Donald Corenman MD DC | Spine Surgeon Colorado

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rypz79
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October 7, 2024 at 7:33 am

Post count: 33

in reply to: L5 nerve root recovery #36295

Dr. Corenman

I’m 5.5 years after the LDH

I’m still suffering from numbness, pain & paresthesia when there is a pressure on the balls of right foot it could be while walking, standing or sitting. the pain gets relieved while lying down.

Last MRI from 4 moths has shown
L5-S1: “Peripheral disc bulge with forminal and extra forminal right degenerative disc. Light impression on the right lateral recess. Severe foraminal stenosis from the right with pressure on L5 from the right”

2nd opinion surgeon I’ve gone to said that only TLIF can free the stenosis and the nerve root but he doesn’t know if the nerve is not permanently impaired.
He’s suggestion is to do a transforaminal SNRB and if there is any improvement in pain levels there is a place to do the TLIF.

What is your opinion on that?
Does the TLIF “worth” the chance of getting improvement on the nerve conduction after so long?
PS I’m also suffering from back pain once in while but it’s manageable.

Thank You Dr. Corenman

rypz79
Participant

November 5, 2022 at 6:04 am

Post count: 33

in reply to: L5 nerve root recovery #35353

Dr. Corenman

I’ve seen the surgeon a month ago he said that in his opinion the compression I have does not require further surgical intervention (discectomy or fusion) . He is conservative and probably doubtful if a fusion will get my spine better then it is now. I’m gonna get a 2nd opinion.

1) The foot seems slowly getting better but I’m still suffering from my back in essence I feel already somewhat fused if I do 50-60% BLT postures I’ll get discogenic pain (and probably inflammation) reaction(s) what is the point of not getting that level fused if it is stiff and prone to pain?

2) There is a cycle I don’t understand: in the morning the foot paresthesia is at it’s worst – painful to walk and put some non cushioned shoes or sandals it gets better (more sensation) as the day progress and at night while lying in bed completely horizontal it feels like the nerve is growing/recovering sense of pleasent heat and tingling it can last couple of hours or so the foot is much less sensitive to pressure (and consequently less painful) but in the morning the story returns all over again. what are your thoughts about it? do you think inflammation has to do with it though it looks like it’s the same cycle even when my L5 -S1 disc is very guarded (unless a very degenerative disc is almost always inflammed not matter if it moves or not)

3) Lastley do you know any of these supplements : L-Citrulline, Acetyl-L-Carnitine, R-Alpha Lipoic Acid , Benfotiamine helpful for non-diabetic neuropathy and or nerve regeneration?

Thank You Dr. Corenman

rypz79
Participant

September 27, 2022 at 3:37 am

Post count: 33

in reply to: L5 nerve root recovery #35318

“Is your back pain central (both sided) or only unilateral?”
I didn’t know that back pain could be unilateral. it’s not from the left (healthy) side. it’s central and right accompanied by inflammation (burning sensation) exactly where the discectomy and laminectomy were done.

“If you are having discogenic lower back pain and that pain is limited to the L5-S1 level, a fusion (TLIF, ALIF or OLIF) should reduce substantially your lower back and leg pain (as long as a decompression is performed with your fusion)”

1. Isn’t nerve decompression comes “built-in” with fusion? when you restore proper disc height the foramen should be wide open and the is no herniated disc to pinch the nerve.
2. Are different fusion techniques suitable for different pathologies? e.g (from what I saw and understood) ALIF could be a better option for single level fusion with no spine instability or deformities it’s less destructive and could be done without the support rods connected to spine by pedicle screws.

Just uploaded my latest MRI scans (https://drive.google.com/file/d/1rMgnLd3zDCY81HraAJZEmCox9FdPvleB/view) and sent them to the neurosurgery unit where i’m treated. from the saggital view you can clearly see the re-herniation on L5-S1. L4-5 is degenerative as well with an annular diffuse bulge but still intact and doesn’t cause any back pain or pinch nerves.

