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Dweber
Participant

March 9, 2021 at 3:46 pm

Post count: 3

#33713 In reply to: 5 months out from MD – whats going on |

Thank you Dr Corenman for replying, I can only imagine how busy you are.

My PCP was the one to order the repeat MRI and they did not do it with contrast/Gadolinium, just a regular old MRI. The radiologist report did recommend to 100% rule out a reherniation to repeat the MRI with contrast.

I have a follow up appointment with my Neurosurgeon on Monday – are there any questions you would recommend I ask?? (currently at 5 months post op on march 16th)

Just an idea but if you had a charity fund etc on here I would happily donate to your cause of choice for your helpful replies. thank you

Thank you again

the report for the L5/S1
The large extruded disc fragment present on the prior study has been resected with a new left laminectomy defect. There is abnormal soft tissue surrounding the left lateral and anterolateral thecal sack as well as the origin of the left S1 nerve root. Soft tissue extends into the left neural foramen. increased signal intensity along the posterior annual margin extending into the left neural foreman is noted. difficult to exclude a recurrent foramina disc herniation given this appearance without IV contrast as granulation tissue may sometimes simulate the appearance of a recurrent disc herniation. prominent transverse processes of L5 are noted but no definite sacralisation . Sacroilac spurring noted with osseous bridging on the right

Donald Corenman, MD, DC
Moderator

March 9, 2021 at 9:19 am

Post count: 8660

#33712 In reply to: Complex back injury question for Dr. Corenman |

You note a “6.5mm central-paracentral-foraminal left protrusion on L5S1, with isthmic spondylolisthesis…EMG showed compression on the left S1 nerve, and small radiculopathy on the right S1 and left L5”. “Eventually, 6 months later I started having muscle weakness in the left calf and had an endoscopic discectomy”.

“Now, 3 months later the left leg is much better, but there is almost no change in my right leg…The pain I have originates from the right part of my low back (around the facet probably) and is focused in my right knee. If I try to do back extensions or try to hang from a pull-up bar, the pain increases in intensity and expands to my right foot. I noticed that if I try to walk with my back flexed, all the pain goes away from my right leg”.

You have classic foraminal stenosis due to isthmic spondylolisthesis causing L5 radiculopathy. Since the foramen narrows with standing and enlarges with sitting or flexion, leg pain is worse with walking and improved with sitting or bending forward.

See:
https://neckandback.com/conditions/isthmic-spondylolisthesis-slipping-of-a-vertebra-because-of-fracture/
https://neckandback.com/conditions/foraminal-collapse-lumbar-spine/

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.

ol99
Participant

March 8, 2021 at 9:07 am

Post count: 14

#33705
Topic: Complex back injury question for Dr. Corenman in forum BACK PAIN |

Hi Doctor Corenman,

I (32M) have an issue that might be interesting to investigate.

Almost a year ago I injured my back while doing deadlifts – had mild, tolerable pain in the left buttock and back of the thigh.

9 months ago, while doing PT, I was lying on my stomach in maximum back hyperextension and pulled my left leg to the side of my body. Immediately I felt sharp pain in the right side of my low back (slightly latteral from the right S1 nerve root, maybe facet location).

A few days later my right leg, felt slightly numb/altered in sensation in the region from the knee to the foot. I did an MRI which showed a broad 6.5mm central-paracentral-foraminal left protrusion on L5S1, with isthmic spondylolisthesis, slight instability, bilateral pars defects, DDD, and an annular tear on the same level.

EMG showed compression on the left S1 nerve, and small radiculopathy on the right S1 and left L5.

I received a diagnostic nerve block in both S1 nerves. The left leg started feeling a lot better, while I felt no improvement in the right leg, and only felt minor improvement in the right side of my low back.

Eventually, 6 months later I started having muscle weakness in the left calf and had an endoscopic discectomy.

Now, 3 months later the left leg is much better, but there is almost no change in my right leg.

A new post-op MRI shows the same things as pre-op, just that the protrusion at L5S1 is smaller.

The pain I have originates from the right part of my low back (around the facet probably) and is focused in my right knee. If I try to do back extensions or try to hang from a pull-up bar, the pain increases in intensity and expands to my right foot.

If I try to do a quick flexion-extension movement, I get a lot of pain in the back of the right thigh.

