Indications for surgery

Tagged: surgery indications for lumbar spondylolisthesis

Viewing 6 posts - 1 through 6 (of 14 total)

1 2 3 Next

Author

Posts
ol99
Participant

March 17, 2021 at 1:35 am

Post count: 14

#33762

I was reading the surgery indications article (https://neckandback.com/treatments/when-to-have-surgery/). Awesome stuff, though I have a question.

I don’t have a huge back problem – I have a single bad segment (L5S1) with a broad-based protrusion, annular tear, lost signal, lost height, and instability. All other segments are OK.

My instability is 1mm retrolisthesis when lying down, and grade I anterolisthesis in extension.

I’ve adjusted my life so that I have almost no pain, and I can walk and do office work. My issue is gait problems and lack of mobility. All issues started after a bad lift while training.

My limitations:

– I can’t go fast or run because I have a limp because of foraminal stenosis blocking nerve movement, I get pain going uphill or downhill. I can’t carry more than 8 lbs without developing bilateral calf spasms. I can’t sit on chairs where my hip is below the knees and I can’t stand still for more than a few minutes. I can’t lie down with straight legs and have to keep a bend in my back to sleep.

To sum up, I can’t do flexion or sit down too long because of the disc and I can’t do extension or stand because of spondylolisthesis, limiting any light sport activity. I used to hike about two times per week previously.

I’m 32 M and the doctors and EMG say I shouldn’t be at any risk for nerve damage. I don’t want to be greedy and get surgery just to maybe get better – since I can still function at about 30% of before my injury, and I could get worse with surgery.

We’re expecting a baby this year and I’m worried about how limited I’ll be in that regard.

I guess in a way I meet a part of the indications for surgery from the article, but I don’t know whether my situation is common and whether people that have a case like mine get better in the long-term with surgery?

I’m scared if I need to have two more fusions by the time I get to 60-70 and then I would have to spend my retirement days in constant pain… Is it even possible or advised to get ADR above a fused level?

Do you have experience with cases like this and what would a usual route be? Would there be value in stopping my instability before it gets to Grade II and beyond (or maybe this doesn’t progress)?

P.S. This has been going on for 9 months – previously I only had mild occasional back pain for about 15 years (since high school). I’d say I get a 1-2% improvement per month in functionality. I did 3x PT and do all the proper spine sparing lifting techniques. I walk a few miles every day and limit sitting time to ~1 hour with breaks.

ol99
Participant

March 17, 2021 at 2:21 am

Post count: 14

#33763

Also to add in case it helps in determining my options – perhaps my gait issue is due to muscle weakness with the S1/L5 nerves, since I do get an occasional foot slap while walking.

Two months ago I had fall while climbing stairs and hit my knee possibly causing injury since I still have pain. The doctors said to get a knee MRI if it doesn’t go away next month.

Donald Corenman, MD, DC
Moderator

March 21, 2021 at 10:27 am

Post count: 8660

#33769

“I don’t have a huge back problem – I have a single bad segment (L5S1) with a broad-based protrusion, annular tear, lost signal, lost height, and instability. All other segments are OK.
My instability is 1mm retrolisthesis when lying down, and grade I anterolisthesis in extension”.

You have an instability of the segment at L5-S1 if you go from a retrolisthesis (backwards position slip) to a grade one (3-7mm) forward slip. This can be quite painful.

You then note “I’ve adjusted my life so that I have almost no pain, and I can walk and do office work. My issue is gait problems and lack of mobility”.

Does your gait deficit and lack of mobility seem tolerable to you? If so and you have no significant motor weakness due to the L5-S1 level, then you don’t need surgery. If however, the impairment is more significant or motor weakness due to L5 nerve compression is present, you should consider surgery. In your case, L5 nerve compression could cause foot drop or gluteus medius weakness leading to a trendelenberg gait.See https://neckandback.com/conditions/walking-disorders-nerve-joint-injuries-change-gait/

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.

ol99
Participant

March 21, 2021 at 3:24 pm

Post count: 14

#33775

Interesting that you note the pain from switching between retrolisthesis and anterolisthesis. I’ve felt that type of pain but never knew that this was the reason why. I’ve had that kind of switching pain (when going from standing to lying down) ever since I was in high school, I guess that’s when I developed the pars defects.

I’m not really against surgery, some days I do think about scheduling it. I’m just scared of the unknowns.

What are the chances I get worse with surgery? Like for example, my gait issue doesn’t get resolved and I start having more pain?

Are there people that don’t have to get a second or third fusion? I’m 32, so worried I’ll get fused up to L2 or L3 by the time I’m 70.

And finally, is surgery easier and more successful if I stop my isthmic spondylolisthesis while it’s grade I? Can this progress to grade II or III? The doctors noted the slip has progressed over time.

Donald Corenman, MD, DC
Moderator

March 21, 2021 at 5:46 pm

Post count: 8660

#33779

The larger the grade of spondylolisthesis, the more difficult technically the surgery becomes. None-the-less, it is not an absolute that over time your slip will become larger. Your level is already unstable so a fusion should help you to the tune of about a 90% success for 3/4 relief of pain. In my opinion, whether you have surgery or not, the chance of the level above becoming a problem is 2.5% per year.

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.

ol99
Participant

March 22, 2021 at 1:43 am

Post count: 14

#33780

Thanks Dr. Corenman for explaining this stuff, it gives me a better picture of what to expect in the future. I will definitely post an update here in case I get a fusion.

One doctor mentioned injections – I once had a bilateral S1 interlaminar nerve block, which didn’t help with the leg pain from where my L5 is getting crushed. Does the injection need to be done differently for my condition? Like, would the L5 nerve need to be targeted in a transformational approach at L5S1, or directly in the root at L4L5?

Also, have a question about OLIF – I know you prefer TLIF, and I can go with that, but what does indirect decompression mean? Does that mean that a part of my protrusion might stay after the fusion? Or is the disc space completely cleared? I don’t have any extrusions or sequestration from the disc, apart from the annular tear. Other than that, I guess OLIF (with posterior fixation) might be too experimental still to try on an unstable segment?

Asking because I have one offer for a TLIF and another for an OLIF. I’d trust your judgment on this – would even come to your clinic but I’m too far away.
Author

Posts

Viewing 6 posts - 1 through 6 (of 14 total)

1 2 3 Next

You must be logged in to reply to this topic.

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel