X-Ray report for Lumbar

Tagged: Progressive symptoms of hand weakness after an ACDF

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wgreenlee
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October 23, 2017 at 6:52 pm

Post count: 53

#26659

Hello,

I move from cervical issue’s, which I still have, to Lumbar issues. I had a x-ray done last week and the report states as follows:

There are five a non-rib-bearing lumbar vertebral segments. There is no acute skeletal injury. There is retrolisthesis of L4-5 of approximately 3mm. There is mild loss of disc height T11-12 with anterior osteophyte formation. T12-L1 and L1-L2 demonstrate minor degenerative disc disease. L2-3 demonstrates mild loss of disc height with anterior endplate hypertrophic change of the superior endplate of L4. L4-5 demonstrates mild loss of disc height. There is endplate hypertrophic change. Moderate facet hypertrophy. There is mild diastases of the right facet on the oblique view. The L5-S1 facets demonstrates moderately advanced hypertrophic and degenrative change. There is no lytic or blastic skeletal lesion identified. No paraspinous soft tissue calcification.

Impression: Degenerative change of the L4-5 facets with mild diastases of the right facet and mild rettrolisthesis of the L4 on L5. This suggest a component of instability. Consider flexion/extension views for further evaluation.
The other disc levels demonstrate relatively mild degenerative disc disease. Moderatley advanced facet hypertrophy L5-S1.

Any help with this in human terms would be greatly appreciated.

Donald Corenman, MD, DC
Moderator

October 23, 2017 at 8:35 pm

Post count: 8660

#26660

You have CBS (crappy back syndrome). The X-rays are only a minor part of discerning your issues. You need to go over symptoms. See https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-lower-back-and-leg-pain/ to describe your symptoms.

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.

wgreenlee
Participant

October 23, 2017 at 8:45 pm

Post count: 53

#26661

The symptoms range from intense shooting pain down right leg to the point I have to stop doing whatever I’m doing at that moment. This usually occurs when walking. When I bend over it feels like a knife is being jammed in my lower back. Sleeping is always a issue. I have to sleep on one side usually the right side and I have tried the pillow between the legs of course the pillow doesn’t last very long. I guess with all this and previous spine surgeries I get concerned I will get that suggestion for surgery because I could be paralyzed from the waist down.

Donald Corenman, MD, DC
Moderator

October 23, 2017 at 10:02 pm

Post count: 8660

#26662

You need a consolation with an experienced and careful spine surgeon as well as an MRI. You have symptoms of foraminal or lateral recess stenosis (“intense shooting pain down right leg..usually occurs when walking”). See https://neckandback.com/conditions/lumbar-foraminal-stenosis-collapse/ and https://neckandback.com/conditions/lateral-recess-stenosis/.

You note “I guess with all this and previous spine surgeries”. Have you had prior surgeries and if so, what and when?

Where do you get this “I could be paralyzed from the waist down”?

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.

wgreenlee
Participant

October 23, 2017 at 10:15 pm

Post count: 53

#26663

Sorry about the confusion. I had a Cervical ACDF C5-7 in 2015. The outcome was not good and it will require another cervical surgery. I’m just a little hesitant after the first surgeon (locally) lied on the post-op report and left things unfinished or never done. So then I get this great news with this X-ray on the Lumbar region. I had a sudden shooting of pain going down the right leg everytime I went for a walk. It got to the point where I was getting voncerned I might have to call someone to come and pick me up. As for the you might be paralyzed from the neck down. That was the line used yo push me into having the neck surgery. I guess when my Primary care doctor ordered the X-rays she didn’t expect these results. She went ahead and setup a consult with a group of spine surgeons here locally. The Andrews Institute in Florida. She basically said I need to discuss both neck and lower back and determine which one is more severe I guess.

Donald Corenman, MD, DC
Moderator

October 25, 2017 at 8:29 pm

Post count: 8660

#26677

The “you might be paralyzed” line is occasionally true but more often than not, the danger might not be as severe as it is explained to you. There are certainly certain conditions that are dangerous but many can be ameliorated with activity restrictions with no immediate danger.

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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