If I try to side-bend to the right, I get pain in the small toe in the right foot (despite not having any herniation). This was true before and after the surgery.

I noticed that if I try to walk with my back flexed, all the pain goes away from my right leg, and I start to have a gait issue with the left one. Conversely, if I try to walk while extended, my right leg pain increases, and I develop a gait problem in the right leg.

Sitting also helps with my right leg and back symptoms, while lying down with the legs straight can be painful.

The question is, what is my pain generator?

I would opt for some kind of fusion, but it’s hard to do so without knowing for certain if my spondylolisthesis or facets are causing it. I guess I somehow injured both my disc and some bony part of my spine while doing the PT hyperextension with the leg to my side. Perhaps I now have some kind of weird lateral and flexion-extension instability on the L5S1 level along a wide a broad protrusion which irritates different nerves in different positions.

Donald Corenman, MD, DC
Moderator

March 3, 2021 at 6:52 am

Post count: 8660

#33682 In reply to: Lumbar Fusion |

Well, new symptoms that don’t match the prior surgical symptoms might indicate a new level of involvement. If these symptoms are not intense, you can try to ignore them. If however, these symptoms are impairing, a new examination and possibly new images could be considered.

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.

zzab
Participant

February 25, 2021 at 1:40 pm

Post count: 23

#33652 In reply to: 3 Weeks Post Microdiscectomy Pain |

Hi Doc,

It has been a while but I have finally got to the bottom of most of my issues. I recently flew out to see a trainer who specializes in low back rehab. The majority of his work is with well known professional athletes so I trust his judgement given the caliber of clients he works with. As I have discussed with you on here, at 4 months post op of my L4/L5 md I felt 100%. No back pain, no nerve pain, no numbness and was back to living completely normal. A little past the 4 month mark I had that fall off a tree and have not been the same since.

The trainer diagnosed with me with lower lumbar instability and lack of lower abdominal function/respiration. He does not see a re-herniation although I do still have a 4mm protrusion. Additionally a 3rd surgeon I saw before him had me take a flexion/extension X-Ray which showed a tiny bit of instability at my operated level which I was told is common after an md. I still have plenty of disc height left and no noticeable vertebra slippage on my MRI.

The trainer gave me some breathing exercises along with other stability exercises that finally got that knife in my back feeling to go away. I have seen a drastic improvement in pain during these two months which I am thankful for. I was told my rehab will have to continue for roughly 2 years so I am still in the early stages.

I am still struggling in one area in which I hope you can advise on. I still get periodic numbness and occasional muscle twitching in both legs. No nerve pain thankfully. The second I fell off the tree my left foot became hot and numb. Prior to my fall numbness had been gone for months and I never had muscle twitching. The numbness and twitching is not permeant either. I would say 80-90% of my day it is not there but sometimes the numbness can linger for hours on end. This has improved since seeing this new trainer but I do worry about permanent nerve damage since it appears daily at some point. What do you think is going on? Is there a chance I have permanent nerve damage or will this likely diminish over the next year as I continue to stabilize? My MD was 9 months ago.

cindy2836
Participant

February 11, 2021 at 6:27 am

Post count: 22

#33641
Topic: Thoracic laminectomy with bone graff and fusion T9-T4 in forum BACK PAIN |

Hello Doctor, next month I will be having the above at Ohio State Univ Neurosurgy in Columbus OH. I have a loose scrw at T10 of my current S1-T10 which we be removed. Then laminectomy due to DD (CT showed vacume phenomen) I have proximal junction kyphosis. I have lived with severe pain in my mid back since 9 months post op of the S1-T10 in Jan 2018. Epidurals and facet injections did not help. I’m a very active 67 year old who still works. I do have osteoporosis for which I do the Prolia injections. A year ago due to arm pain I had the ACDF surgery of C3-C7. So after this extension fusion next month, I will have very few vertebrae without hardware on it. I had reached out to you in July and I appreciated your thoughts on the kyphosis. I had to ask my ortho surgeon to refer me on as he did not recommend surgery as he said too rough of a recovery. My surgery will be posterior. Of course my surgeon offers no promises but I have to do something as my quality of life has declined. I’m to expect 7-10 in the hospital for this and then recover at home. I believe you said to put off surgery as long as possible and I lived with the pain but decided to pursue a fix of it. Thank you for your time!! Cindy
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Viewing 6 results - 157 through 162 (of 2,199 total)

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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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