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LA_Frankie
Participant

September 1, 2020 at 8:00 pm

Post count: 21

in reply to: Disc reherniation confirmed by MRI… surgeon and pain mgt don’t sound hopeful. #32931

Thank you for the prompt reply as always.
My surgeon said exactly the same things you mentioned in your reply.
However, since I still have motor loss in my right calf from S1 decompression 12 weeks ago as well as significant muscle atrophy in right leg, my surgeon said he can do the revision surgery for me sooner than later as to not risk further weakness/atrophy.
He left it up to me to get another ESI. The first one I had this year in May had no effect.

Question: what are the risks involved with multiple ESI within a 6 month time period? Does it negatively effect the outcome of the healing and or structure surrounding the disc herniation?

Lastly, would you advise a patient to try and tolerate the pain for a minimum of 6 weeks after reherniating to reassess surgery as an option?

Regards,

Frankie

LA_Frankie
Participant

July 15, 2020 at 9:30 am

Post count: 21

in reply to: L4/L5 was not touched during surgery, despite MRI report #32760

I met with the surgeon yesterday for the first time and asked why there was a change in surgical plan. He felt that the disc herniation was so large at S1 and the compression was so severe that repairing that would alleviate most if not all of my symptoms. Also I did not present with any symptoms of L5 compression from the L4/L5 despite what the radiologist report said. He also brought up additional risks with doing another level. He used a tool to feel up to the L4/L5 level to check how much room the nerves had and said it was acceptable. He didn’t feel there was enough crowding of the descending nerves to warrant the additional risks.

When I asked how the L4/L5 bulge affects my rehab going forward he couldn’t say. My body could just adapt to it, the body may absorb some of it, or I may need to address it surgically at some point. He really gave me the standard ANYTHING CAN HAPPEN response.

I guess it’s all in the rear view mirror now. Thank you again for discussing this concern with me. Thought I would tack on this last note.

LA_Frankie
Participant

July 7, 2020 at 11:51 am

Post count: 21

in reply to: L4/L5 was not touched during surgery, despite MRI report #32723

After reviewing the ‘Symptoms of Lumbar Nerve Injuries’ it doesn’t appear as though I currently have any of the L5 symptoms coming from the L4/L5 herniation.

However when I read the S1 section, it is basically describing everything I had prior to surgery and some of the lingering symptoms — especially the ‘push off’ weakness when walking.

Also the atrophy has occurred in the lower part of the gluteus maximus which sounds S1 related as well.

I still am really curious why the surgery plan changed day of… maybe it’s a moot point if I am free of L5 symptoms.

Thanks again for providing the link.

Frankie

LA_Frankie
Participant

July 7, 2020 at 10:58 am

Post count: 21

in reply to: L4/L5 was not touched during surgery, despite MRI report #32722

The surgery was done on the right side of the spine. All of my pre-op symptoms were down the right leg. Main location of pain was Rt glute/hamstring where the atrophy is now located. And as far down as my calf where the motor loss is still present but improving slightly.

Frankie

LA_Frankie
Participant

July 5, 2020 at 5:42 pm

Post count: 21

in reply to: L4/L5 was not touched during surgery, despite MRI report #32717

Thank you for the response.

Due to the timing of my injury and the pandemic, the first time I actually met the surgeon ‘in person’ was the day of surgery. We had several video calls month to month where he was made aware of the symptoms. Some of the symptoms got better at first (motor loss in calf improved after 1st month) but then I aggravated/worsened the protrusion at L5/S1 which was confirmed by a 2nd MRI.

The original surgical plan, made over the video calls, was to fix both levels although the surgeon reiterated that he believed most of my pain was due to the S1.

I was set to receive an EMG test prior to surgery but when I ended in the ER and could not stand after worsening the L5/S1 level I opted for surgery.

Day of surgery when he examined me, he never told me he would not do the L4/L5. However he did explain again that my pain falls along the S1.

As you said, proof may be in the pudding. I feel a lot better. 80% of the symptoms are gone. I am just having the very dull, burning feeling in back of the upper leg. And the calf soreness/weakness has returned — although it has slightly improved in recovery.

I see the surgeon for the first time since surgery next week and I will ask why he changed the plan, but also how does leaving the L4/L5 as is affect my rehab going forward?

Dr. Corenman, lastly, what type of symptoms would a L5 impingement cause? I don’t know if what I am feeling post-surgery is from the L5 or the irritation of the decompressed S1…

Regards,

Frank

LA_Frankie
Participant

June 26, 2020 at 1:48 pm

Post count: 21

in reply to: 2 weeks Post MD/decompression, pain on ‘good side’. What could this mean? #32705

Thanks again, I definitely will.

In another thread I saw you mention ‘some surgeons don’t want to get to know you after surgery’… I am paraphrasing, but that is the feeling I am getting from my surgeon’s office. I mentioned a new post-op symptom that has been bothersome (which I will mention below,) and the office only told me to ‘give it time’ and continue with PT as planned.

I started noticing recently that when I sit or lay down I start feeling ‘pins and needles’ in my hands, forearms, hips or feet. Not all at the same time but it varies. This was not present prior to surgery. Pins and needles in my affected right leg were there, and occasionally in my left foot. But now I feel it sporadically all over.

I am not on any medication other than NSAIDs. My blood glucose tested at home is normal.

Could new paresthesia post-op be related to the procedure and the irritation of the nerve? Why would a right sided L5/S1 procedure lead to paresthesia in the arms and legs on both sides?

Sincerely,LA
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Viewing 6 posts - 7 through 12 (of 16 total)

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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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LA_Frankie

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