XLIF - Day 1

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

Author

Posts
jayd10033
Participant

February 26, 2022 at 3:57 pm

Post count: 79

#34908

Hell Doctor, I believe I mentioned I was having XLIF and I’m one day post-op and discharged home.

I was told incisional pain could be alot, and it is much more so than with the previous microdiscectomy I had. It is VERY painful to move or adjust in bed. Pain meds help somewhat, but not a lot. I’m hoping this is normal (I am so fearful of another discitis, and this pain feels somewhat like that did I think b;c of the psoas being involved in the approach).

My actual question is about my abdomen, which seems bloated, and swollen. My surgeon said it’s due to a combination of gas,fluid from surgery, and not having a BM yet, and it will go down in time. Is that your experience as well?

How many days will the pain be this limiting barring complications? I can get up and walk around, but I have some discomfort in the front of my thigh, etc.

Will keep the group posted on progress if it’s helpful.

Details from surgery below:

HARDWARE:

SPACER MOD XLW 10 DEG 8X22X50MM – LOG2222714
SPACER MOD XLW 10 DEG 8X22X50MM
NUVASIVE INC
ML1639
Anterior 1 Implanted

DRAINS: NONE.

CONDITION: STABLE TO PACU.

FINDINGS: L3-4 SPONDYLOSIS S/P DISCITIS, LEFT L3 NERVE ROOT PERINEURAL SCARRING S/P DISCITIS, RETROLISTHESIS.

PROCEDURE: The patient was transferred here from the operative holding area to the operating suite where general anesthesia was administered by the Department of Anesthesia. Sequential compression devices were placed on the bilateral calves because for DVT prophylaxis. Perioperative intravenous antibiotics were was administered. Neuromonitoring leads were placed.

POSITIONING: The patient was positioned in the lateral decubitus position with the left side up on the Amsco bed with care to position the cervical spine in appropriate position and the axilla free of compression. All bony prominences were well padded as well as the ulnar nerves at the elbows and peroneal nerves at the knees.

PREPPING AND DRAPING: The patient was prepped and draped in the usual sterile fashion and manner utilizing ChloraPrep solution and Ioban draping.

INCISION AND EXPOSURE: Following surgical time-out and radiographic localization, a 4 cm incision was made in the left flank over the L3-4 disc space in a transverse manner. Electrocautery was utilized to achieve hemostasis. Blunt dissection was utilized to dissect through the subcutaneous fat. With great care in the lumbar fascia was incised with Metzenbaum scissors. The external oblique, internal oblique and transversalis musculature was spread bluntly. The transversalis fascia was snipped and the retroperitoneal space was entered. Digital dissection was utilized to develop the plane lateral to the psoas and to reflect the peritoneal sac anteriorly. Retroperitoneal fat was gently dissected. The psoas muscle was palpated.

SEQUENTIAL TUBE DILATION: Sequential tube dilation was performed with the NuVasive NeuroVision system with triggered EMG hunting algorithms and fluoroscopic guidance gently spreading the fibers of the psoas muscle and docking on the left L3-4 disc annulus. A K wire was inserted into the left L3-4 disc annulus for stabilization. The Maxcess retractor also under triggered EMG and docked on the disc. This was also performed under fluoroscopic guidance. The lateral annulus was visualized. A hand-held EMG probe was utilized to confirm that no neurologic structures were within the surgical field. Microscopic magnification and microsurgical techniques were also utilized for hemostasis and to confirm that no neurologic structures were at risk.

EXPLORATION OF LEFT LUMBAR PLEXUS: The left L3 nerve root was visualized and explored status-post discitis with extradiscal and foraminal extension resulting in radiculopathy. Neuroloysis of the left L3 nerve root and lumbar plexus was performed utilizing surgical microscopy and microsurgical techniques. At the the completion of the this portion of the procedure, the L3 nerve root and component of the lumbar plexus was free of further compression.

