What Exactly is wrong! Leg pain, bilateral,constant...

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Tammysroses
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February 3, 2013 at 2:18 am

Post count: 5

#7892

Dear Dr Corenman,

Thank you for the time to help people! You are an amazing person.

I am a 46 year old female who was working out 5 days a week, cardio weight lifting,Stop for a bout a month, So first week in July was at a wrestling camp in Nebraska sitting on a hard bench for 4 days,watching my son,remembering how much my butt and back hurt from sitting there,So I would get up and walk around..But the big problem was my right calf muscle started to contract never get a cramp, but you could see the muscle going in and out..Well on the long drive home back to the mountains in Colorado, My leg was still contracting, went to work the next few days and legs were so stiff and in pain,( I am a waitress)..So the pain in the legs got bad,Stiffness,aching,weird sensations..Went to Doctor after Doctor,One doctor had me do test for ms, brain Mri Normal EMT, normal NCS normal..All blood work normal..Started going to the chiropractor, Everytime he would work on my lower back I was buzzing like he was moving a nerve…Did that for 6 weeks didn’t work, he did say I have a fracture and maybe a pinched or irritated nerve, He said you should have seen me years ago..Thought that was funny..So after the chiropractor..Finally had a MRI done of the Lumbar All the doctors seem to think it is Ok!!!Including one of the spine doctors…

MRI FINDINGS….
LUmbar vertebral morphology, alignment and bone marrow appear normal.There is a T2 signal loss and narrowing involving the T11-12, L3-4 and disk spaces reflecting desiccation and degeneration.There appear to be minimal posterior protrusions at L3-4 and L4-5.A benign hemangioma lies in the vertebral body.

The conus medullaris and cauda equina appear normal..The conus terminates at L1

There is a unilateral pars intraarticular defect on the right aspect of L5 without associated spondylolisthesis.

The T12-L1 L1-2 L2-3 and L5-S1 disk levels are normal.

L3-4 theere is very minimal broad based protrusion measuring less than 3mm Grade 1..It does not produce significant canal or foraminal narrowing.The facets are mildly degenerated.
L4-5 there is a very minimal right lateral protrusion measuring less than 3mm grade 1. It does not produce foraminal nerv root or spinal canal compromise the facets are slightly degenerated..

IMPRESSION:
1. Minimal grade 1 protrusions L3-4 and L4-5 without significant canal foraminal or nerve root compromise.
@. Unilateral right L5 pars interarticularis defect.

So after this went to pain management center, received an epidural block. Somewhere in LTF E S1… Didn’t work, Second one lumbar facet Lss. Numbing medicine work steroids did not help..Went back to confirm. numbing medicine only worked for about 45 minutes, Don;t know if I am a candidate for rhizotomy, cause they want the relief to be 2-3 hours…
My back just stared getting worse with more pain..60/50 Legs 80/20..When sitting my back hurts and buttocks and legs hurt real bad when getting up from sitting position I am stiff..When standing legs hurt calf’s hurt throbbing pain…Thighs feel achy, buttocks hurt..Walking feels better …Pain in my ankles, some spasms in buttocks and legs..
My question to you is..Should I get a new Mri, the pain is intolerable the pain makes me tired all the time,,What can I do!! No doctors have given me any answer..Just wondering what you thought!!

Forgot also had an Mri Of my pelvis, No one has said anything about that!! Do you think it might be a compressed nerve, I mean the buzzing is weird…
Thank you so much! I hope I made this so you can understand it..

Tammy!!!

Donald Corenman, MD, DC
Moderator

February 3, 2013 at 10:51 pm

Post count: 8660

#7895

It might be worth getting a CT scan limited to L4-S1. If there is one pars fracture at L5-S1, the MRI might under diagnose the other side. Bilateral pars fractures at L5 with micro instability could explain your symptoms. If your symptoms are only unilateral (one sided- the symptoms do not sound one sided), the pars fracture might also be a pain generator.

Facet blocks with only 45 minutes relief do not lead me to consider a rhizotomy but you did have good relief from the first set. Like anything else in spine, there are never consistently perfect injections. Another repeat injection of the type that failed the second time might also be considered. Good relief for at least three hours would lead to potential rhizotomies.

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.

Tammysroses
Member

February 12, 2013 at 7:21 am

Post count: 5

#7986

Hi Dr Corenman,
Just got another Mri, because of all the pain I am having..The mri goes like this…

L4-L5 Mild circumferential disk bulging is noted with ligamentum flavum and facet overgrowth.Mild bilateral neural foraminal narrowing is noted without canal stenosis.
L3-L4 Mild circumferential disc bulging is noted without canal or neural foraminal…L2-L3 Negative L1-L2 negative T12_L1 negative..

So my question too you is< can this be causing all the pain in my legs? this Mri Did not pick up on my Pars fracture at L5….my buttocks, upper thighs, calfs ankles to my feet, are always in pain, numbness, tingling, buzzing here and there…But leg pain is awful…Compared to my other Mri, it never mentioned facet overgrowth and what is that, not getting much help on finding the definition on that.Just wondering what you thought..

Thank you for getting back to me, on the first Mri, Tammy

Donald Corenman, MD, DC
Moderator

February 12, 2013 at 8:12 am

Post count: 8660

#7989

Pars fractures are not easy to diagnose on an MRI and you can now see the dilemma that occurs when depending upon a radiologist’s report. The findings of your second MRI might suggest a degenerative spondylolisthesis at L4-5 but that may be over-deduction.

Again, you might consider a limited CT scan of L4-S1 to help differentiate these disparate image readings.

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.

Tammysroses
Member

February 12, 2013 at 10:22 am

Post count: 5

#7990

Thank You Doctor,
Was pushing for the CT scan, but she said an Mri is better..I will keep trying… Thank you so much!!!
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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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What Exactly is wrong! Leg pain, bilateral,constant…