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rypz79
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October 23, 2021 at 10:42 am

Post count: 32

in reply to: L5 nerve root recovery #34544

Dr. Corenman

I’ve pin pointed the paraesthesia & walking problem I have limited force to exert on my metatarsal area before pain arrives and start to get stronger.
The more I can spread my feet on the ground the more I can walk (there is no pain walking barefoot in the house though I “feel” the the incorrect signals coming from it) I wish It just “simlpe” numbness and not accumulated pain.

One more question before I see the surgeon If the concurrent MRI scan will see ANY impingement still pressuring the L5 nerve root is there still a possibility that it can heal more (less pain & paresthesia) if it will be totally decompressed with fusion, or that more than 20 months pre-op there is no chance that this kind of nerve damage will get any better?

Thank You Dr. Corenman

rypz79
Participant

October 2, 2021 at 7:35 am

Post count: 32

in reply to: L5 nerve root recovery #34435

No, the pain is in the foot itself when I’m with my thong flipflops it’s usually starts after 5-10 minutes of walking between the 1st and 2nd finger and going in strait line all over the dorsum of foot. I think it’s getting better with timw but it’s a very slow and unstable process.

I don’t have forminal collapse and I can’t tell if my forminal stenosis is lateral recessed or far lateral but from the symptoms you suggested it looks like far lateral (at the exit)

I do think there is still mechanical pressure on the nerve root when sitting in certain posture for certain amount of time I start to get “electric signals” and pain in my foot. my guess is that it shrinks the foramen just enough (probably matter of millimetres) to start “choking” the nerve.

My IDR is in bad shape. It got worsen since my discectomy & laminectomy op.
I often get those inflammatory cascades which feels like a burning sensation in the exact spot of the surgery. pain also occurs when I’m bending down several times without any support or not sitting straight 90° (e.g riding a bicycle) It’s burning and painful and as you described can take hours even with NSAIDs to subside that’s why I use a strong back brace even though I’ve strengthen my core a lot.

My L4-L5 is has also started to degenerate on rough assumption It’s 70-80% intact compared to the 20-30% of my L5-S1 where under 50% you’ll start to get DDD symptoms.

I don’t understand, there isn’t any ROM loss compared to the degenerative state my disc is (not compared to a healthy disc) or there is some sort of compensation made the body/physical therapy in time?
Is that also true for two level lumbar fusion usually L4-L5-S1?
then what’s the point of ADR(s) surgery apart from the much quicker recovery time?

Thank You Dr. Corenman

rypz79
Participant

September 9, 2021 at 9:34 am

Post count: 32

in reply to: L5 nerve root recovery #34329

Dr. Corenman

~18.5 months post op there is a significant improvement in the paraesthesia. 70-80% roughly most of the numbness is gone. heat/cold thresholds are almost the same in both feet, but there is still pain when walking with flipflops or non-cusioned shoe/clog and where I live ATM I use those a lot.

I’m considering the pros and cons of a fusion surgery. I met the surgeon couple of months ago he “pushed me” towards strengthening my core saying something like fusing one level could lead pretty quickly to ADD in the level above and strengthening my core is the “real cure”

although I think I’ve strengthen my core muscles significantly using a roman-chair an inversion-table at 90° and deadlifts there is always a position and time that will cause stress to the nerve (e.g driving an hour+ , sitting on the couch in a certain posture) or cause a vicious cycle of discogenic pain (mainly from bending forwards) even with a very good lumbar support strap in which I feel very stable and less prone to any sort of pain.

If I do a MIS TLIF to L5-S1:
1) The discogenic pain should be gone?
2) The L5 nerve root (which I believe is pretty much “alive”) will get maximal and permanent decompression no matter what’s my core strength/body weight+physical pressue ratio?
3) Will I loose significant Range Of Motion comprared to the ROM I have now with my current degenerate disc?

Though fully recovering from this kind of surgery takes about a year (bone to fuse) we are talking about a long term solution to my L5-S1 DDD while keeping L4-L5 healthy will be in my hands i.e ADD is very much avoidable ?

