What approch should I consider?

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HG in Houston
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January 5, 2013 at 2:04 am

Post count: 6

#7690

Thanks Dr. you do a great job of responding. I have 2 appointments set to get other opinions.

What a Micro D. procedure still be the surgery of choice for this condition?

Donald Corenman, MD, DC
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January 5, 2013 at 3:23 am

Post count: 8660

#7691

If you need a surgical procedure, a microdiscectomy would most likely be the procedure of choice.

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.

HG in Houston
Member

January 23, 2013 at 11:16 pm

Post count: 6

#7799

Quick update. I went to see another surgeon who also spoke with a Neur on staff and they felt surgery was needed because of the mechanical issues I am experiencing. To them it appears mainly L5. His opinion was the same as others. Due to the legnth of time of the compression he does not know what I will get back. However he said I need to strenghten what I have. I am dug in for a long battle of rehab if need be.

My Microdisc surger is scheduled for tomorrow so I will provide an update periodically going forward to track progress.

Some things I have done the past few weeks:
1. I bought an inversion table which helped to relieve pain but since then I have noticed that I have more movement in my right big two than before. Perhaps coincidene but progress.
2. I measured the atrophy in my uppers legs. My right leg is about an inch and 3/4 small than my right. I am going to use this as a bench mark going forward. Have glute atrophy but not way to measure it.
3. I starting working my right leg to build strength and to get an idea of where denervation has occured. Definately more on the top of the quad.

Dr. C a few question for you on what you tell your patients:
1. I have read mostly where sitting is bad and walking good. Because of my condition I limp. Is it still better to walk or can I ride an upright stationary bike?
2. Since I live in Houston and with traffic I typically take at least an hour to get to work which means extended sitting. How long do you typically recommend before I return.
3. PT is going to be needed. How long before I should start that?
4. I want to start strengthening the right leg. How long before weight training or exercises like lunges or single leg squats with no weights?

HG in Houston
Member

January 24, 2013 at 3:45 am

Post count: 6

#7801

Sorry did have one more question. With the atrophy and drop I am interested in knowing the level of nerve damage I have. Just curious is typically another emg done? Would it show whether the nerve has been repaired at the source and the level of damage that I have?

Donald Corenman, MD, DC
Moderator

January 24, 2013 at 8:14 pm

Post count: 8660

#7804

You now use an inversion table and have found this reduces symptoms and possibly has increased your ability to move your toes. Inversion tables create traction on the lumbar spine and this can reduce the compression on the nerve root temporarily. Unfortunately, many individuals cannot tolerate this position but for you, this seems to work.

The circumferential measurements that you are using to check muscle mass are a good tool. I use them in the office for diagnosis and they are reliable.

You note atrophy “on top of the quad” and this worries me. We had previously been discussing an L5 or S1 nerve involvement. Either of these nerves would not affect the quadriceps femorus muscles (quad muscles-L3-4 nerve roots) but atrophy of the L5 or S1 muscles would be noticeable in the calf region.

In general, compression of the nerve in the spinal canal from a disc hernation would respond better to standing and upright activities. Compression of the nerve in the foramen from a herniation would respond better to a flexed forward posture. With a mixed location (HNP both in the canal and foramen), there are few positions that would yield relief.

After a simple microdiscectomy, many patients can sit for one hour after about one week post-op. There are a subset who might not be able to do that. It really depends upon the situation.

I start patients in PT from 7-10 days after microdisc surgery.

I am generally not a fan of lunges after surgery as this exercise creates sheer forces which can reherniate a disc. When to start general weight training after surgery is best left to the decision of the physical therapist who is with you twice a week during your rehabilitation and can determine when these stresses can be applied.

An EMG generally does not demonstrate with great accuracy what the status of the healing nerve is other than with nerve budding (see website for nerve healing info).

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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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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