L5 S1 Retrolisthesis with DDD

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TToney
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December 26, 2013 at 2:13 am

Post count: 3

#9998

Dr. Corenman,
I have a question/dilemma that I was wondering you if you could possible help me with. I’ve been an athlete my whole life and currently own a CrossFit affiliate. Weightlifting, running, jumping, climbing is a big part of what I do on a daily basis. Unfortunately this is accompanied with chronic pain. I’ve been suffering from back pain for the past 6 years. I attribute this to years of wear and tear accompanied with lifting weights incorrectly (squatting/deadlifting). In the last few of years I’ve learned to lift the correct way, improve my posture and strengthen my core. Overall, the pain has kind of come and gone, but for the last year it has been pretty constant. I had a significant flare-up last year around this time. I’ve tried chiropractic, decompression, message therapy, injections, etc. I am a big proponent of proper lifting technique and active mobilization. Unfortunately, I am beginning to think that my injury is beyond recovery through mobilization.
My last MRI in Jan of 2013 showed a herniated disc at L5-S1 with a stable grade 1 retrolisthesis. There is evidence of moderate to advanced DDD at this joint level as well. I’ve been to numerous consultations with surgeons and they all recommend a TILIF fusion. I am at a loss as to what to do. I deal with pain/ numbness at different thresholds almost daily. For the most part it is tolerable but is getting to the point of frustration. I attribute CrossFit training for keeping me in the game this long. I have a really strong low back/core but the constant nagging pain is wearing on me. Part of me believes that surgery is inevitable at some point. Am I correct in thinking this?Based on your experience, do athletes recover from this type of surgery? If I were to have it performed, what are my limitations once I have fully recovered? Are my days of squatting, deadlifting, running, jumping, pressing over with? We have a few members at our gym who have had lumbar and cervical fusions and they are performing great with minimal limitations. Is this the norm? To me, it is strange to think that I am a spinal fusion candidate with all of the things I can still do in the gym. With that being said, I am tired of the pain. My thinking is to fix the damaged joint and start completely over with the knowledge that I have gained of proper body positioning and mechanics. I am hoping that you may be able to shed some light on my situation. I thank you for your time Dr. Corenman

Sincerely,
T. Toney

Donald Corenman, MD, DC
Moderator

December 26, 2013 at 9:49 am

Post count: 8660

#9999

You are asking whether you need a fusion for lower back pain. The answer is that it depends upon the cause of your lower back pain. Degenerative disc disease can be quite painful and possibly you could need a fusion to relieve your pain.

Have you had a conservative treatment? This includes medications and injections (epidurals)? I assume that you have a strong core so PT might not be necessary.

Have you had a workup? This means possible facet blocks and/or a discogram? Depending upon your examination findings, it might be that the facets are causing your pain and you do not need a fusion but need rhizotomies (see website). If there is more than one disc that is degenerative, you might need a discogram to make sure this lower disc is the painful disc.

A lumber fusion are generally very good for pain relief in the right patient. I am a bit worried that you plan to go back to squats and dead lifts as these actions place tremendous sheer forces on the discs. In my opinion, these actions should be avoided in your case.

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.

TToney
Member

December 27, 2013 at 8:46 pm

Post count: 3

#10006

Thank you for the reply Dr. Corenman. I truly appreciate your time. The last MRI revealed that all other discs above L5 were in normal shape and good condition. I have had numerous epidural injections to attempt to calm the area down at L5 S1. Other conservative treatments have included, spinal decompression, message/physical therapy. In my experience, these only provided temporary relief. I am scheduled to have a RFA performed on the nerves. Is this the same as rhizotomies that you mentioned? I’ve read on forums that many people are worse off after having this done. Any truth to this? I’m just wondering if all of this is just a temporary solution to the problem. With the DDD and retrolisthesis at L5-S1 is it not correct to think that fusion surgery is inevitable at some point?

Donald Corenman, MD, DC
Moderator

December 29, 2013 at 1:57 am

Post count: 8660

#10010

The RFA is radio frequency ablation which is the long way of saying rhizotomies. I would recommend this treatment next as long as you had an adequate trial (facet blocks or medial branch blocks that gave you great temporary relief).

Finally, if nothing else is effective, a fusion could be in your future. There are certain appearances on the X-ray and MRI that can indicate a better success rate but your history does indicate you could be a candidate for fusion surgery.

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.

TToney
Member

January 21, 2014 at 2:27 am

Post count: 3

#10195

Dr. Corenman,
I’ve decided that L5-S1 fusion is on my horizon. With the DDD and retrolisthesis at L5S1, conservative treatment has not worked. A recent RFA provided no relief in symptoms. Some days, I feel great other days it’s aggravating pain. I’m tired of the cycle. I’ve had numerous consultations with neurosurgeons within the last year and some have recommended a TLIF fusion. The most recent surgeon that I have consulted with believes a PLIF is the best approach considering my spine condition at that level along with my lifestyle expectations post surgery. Are there advantages or disadvantages of either. Why the differences in approaches by the surgeons? Any help in clarification would be greatly appreciated. I appreciate this forum and the time you devote to answering questions.
Thank you.

Donald Corenman, MD, DC
Moderator

January 21, 2014 at 7:50 pm

Post count: 8660

#10197

The difference between PLIF and TLIF is not a big one. The fusion rate should be the same. TLIF however only requires the retraction of one nerve root for the surgery and PLIF requires the retraction of both sides. It is rare to have a nerve root “complain” from retraction but if you want to split hairs, there is slightly more chance of an irritable nerve root from a PLIF than a TLIF.

There always is a difference in “style” between surgeons. Find the one that you think is the most competent and educates you the most completely regarding his or her type of approach. Don’t be afraid to ask questions.

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.
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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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