Treatment for Annular Tears

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Greg
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July 15, 2015 at 6:10 pm

Post count: 29

#20024

Thanks Dr. Corenman for your explanation of diagnosing a patients symptoms related to the annular tear vs a ruptured disk. I am 63 and a hardwood floor contractor. I have been treated with Epidurals at L-5.S-1 left sided for about the last 10 years related to the symptoms of annular tears. Oh! My back went out with instability in the vertebral L-5 area. Usually the left muscles lock up and radiate around the left groin area. This last one which started last Wednesday when I started to stain a staircase was like a minor electrical shock across the L-5 meridian. Within minutes I was in complete spasm. I went home as my employees completed the stain work. All I could do was sit in my Danish Back chair and go to bed laying on my sides. I had to get out of bed to turn over. Lol my pain management specialist got me in Monday for an 80mg Depo Medrol injection. When I got off the table with no sedative I had no pain so the diagnostic aspect says he injected into the heart of the inflammation. It usually takes me a full month to full recovery and during that time I may have a few minor back aches and then none for up to one year. I had no injections from 2008-2013 as the recession had me working part time. My last MRI over a year ago stated that I had moderate to severe nerve compression from L-4 to S-1 with 1-3mm bulges. 3mm at S-1. My question is if I did nothing most likely I would be back to normal in 14 Days. The epidural took 70% of my vertebral pain away in 24 hours. I am back walking normally and no gait in 48 hours. I still have some soreness in the joint if I walk too much. Sitting in my back chair with an ice pack seems to release that tension. Also do Annular Tears heal left untreated? Am I possibly in a tear, back spasm, epidural and healing of the Annular Tear process, one to the next, year after year?

Greg
Participant

July 15, 2015 at 6:21 pm

Post count: 29

#20025

Sorry for the multiple posts. I did not see the edit feature. Is there a way to delete a post?

Greg
Participant

July 16, 2015 at 7:58 am

Post count: 29

#20027

Although I performed a search on Annular Tears nothing came up. I found your comments on them on another posted page. I did review my last MRI on 5/13 and it says I have a posterior tear within the disk at L-3/4 and at L4/5. Not one at L5,S1. Do you think it is time for another MRI or are the symptom findings typical of Annular Tears and treatment enough? Since the MRI’s are no longer a financial issue; 1600.00 in 2000 vs 300.00 now and the fact that there is no radiation I was considering calling for an order today from my pain specialist. I did have him order physical therapy as he describes as Lumbar DDD treatment. btw: I have been wearing a back brace throughout the work day for the last 10 years. I am 5’10”, 160 lbs. The brace has really helped with pain issues but i understand your reluctance to promote the use as it deflects from core strength. I need to work on those issues in PT. Your site here is the best I have found anywhere on the net by a large margin. Thanks for sharing your time and professional skills online.

Donald Corenman, MD, DC
Moderator

July 18, 2015 at 12:45 pm

Post count: 8660

#20045

Annular tears are quite common and may or may not cause pain. Lumbar degenerative disc disease (LDDD) is the progression of an annular tear to a more global degenerative state of the disc that can also involve some degeneration of the facets (although facet disease does not have to be a part of this condition).

Significant lower back pain (LBP) is generally caused by LDDD but many other conditions can cause lower back pain. See the section “Causes of lower back pain” for a better understanding of back pain sources.

The fact there is no radiation of pain generally means that the nerve roots are not affected and this is a disc issue.

Read the section “conservative treatment of mechanical lower back disorders” to understand how to rehabilitate the spine.

Epidural steroid injections are in my opinion the single best way to address a lower back attack (severe onset of pain with muscle weakness due to pain inhibition). With a history of low back pain and multiple crisis episodes, you might consider a work-up to see if surgery can be helpful to you.

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.

Greg
Participant

July 18, 2015 at 6:19 pm

Post count: 29

#20055

My pain specialist told me once to start a swimming program and I would never need another injection. that is something to consider. I had my epidural on Monday and I am now nearly symptom free with minor soreness in the affected disk. When should I start seeing the physical therapist to start the stretching and muscle conditioning program? I was thinking of waiting for a few weeks until I have my strength back and feel symptom free. Btw. Thanks for the reply.

Greg
Participant

July 18, 2015 at 6:32 pm

Post count: 29

#20057

I want to see a Neuro Surgeon in the area that has high reviews for his spine speciality. I may be getting another MRI if this last episode doesn’t heal according to my pain specialist. He said I don’t need a new one if my symptoms don’t come back after this weeks injection. It has been two years since the last one and considering the intensity of last weeks spasm it seems something new may appear with an updated scan. I would like that scan if I see the Neuro Surgeon.
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Donald Corenman, MD, DC

Average rating:

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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