Young man with back and leg pain... What is my problem?

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cnalbert
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March 14, 2012 at 1:24 pm

Post count: 2

#5761

Dear Dr. Corenman,

I saw your video on Youtube and I am here trying to find some help. Thanks in advance! Recently I have been suffering from back and leg pain for a month and I am seriously worried about it. I went to see the doctor and he recommended me physical therapy, but I don’t see sign of improvement…I actually feel it is developing… Here is how things happen: (as brief as I can)

Background: 23 years old, no accident, was perfectly healthy until…

[Start] Went to gym, tried some waist/leg exercises I didn’t do before, felt exhausted.

[+1 days] Started to feel pain and sting on right outer thigh, especially when walking.

[+4 days] Went to see doctor. Leg raise positive. Reflexes and muscle strength normal. Naproxen proscribed.

[+5 days] Started to feel pain on right calf, and the area behind the knee.

[+6 days] Started to feel stiff back.

[+8 days] In rare cases sting and pain on left leg.

[+12 days] Obvious pain on spine (lumbar area) when bending forward. Lower back pain started. Pain on hip and the right front thigh.

[+15 days] X-rayed. Perfect spine, according to the doctor.

[+20 days] Physical therapist gave me some exercises to do at home and told me to avoid bending.

[+25 days] Good news: No leg pain and sting for most of the time.

[+30 days] Developed CONSTANT SORENESS ON THIGH, CALF, KNEE AND EVEN ANKLE OF BOTH LEGS. Also, stiff back remains. I can’t bend forward because it causes pain in the back. Piriformis and hamstrings very tight, according to therapist.

I honestly don’t know if I am getting better or worse. The good side is that I no longer feel obvious pain and sting, I just have soreness now. But the bad side is the symptom seems to spread, from right outer thigh, to the whole right leg, back, hip, left thigh, left calf, and finally both legs.

Should I be worried about this? I am a student and I am seeing doctors from the university health services. They didn’t find the exact cause but they said it is usually not a big deal for young people. They did x-rayed me but they said it was perfect. But for me I don’t believe it could take so long to recover. It is now more of a mental burden to me… My father even scared me over the telephone: “I hope it’s not bone cancer!”

Someone mentioned that it could be spondylolithesis(I don’t remember the spell…). Someone suggest me asking for extension/flexion x-ray, CT, MRI or EMG… I have an appointment next week, but I am thinking maybe I should see another doctor earlier… Any suggestions and comments are greatly appreciated! Thank you!

Donald Corenman, MD, DC
Moderator

March 15, 2012 at 7:31 pm

Post count: 8660

#5765

By your description of your symptoms, it appears that you have a radiculopathy or inflammation of one of your lower back nerves. The most common cause is a herniated disc in your lower back, typically at L4-5 or L5-S1. The X-ray can appear normal but I bet there is some narrowing of one of the disc spaces that is subtle and is not normally noticed by physicians who are unaware of this finding.

An MRI is the next test to be ordered typically. If you have no motor weakness (you can walk around on your toes and heels without difficulty and can crouch walk), then treatment does not initially involve surgery. If you cannot perform those activities, you need to see a surgeon.

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.

cnalbert
Member

March 26, 2012 at 1:24 pm

Post count: 2

#5858

Thank you Dr. Corenman!

I don’t have motor weakness. I can crutch walk and walking on my toes, though it does need a little bit more strength.

Yes, you are right! The narrow of disc space is revealed on MRI, though i don’t know if it is the real cause.

I had an MRI a week ago. The report indicates that I have 3 mild diffuse bulged discs, mild facet antropathy, stenosis of the lateral reces, mild central canal stenosis, thickened ligamenta flava at L2-L3, L3-L4 and L4-L5. Looks like L1 is the only normal one…. The canal stenosis seems to be congenital, but other factors together contributed to a moderate to severe canal stenosis at L3-L4 level. Additionally, I have mild straightening of lumbar lordosis and Schmorl’s Nodes on L3-L4 level.

I know it sounds terrible… I didn’t realize I have so many abnormal/broken parts on my spine until the MRI… Feel depressed…

Do you think that a single gym visit could account for so much? I personally think that it might be a combination of chronic diseases with acute sports injury…

For next appointment i need to wait for a month. This is the busiest period of time of my life. I can’t just ask for a leave and take a long vacation staying at home… I really want to recover soon. I know it may not sound feasible, but do you have any other recommendations?

Thank you again and have a nice day!
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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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Young man with back and leg pain… What is my problem?