Thank You

rypz79
Participant

September 17, 2022 at 5:18 am

Post count: 33

in reply to: L5 nerve root recovery #35283

Dr. Corenman

2.5 Years post-op there is a good steady slow improvement on my right foot sensation. Now I know that all the top of my foot was also numb only half of it remains partially numb. I also know that it is the same kind of numbness as in the balls of foot area which I always complain about but you don’t feel it because you don’t walk/press on this area.
I still have problem with sitting on straight chair mechanical pressure sets in shortly after followed by discogenic pain after 1-2 hours. I still cannot put pressure on the balls of my foot, stand and walk freely on them, numbness (which doesn’t bother me) becomes pain that still remains THE major issue as it restricts me from doing physical sports and hiking as I used to do.

two weeks ago I did an MRI the results on L5-S1 were: No demonstration of abnormal contrast medium enhancement after gadolinium injection. a right disc herniation pressing on the sac, pushing the root of S1 in the canal space on the right as well as on the root of L5 out the right foramen. The roots on the left are free. facets are preserved.
Well if there is pressure when lying on the MRI bed it probably increases by several folds when you stand up (I don’t have back pain when standing) and obviously when you sit down.

If I opt to fusion (MIS TLIF) (after a successful surgery, recovery and PT):

1) will I’ll be able to sit more time freely without any mechanical pressure causing discogenic pain? i.e does “no motion no pain” principle applies mainly to vertical disc motion (instead of shock absorption in a normal healthy disc)?

2) From a nerve recovery perspective is there any medical logic of fully decompressing the nerves 3.5 years after the initial damage or to much time has passed and will have no effect on the L5 nerve root damage?

3) Other then stiffness what “new” pain fusion may bring after successfull recovery (6-12 months)?

Thank You

rypz79
Participant

March 26, 2022 at 10:21 am

Post count: 33

in reply to: L5 nerve root recovery #34984

Donald Corenman, MD, DC wrote:

The upper portion of the root healed but the lower portion remains damaged and “numb”.

1) Then what is more likely to have happened does the compression impcat * time destroyed parts (or “wires” if we take the telephone cable analogy) of the L5 NR so that only the remaining “alive” parts of the nerve did regenerate hence the remaining residual symptoms or the problem is that the afferent nerve endings in the foot have atrophied so they cannot guide the nerve parts (wires) to regenerate into them?

2)”Functional” recovery will be the ability to put pressure (weight * distance) on my right foot balls (plantar flexion) without causing pain aggravation does a Radiofrequency Ablation (RFA) to the foot balls area can completely numb those damaged nerves?

3) Agmatine sulfate. there are some studies (including for NASS) suggesting it might help “alleviating pain and improving quality of life in lumbar disc-associated radiculopathy” have you heard of it? do you think it might help in conjunction with 300mg of pregabalin?

Three months prior to the surgery I did a TFESI SNRB with Betamethasone mixed with Lidocain It did little to no help. I really doubt if it will make a an impact but I’ll give it a try.

Thank you Dr. Corenman
I really hope something will help eventually

rypz79
Participant

March 24, 2022 at 2:47 am

Post count: 33

in reply to: L5 nerve root recovery #34972

Dr. Corenman

25 months post surgery though I really started doing PT including inversion table 3-4 months or so after the surgery due to the covid19 outbreak.

There has been oveall improvement.
I think the nerve recovered from L5 root down to the foot. I now can sit with my right leg on the left one or lye (put pressure) on my right sciatic nerve without it aggravating my foot paresthesia.

The problem still remains in the foot I can feel somthing is going out there (burning, tingling, stabing pain) but still wearing a tight close shoe or putting pressure on my foot balls is painf and unpleasant. the process didn’t reach all the afferent nerve endings.

Based on the fact that we don’t know exactly what damage have been caused to my L5 NR during those 9-10 months of compression and assuming that we are talking about axonotmesis with these symptomatic findings over this period of recovery time my questions are:

1) From the known medical literature can sensorial (afferent) nerve get atrophied / become scar tissue? I mean can I feel numbness instead of pain or in other words the path to recovery is pain becoming numbness and maybe afterwards correct sensation signals?

2) Does lumbar radiculopathy (sciatica) that causes ONLY foot paresthesia classified as axonotmesis with recovery time greater than 24 months will ALWAYS end with some kind of neurological deficits?

Thank You
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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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rypz79

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