Thank You

rypz79
Participant

May 1, 2021 at 7:15 am

Post count: 32

in reply to: L5 nerve root recovery #34025

Dr. Corenman

I still have problem with sitting.
Even for a few minutes even on a stable chair or on a comfortable couch. Almost immediately I feel pressure on my L5 nerve root which escalates the numbness to burning sensation on my right foot bed.

I’m currently overweight ~225lbs on 6’1 frame trying to maintain a healthy diet but not living a “healthy lifestyle” which includes daily aerobic exercises some of it has a mental issue with pain/paraesthesia tolerance which I’m trying to solve with a specialist.

A few days ago I went to see the surgeon.
He said that the “next stop” for me as you projected is TLIF he said that it’s not a necessary surgery but can be useful.

Now the question I want to ask is if theoreticaly I’ll loose ~30lbs and/or strengthen my core muscles (i.e the more weight I have the more strong those muscles must be) I will not have any problem with normal sitting or my DDD w/ forminal stenosis is such a biomechanical failure that no matter what I do with your core muscles and weight loss you will get nerve pressure wherever you sit or sit for prolonged time?

I can ask this from another direction will TLIF solve this pinched nerve problem without me having to loose weight or strengthen my core muscles or anyway I’ll have to loose weight/strengthen my core even after TLIF because of potential ASD (Adjacent Segment Disease)?

Thank you Dr. Corenman

rypz79
Participant

March 12, 2021 at 8:53 am

Post count: 32

in reply to: L5 nerve root recovery #33718

Dr. Corenman

10 days ago I went for a one year post-op checkup. As you suggested the surgeon said that a re-herniation could’ve occurred but the fact that I said that I feel less pain and numbness made the impression that the re-herniation fragment probably have been absorbed.

The real truth is that my leg pain is in volatile condition it seems to me that the pain/numbness is worse in the morning while I take my first steps and gradually becomes less symptomatic during the day & night after I take my 2×150mg Pregabalin straight in the morning together with 3×0.5mg Klonopin spreaded through the day.

I try to maintain a daily routine of twice a day 10min 90° inversion stretches and core crunches along with twice a day 10min side bridge manipulation on a very wide yoga bolster. Unfortunately though I feel my back is much more stronger then 4 months ago there are still “bad” postures that never existed prior to the injury which aggravates my pain/burning sensation significantly.
I cannot live normal life while babying my back that’s impossible.

So my question is in practice if I’ll undergo a successful TLIF surgery to the stable and reconstruct the normal disc space thus open the foraminal stenosis completely will I’ll be able to sit/lye in those “bad” postures without having my symptoms aggravated or I will need to “baby” my back and avoid those “bad” postures with ones that don’t aggravate my symptoms in any case (w/ or w/o a TLIF)?

Thank You Dr. Corenman

rypz79
Participant

January 31, 2021 at 9:40 am

Post count: 32

in reply to: L5 nerve root recovery #33600

Dr. Corenman

AFAIU I’m dealing with several indirectly connected issues that are stemming from the same source – DDD:
1. Discogenic pain
2. Facet joint syndrome
3. Spine instability
4. Nerve pressure/damage

Again according to date medical knowledge there is no guarantee that even If I go for a TLIF surgery there will be an additional improvement with problem #4 but it will solve probelm #1 and prevent problems #2 & 3. am I right?

Total disc replacements (TDR) or “arthroplasty-ADR” works well in the neck but are not very good in the lower back

In general, why? because it doesn’t solve “posterior issues“ such as spine stability and facet joint syndrome?
Common sense says tells me that if you restore the disc space to it’s previous state it also decompress the foraminal space reliving the stenosis and the exiting pinched nerve on this level.

According to this brochure
There is a surgery called Total Lumbar Facet Replacement which uses a newly TOPS or NEXUX artificial joint systems that stables the facet joints function while preserving motion.

Now the question I’m asking is if you add TLFR does it (at least it theoretically) solve the problems you presented with having a TDR:

….redo decompression to free the nerve. This procedure might require removing significant facet bony mass which could make the facet incompetent. An intact and functioning facet is necessary to allow a TDR to function properly.

Thank You very much Dr. Corenman
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Viewing 6 posts - 7 through 12 (of 31 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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rypz79

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