Incomplete Spinal Fusion

Tagged: failed back surgery syndrome, Incomplete Fusion lumbar spine

Viewing 6 posts - 1 through 6 (of 108 total)

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sperryguy
Participant

May 11, 2015 at 12:22 pm

Post count: 68

#19375

Dr Corenman

I underwent a TLIF procedure on my L4/S1 in November 2015. It was tough recovery possibly because I over 58 years old. I am in good shape, lost weight, don’t smoke and only an occasional glass of wine. The pain did subside and at around 2 to 3 months the numbness, tingling, and some leg pain return along with the stiffness and a level 2-3 pain. The pain level would depend on my work day(office work). The surgeon did a few xrays and was satisfied. He said this is normal. However as the symptoms increased, he relented and ordered CAT and MRI with and without contrast. The imaging showed an incomplete fusion. He wasn’t concerned and said to strengthen my core muscle through PT. Initially he felt PT wasn’t necessary. After close to 7 months, I am concerned, and questioning the success of the surgery. What are my options? What questions should i be asking? Should i go for another opinion. What are my options if this continues? The instrumentation is titanium. Thanks again for all your help(posted pre surgery)

Donald Corenman, MD, DC
Moderator

May 11, 2015 at 5:49 pm

Post count: 8660

#19378

A solid fusion can take up to one year but suspicion of a pseudoarthrosis (lack of fusion) has to be considered at this point. If a CT scan was performed, there are “clues” or certain findings that can convey a feeling that this will eventually fuse or might go on to non-union.

An electrical stimulator can be considered (called a bone growth stimulator) and this might be able to tip the scales to fusion (depending upon the findings of the CT scan).

A second opinion might be helpful as long as this fellow (or madam) is honest and not out to disparage the initial surgeon.

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.

biofreeze
Participant

May 12, 2015 at 8:27 pm

Post count: 99

#19468

Sperryguy

Can you please tell us if your surgeon
used BMP in your fusion surgery ??

sperryguy
Participant

May 13, 2015 at 5:18 am

Post count: 68

#19474

Yes though I did expirience spasms at around 6 weeks. Some people are more prone to this side affect. They gave me Valium low dose. It did work.

biofreeze
Participant

May 13, 2015 at 7:54 am

Post count: 99

#19475

That is interesting. Thank you.

I’m suppose to have same surgery soon.

Most Drs say that if BMP is used that you drastically increase your fusion rate.

It sounds like you had a good surgeon. Let’s us know what happened regarding fusion.

This is a tricky surgery. It does sound like it can take a full year to recover.

Good luck !

sperryguy
Participant

May 13, 2015 at 8:46 am

Post count: 68

#19476

I was told that roughly 10% of those using it have a reaction. My experience taught me not to push going back to ones regular routine to quickly. Walking is essential, and the best therapy. Rest, Rest, and more Rest. Good eating habits so the bone fuse properly. I also insisted on a service that monitored my spinal cord during the surgery to avoid issues. I was fortunate and had a neurosurgeon and an orthopedic surgeon working together. To avoid nausea(I was prone to this)or at least reduce the possibility, a night before I was given a anti nausea patch and then during in the IV they gave me Zofran. Works very well. This should continue throughout the week. Takes that long for all the drugs to leave your system. Best of Luck, and heal well
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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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