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rypz79
Participant

June 3, 2020 at 10:32 am

Post count: 33

in reply to: L5 nerve root recovery #32603

Hello Dr. Corenman,

I’ve checked all the symptoms and compared the affected dermatome areas it’s very unlikely that we are talking about TTS.

The only thing that botheres me in this situation apart from the discomfort of numbness and pain is the idea that it will persist.

“A decompression surgery of the nerve (microdiscectomy of the lumbar spine or lateral recess decompression) will generally take the pressure off the nerve and in 90-95% of the cases the nerve will recover”

is very encouraging.

The question is how do you define recovery:
is it full, partial or just an imporvement from the the pre-op status?

Do “low grade” symptoms are the thoughest to heal or just the opposite it means that the nerve is much intact and very likely to fully heal?

Does numbness differs from pain in terms of nerve damage and repair?
Is this pain called neuropathic or somatosensoric pain?

And last question is the “time table” for this kind of nerve repair is up to 12 months in which diminishing negative symptoms is the only indication for it’s progression?

Thank you very much Dr. Corenman

rypz79
Participant

May 20, 2020 at 8:00 am

Post count: 33

in reply to: L5 nerve root recovery #32573

Hello Dr. Corenman,

It’s now 3 months since my operation.
S1 is clear I confirmed that with the surgeon.
The remaining issue is numbness mainly in the balls of the foot and in dorsum of it, the same symptoms that led me to do the operation.

The problem with the balls of the foot is that you use them all the time standing, walking, running or doing heel raises. The more pressure there is on this area the more painful/irritated it becomes. There is also a loss of skin sensation (dermatome) in this area compared to the other sole.

Why do I have those symptoms in the terminal parts of the nerve and never in the path of it?

If we are talking about some axonal damage with the myelin sheath still intact does the distance (from l5) plays a role in this situation ?

Thank you very much Dr. Corenman

rypz79
Participant

April 17, 2020 at 4:15 pm

Post count: 33

in reply to: L5 nerve root recovery #32458

Hello Dr. Corenman,

Well while testing the toe raises again and again I found out that both heads the calf muscles (Gastrocnemius and Soleus I can’t really tell) are weak the outer head feels somewhat dormant. They just won’t contract as in the left leg. You can easily tell by just contracting them both while sitting the right ones feel weaker. The muscle feels like it shrunk but it’s not visible.
When I’ve checked in your article https://neckandback.com/conditions/symptoms-of-lumbar-nerve-injuries/ I’ve found out that those muscle group are fed by the S1 nerve root could I have also some irritation there ?

A question about nerve budding. does exercise encourages this process? i.e the more you try to activate those dormant muscle cells the more chance they can bud with a nearby active cell?

Thank you very much Dr. Corenman

rypz79
Participant

April 13, 2020 at 9:34 am

Post count: 33

in reply to: L5 nerve root recovery #32437

Hello Dr. Corenman

There are somethings that I’m not sure I’m fully understand from https://neckandback.com/conditions/peripheral-nerve-anatomy/ I’ll try to question as precise as I can:

1) It’s written

A nerve is really a collection of thousands of nerve cells in one bundle- something like a telephone cable with thousnds of individual wires within the cable

So when we are talking about a nerve root (cable) damage we can be talking about multiple injury types i.e each nerve cell (wire) can sustain a different type of injury?

2) In axonal regeneration its written that

The nerve ending may terminate in a muscle, a sensory organ (skin sensation) or a proprioceptive organ (coordination sensation…)

So in case of l5 or s1 nerve root damage as this, how can the lower leg/foot recover from paresthesia while it cannot recover from motor/muscle loss or it can’t recover from both? or does axonal regeneration is reserved only for muscle nerve cells?

3) In nerve sprouting it’s written

This sprouting activity can take from 12-16 weeks after the initial injury to occur

While the compression place, degree and time determines the type of nerve injury sustained are all the nerve recovery times written: Myelin injury: 8-14 weeks , Axonal regeneration: 12-18 weeks , Nerve Budding: 12-16 weeks, get restarted from the time of the decompression surgery?

Thank you very much Dr. Corenman

rypz79
Participant

April 10, 2020 at 11:40 am

Post count: 33

in reply to: L5 nerve root recovery #32421

Hello Dr. Corenman

I’ve reached the half-way mark of 12 weeks.
My leg strength is improving I’m now able to do 20 toe rises much easier. I will move to sets now, trying to complete 3 sets of 20.
I’ve also got balance problems I’m a bit shaky while standing on this foot, I’m working on it also. There is some pain when I’m dorsiflexing my right foot forward while sitting.

BTW I saw the heel rise exercise for the S1 nerve root it is quite similar to the toe rises but you needed somekind of step for that am I right?

I’ve just walked half a mile and I feel the improvement but still it’s not as my left foot.
It still aching. not painful, not numb but with a loss of sensation. The irritation (feels like burning) grows when I’m crossing my right leg over left one that is one of my favorite ways of sitting.

I’m more worried from the radiculopathy/sciatica then from the motor loss/weakness.
With this progress can I expect all these symptoms to reslove within the the 12 week mark?

Thank you very much Dr. Corenman

rypz79
Participant

April 2, 2020 at 10:26 am

Post count: 33

in reply to: L5 nerve root recovery #32397

Dear Dr. Corenman

After further checking the physical condition of my foot using a video tutorial I did find wasting of the Extensor Digitorum Brevis i.e the muscle ball near the ankle of my right foot doesn’t feel as strong and is less visiable then of my left one I’ve also tried the test for weakness of the Extensor Hallucis Longus and passed it there is no differences with the toe power. SLR was always negative, there is no noticeable diminished sensation on dorsum of the foot.

From your tutorial https://neckandback.com/conditions/home-testing-for-leg-weakness/
On L5 I’ve passed the 20 feet duck walk test with ease but when I’ve tried the 20 straight tip toe check I immediately saw that there is a noticeable difference between the two legs I can do it with my right foot (not without sending a hand to stabilise myself) but it’s much easier to do with my left one. I will practice on that more depending on the pain produced but in general is this muscle power unrecoverable if we’re talking about axonal damage?

Is the pain I’m feeling after this exercise in the balls of my feet is meets your definition of “pain inhibition”? It gets worse when I push harder.

Is my “voluntary limping” (to minimize pain while walking normally) for several months prior to the surgery could also contribute to this muscle weakness?

Are those new weakness findings suggest anything about the type of injury I sustained and the time needed for recovery?

Thank you very much Dr. Corenman
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Viewing 6 posts - 19 through 24 (of 32 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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rypz79

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