occurrence with sitting is gradual and intensity changes intermittently. Your MRI notes DDD of L4-5 and L5-S1.

    Some questions. What is the percentage of back vs. leg pain? It seems to change with standing vs. sitting. Would you say that you have 80% lower back pain and 20% leg pain with standing but the percentage changes with sitting? When you sit, does the leg pain always start in your feet and radiate up or does it start in your buttocks and radiate down?

    There are some potential different diagnoses for your leg pain. Your back pain is most likely from your degenerative disc disease. If you have a condition called isolated disc resorption (see website) where the disc cushion has completely worn away, as a pilot you are more susceptible to vibration generated by the plane and this will increase your back pain.

    The leg pain can occur from spinal nerve irritation but if your MRI notes no significant nerve compression (including lateral recess stenosis which can be missed on some MRIs), the foot pain can be generated by peripheral nerve entrapment. Leg nerves run in tunnels just like the median nerve of the hand runs in the carpel tunnel. This entrapment is also somewhat common with pilots. An EMG/NCV test can help to diagnose nerve entrapment.

    By the way, yes I very much like pilots and do take care of many fixed and roto-wing pilots. I am a pseudo-pilot myself (need 10 more hours and better cross-wind landings).

    Dr. Corenman

    michael
    Member
    Post count: 7

    Dr. Corenman,

    The percentage of back to leg pain varies. It’s usually more leg pain than back pain. I’d say 70% leg to 30% back pain. And lying down or standing/walking always relieves most of it. If I’m bent over working on my classic cars the back pain gets pretty bad as well. I don’t really work on my cars anymore because of it.

    The leg pain is almost always in my feet first (burning, tingling, stinging sensations…like the sensation you get in your arm/hand when a blood pressure cuff is inflated). After sitting for a bit I will start to get mostly aching type pains in my outer/back thighs, side and back of buttocks. Mostly in the left leg, but some in the right as well. (some of these sensations are like hot/cold feelings)

    My back pain is usually centralized right in the middle where the L5/S1 disc would be. I know this because of where the needle tracks are from my steroid shots. Can a TLIF be utilized for a two level fusion? And what is the procedure for the nerve entrapment you mentioned?

    I’m more than willing to travel to see you as you have explained more than any other doctor I have seen. I forgot to mention that I’m 39 years old. Go get those your last ten hours of flight time and get your pilots certificate! I learned up in the mountains of Colorado in Rangely. Mountain flying experience is invaluable.

    Michael

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    The back pain you experience is most likely from the degenerative disc disease. A two level TLIF is a common procedure and most patients do well. There are limitations with a two level TLIF however. Impact sports and activities (running, tennis, heavy lifting and some other need to be avoided. You are replacing pain for stiffness in the spine.

    The problem is that pain relief after surgery is generally good so some patients forget their restrictions. They go back to all the activities they have avoided due to pain and can then stress the disc above. The genetics of the annulus (brittle collagen- see website under DDD) do not change and these patients have an increased chance of tearing the disc above. As long as you can be satisfied with pain relief and only some increased activity, then a two level TLIF is a good choice.

    Your leg pain needs to be worked up. Ask your current physician if they would consider ordering an EMG/NCV test by a neurologist. This might note the source of your foot pain, especially if you do have peripheral nerve entrapment.

    By the way, mountain flying is just plain fun.

    Dr. Corenman

    dustingfab
    Member
    Post count: 27

    Thanks for the clear explanation Dr. Corenman. So a fusion regardless of location of the spine replaces pain for stiffness. And with stiffness, a person would need to change their lifestyle and level activity.

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