ANTERIOR DISCECTOMY: An annulotomy was performed in the left lateral annulus followed by discectomy with pituitary rongeurs and Kerrison rongeurs. A sharp Cobb was utilized to elevate the cartilaginous endplates were well was left to them off of the cephalad aspect of L4 and the caudad aspect of L3. The remaining cartilaginous endplates were removed. There was no gross evidence of infection in this disc. Similarly, the bone was of good quality. Ring curettes and rasps were utilized to prepare the endplates with healthy bleeding bone.BONE MARROW HARVEST: 10cc of bone marrow was harvested from S1 utilizing a Jamshidi needle and syringe for autologous fusion purposes.

ILIAC CREST BONE MARROW HARVEST: A Jamshidi needle was inserted through a separate fascial incision and separate skin incision into the left posterior superior iliac spine. 5 cc of bone marrow was aspirated in order to combine with of ethos tricalcium phosphate allograft for fusion purposes.

ANTERIOR LUMBAR INTERBODY FUSION: An appropriate-sized NuVasive titanium cage was chosen with a 55 mm x 22 mm lordotic footprint 8mm cage chosen. This was filled with a combination of local autogenous bone graft saved from the endplate shavings, allograft with bone marrow aspirate and extra small infuse. The cage was then inserted under fluoroscopic guidance. Excellent distraction and fit was noted.

Hemostasis was confirmed and the retractor was removed.

CLOSURE: Copious irrigation was performed. The transversalis fascia was closed with 0 strata fix PDS suture, the transversalis musculature, internal oblique and external oblique were all reapproximated with 0 Vicryl suture. The subcutaneous tissue and lumbar fascia were closed with 2-0 Vicryl suture. The skin was closed with 4-0 Monocryl suture. Dermabond and Steri-Strips were applied. A sterile Bioclusive dressing was applied.

WOUND CLASSIFICATION: CLEAN.

SPECIMENS: NONE.

COMPLICATIONS: NONE.

Donald Corenman, MD, DC
Moderator

February 27, 2022 at 1:42 pm

Post count: 8660

#34910

Your experience is not unusual. A retroperitoneal approach can commonly cause an ileus, This is where the intestines “go on strike” which causes abdominal discomfort, bloating, nausea, lack of passing gas and swelling of the belly. This can last for 2-4 days and food intake needs to be restricted. This will pass. Did you have a posterior instrumentation?

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.

jayd10033
Participant

February 27, 2022 at 1:52 pm

Post count: 79

#34912

Thanks doctor, I guess I didn’t copy the whole thing. Below is the Posterior work:

POSTERIOR SPINAL FUSION: Utilizing the retractor blades, the left L3 and L4 medial transverse processes, L3 pars, and the lateral aspect of the left L3-4 facet joint were identified. The posterolateral bony elements were denuded with electrocautery and then decorticated utilizing aggressive currettage. The space was packed with local autogenous bone graft and additional Vitoss with bone marrow aspirate in order to perform posterior spinal fusion posterolaterally at the facet.

POSTERIOR INSTRUMENTATION: A 55 mm rods was placed. Set screws were placed and then finally tightened utilizing torque-limiting screwdriver. The entire construct was then visualized utilizing fluoroscopic imaging in both AP and lateral views and noted to be in appropriate location. In this manner, posterior non-segmental instrumentation was performed.

CLOSURE: Copious irrigation was performed. The fascia was closed with #0 Stratafix suture. The subcutaneous tissue was closed with 2-0 Vicryl suture. The skin was closed with 4-0 Monocryl Stratafix suture. Dermabond and Steri-Strips were applied. Marcaine 0.25% was injected. Sterile bi-occlusive dressings were applied.

jayd10033
Participant

February 27, 2022 at 2:10 pm

Post count: 79

#34913

Today I was able to pass gas, and have a very small, mostly liquid BM, but continue to feel bloated. I have not restricted eating (though I am eating much less) — perhaps I should.

Donald Corenman, MD, DC
Moderator

February 27, 2022 at 4:48 pm

Post count: 8660

#34914

You are on the right track. Passing gas is a good indicator of clearing the ileus. As long as you limit your intake for now, you should be fine.

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.

jayd10033
Participant

February 28, 2022 at 8:54 am

Post count: 79

#34917

Thanks. The incision is very painful, and any use of my abdominal muscles is as well, which makes it impossible to easily pass a BM. Taking Miralax and Senna and hoping it improves over the next few days.
Author

Posts

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

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

XLIF – Day 1