Maxillary/Mandibular vs Skeletal Osseointegration

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SpinelessWench
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January 25, 2015 at 10:46 am

Post count: 38

#12071

Dr. Corenman,

I hope all is well with you. Just a quick inquiry regarding a recent oral surgery procedure, and its (non-) relationship with other orthopedic surgeries I’ve undergone in the past.

Approximately one month ago, I underwent oral surgery involving the extraction of my remaining 17 teeth. During the past 4-5 years, the integrity of my teeth had progressively deteriorated — they’d either develop underlying abscesses, crack, or loosen to the point of needing extraction. I’ve also had a 10-year history of developing large, mandibular tori, especially along the rear intra-lingual region. During one oral surgery procedure, I had two tori removed that extended into the lingual space 1/4″.

My oral surgeon has commented a few times that insofar as bone density is concerned, I have an over-abundance with which to work. At any rate, this most recent procedure (once the teeth were all extracted) involved the placement of 6 titanium implants — 4 in the upper arch, and 2 in the lower arch. I’m in healing dentures now, and will progress to permanent implant dentures in another 7 months. For now, we’re waiting on overall healing, plus full (hopefully) osseointegration of the implants prior to loading them with the upper and lower permanent dentures.

My question is this:

I’ve had 15 “non-spinal” joint surgeries, and 13 spine-specific surgeries… Those include the most recent (2012 – 2013) bilateral SI joint “iFuse” procedures. A post-operative consult several months ago revealed partially failed implant osseointegration on the right, as well as some loosening of the SI implants on the left. Aside from the SI failure issues, I’ve had a history of failed osseointegration (again, with implants) in the cervical and lumbar regions.

Have you run across anything in the literature positing a correlation between successful (or failed) implant osseointegration of fused spinal or cervical areas, and that of the mandibular or maxillary regions? My dental team has cautious optimism that the oral implants will fare better than some of the spine-related issues, but they’re obviously concerned given my history.

Much appreciated, as always..

SW, N.C.

Donald Corenman, MD, DC
Moderator

January 25, 2015 at 10:28 pm

Post count: 8660

#12077

You might have a non-identified disorder that makes your bone less likely to integrate with metal but I am not aware of any named disorder that would do this. I talked with a colleague this weekend about SI fusion (he does a lot of these surgeries) and he has a 70% incorporation rate. Having both sides not incorporate does go against what would be expected.

WIth all of your other surgeries, many of which I remember did not work well, there might be an undiagnosed disorder of bone metabolism that you have.

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.

SpinelessWench
Member

January 26, 2015 at 3:42 am

Post count: 38

#12084

Thanks for the quick reply, Dr. Corenman..

Is there a series of tests or labs that could identify or perhaps suggest a metabolic disorder of the bone? If so, I’d appreciate any suggestions … Might be worth it to investigate this, just for my peace of mind. These surgeries are getting a little old, especially without an explanation to precede them. I have a hard time believing that all 28 orthopedic / joint / spine-related procedures have been completely coincidental, or just the result of being a little rough on my body years ago.

The majority of the non-spine surgeries have been related to tears in the rotator cuffs of both shoulders (including a Type IIa acromion and SLAP II, which was just repaired this past Weds); tears and separations of the lateral epicondyles of both elbows; deteriorated cartilage and tears in the knee; and / or separated bone fragments & osteophytes that eventually needed removal. Many of these anomalies resulted from NO identifiable trauma or accident beyond age 35 … I just wake up (literally) in the morning with a torn tendon somewhere. And, to my knowledge, I’m not sleepwalking and scouring the woods near our home like Rambo.

You may be able to lend an opinion based on this: I was adopted as an infant (4 months of age) from a foster home. During my first 4 months of life, I was mostly fed whole milk … no supplements or other nutritional / dietary augmentation. Once adopted, my pediatrician identified me as a “milk baby” (a term that I’m not sure is still used in pediatric parlance) … To this day, my mom believes this may’ve had something to do with this bone mystery. Your thoughts?

Again, thank you.

SW, N.C.

Donald Corenman, MD, DC
Moderator

January 26, 2015 at 8:41 pm

Post count: 8660

#12089

It sounds like you might have a genetic collagen-type disorder or an insertional disorder (collagen tendon-bone interface). There are many of these disorders and I am not an expert on these. I cannot tell you where to begin but the search on Google might be helpful to start educating yourself.

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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