I am worried about have this surgery done

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samstrt
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January 31, 2014 at 10:28 am

Post count: 2

#10271

I have seen your surgeries on you tube and am very impressed.. I’m a male 54 yrs old.Diagnose through CT scan Facet joint disease at L5-S1. At L4-L5severe disc desiccation with severe loss of disc height, broard base disc bulge,mild central canal narrowing, indentation of the thecal sac from its right lateral aspect due to proliferative changes moderate to severe bilateral foraminal narrowing , suggestion of right paracentral protrusion. At L3-L4 diffuse disc bulge. and ligamentous hypertrophy and Facet joint disease, severe bilateral foraminal narrowing. Plus more. I do have a spinal cord stimulator since 2000. and replaced with new one in 2013. symptoms of neurogenic cluadication doctor want to do surgery on L3-L4 Laminoforaminotomy to address dineurogenic claudication from central stenosis. plus a lumbar fusion and also would like to add another SCS around area of the conus and L1-L2 to address my severe pelvic pain I am affraid of this surgery he had said that chances are that he could perice the nerve sac, which fluid would leak out and then he would have to go back in to repair it. I would give you any more infore but your thought would be very calming and useful to me. this would be my 5th surgery in 20 years.

Donald Corenman, MD, DC
Moderator

January 31, 2014 at 5:36 pm

Post count: 8660

#10272

There are many questions to be answered based upon your MRI findings. Why do you have a spinal cord stimulator? Normally, one is implanted if a surgical procedure was unsuccessful and you are left with chronic radiculopathy (see website).

There is no indication of prior surgery on your MRI report in spite of your having multiple prior surgery. You note this will be your 5th surgery in 20 years. Were these spinal surgeries or something different?

You note you have symptoms of neurogenic claudication. This might be but can you describe your symptoms directly. You might have neurogenic claudication but also might have symptoms of foraminal stenosis and even degenerative disc disease.

Having a dural leak (a leak in the dural sac) with prior surgery is generally not common but if occurs, can be repaired if necessary.

Has your pelvic pain origin been diagnosed?

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.

samstrt
Member

January 31, 2014 at 9:48 pm

Post count: 2

#10284

OK Dr.,
I have a stimulator because of severe pain based on my first and second back surgery in 1995 and 1996 the first surgery was to repair a herniated disc in the L4 region and the secound surgery was to remove scare tissue for the same after those surgeries i had suffered with intence pain and numbness in lower back and legs . had all sorts of injection and even ( forgot the name) where under x-ray the doctor used micro waves on the nerve? but that all didn’t work. finnaly i went to a pain management doctor in 1999 and she had gotten my pain down to a sometimes manageable point to eventually suggested a stimulator to help with my chronic pain the procedure was done in 2000. and i dealt with it for 8 years though i stopped the pain meds in 2001. in 2008 i had a ruptured disc in my neck and then in 2011 i was suddenly experienced severe pressure -pain in my pelvic region enough pain to bring me to my knees. I went to a neuro surgeon and he never suggested and treatment for me other than to replace the stimulator with a newer one . symptoms are severe pain in the L 4 L5 pressure pain in the pelvic area numbness in left leg and right. I do have degenerative disc disease Failed back symptom. the surgeon says he can say if the pelvic problem is cause by what i had read from the report. i had a CT with contrast done but no tumor. I am scheduled for a mylogram. But no MRI because of my stimulator I ‘ve seen 2 doctor and the reason i am scared is they both say i can become crippled if i don’t have this done beside the dual leak. Anyway doctor that’s what going on and i have been dealing with this back pain and numbness and weakness since 1994. to note . my family history has – my brother have spine problems -my uncle had back surgeries and 2 generation ago on my moms side 2 crippled relatives. so i’m guessing that’s where it all comes from. Thank you very much for spending some time with me from you busy schedule Joe

Donald Corenman, MD, DC
Moderator

February 2, 2014 at 8:52 am

Post count: 8660

#10295

Unfortunately, you developed chronic radiculopathy (see website) that the two surgeries in the 1990s failed to cure. You underwent chronic pain treatment and finally had a stimulator place in 2000 which was helpful.

For no reason known to you, you developed chronic pelvic pain in 2011. This was in addition to chronic lower back pain and numbness in the lower legs. I assume that these other symptoms (not pelvic pain) were also new and not preexisting. Correct me if I am wrong.

If you have no identifiable compression in the spinal canal based upon the CT myelogram, your numbness is more likely than not from chronic injury to the nerves. If you have compression of any neural elements, this compression could be your source of leg symptoms.

Your lower back pain could be another story. Degenerative changes of the discs and facets can cause lower back pain. Occasionally, this pain can be treated surgically.

If you avoid a new stimulator implantation, it is unlikely that you will be crippled but your pain will not improve. There is alway the chance of a dural leak with a stimulator implantation and removal but this is unlikely.

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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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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