4 surgeries and still in pain

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Bettyb
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January 17, 2013 at 11:45 pm

Post count: 2

#7768

Hello Dr. Corenman, I have several things wrong with my spine but I will keep this short. My first surgery, a laminectomy, L5-S1 was done 9/08. Shortly thereafter my disc ruptured. This led to an L5-S1 fusion in 2/09. Next surgery was 9/09 – right SI joint fusion. This fusion failed and in 9/10 I had the iFuse surgery to the same SI Joint. I had no pain for the first 15 days. I followed post op instructions to a T. It’s over 2 years later I am in more pain now than I was before the SI joint surgeries. A couple of months ago I had another Cat Scan and Xray and it showed the pins were still stable. I am currently enrolled in a pain management program however I have problems with discs in my thoratic spine that prohibit me from doing many of the exercises for my lower spine. I can barely move as the pain in my right SI joint is so severe. I have tried many things, most recently acupuncture, physical therapy (again), Tens unit, etc. and while it’s too soon to give a fair report on the acupuncture, I feel so much worse after the physical therapy. My physical therapist uses ultrasound and massage and I can barely move for days, sometimes weeks afterwards. I am at my wits end. Nothing I do improves my pain, it only makes it worse. Do you have any suggestions? Thanks. Susan

Donald Corenman, MD, DC
Moderator

January 18, 2013 at 11:32 am

Post count: 8660

#7770

First-is your L5-S1 fusion solid? If so, was that proven by a CT scan or by standard X-rays?

Second, how was the SI joint demonstrated to be a pain generator? Commonly, the SI joint is a referral point for radiculopathy. Did you have SI blocks and also nerve blocks of the lumbar roots prior to the SI fusion?

How was the first attempt at an SI fusion carried out? How do you know the “pins” of the Ifuse procedure are stable? They may be “stable’ but they really need to be incorporated. Does a CT scan demonstrate that?

Where is your pain now? Where does it radiate? What makes it better and worse?

There are many unanswered questions. The more thorough you can answer these questions, the better an understanding can be gained of the pathology.

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.

Bettyb
Member

January 20, 2013 at 9:53 am

Post count: 2

#7779

Hello Dr. Corenman, Thanks for replying. It seems the L5-S1 fusion is stable with bone growth according to x-rays and a CT scan. As for my SI joint, over the period of 8 years or so I have had upwards of 17 SI joint injections under fluoroscopy and Cat Scan with 75 percent relief for 6 to 8 weeks. I have had other cortisone injections at other locations in my spine as well with little to no relief. After my L5-S1 fusion, even though I got relief from the injections I felt I had way too many and when my spine surgeon said he could help, I didn’t think twice. He did a few in-office tests like moving my leg, etc. to determine that indeed a fusion should work to help with the pain. 8 months or so after the first SI joint fusion, I was in quiet a bit of pain so I had another type of scan done. The scan showed only minor bridging with no other bone growth – failed fusion. That SI joint fusion was done with 2 screws. Since it had been 8 months my surgeon felt that it was not going to fuse on its own, which is why I had the iFuse surgery done in 9/10. I had a CT scan in May of 2012 and that scan report stated that there was no significant change and pins were still in place. I am not sure what you mean by incorporated so I am going to pull out my medical report of that scan to see if anything like that is mentioned. As for the pain, at times it does radiate down my leg to just above my knee. It hurts when I turn, it hurts when I sit, it hurts when I walk, etc. Ice helps as does pain medication but that’s about it. Lying down and exercise aggravates my entire spine. I have problems at T-8, T-9, T-11, T-12 as well as L4 and when lying on my back I get electrical shocks and knife blade pain in my thoracic spine, with nerve pain radiating around to my abdomen. My concern is that I will have to live with this SI joint pain for the rest of my life and I’m told that now the injections aren’t even an option since I have hardware in that joint. Hope this gives you a better picture and answers to your questions. Thank you. Susan

Donald Corenman, MD, DC
Moderator

January 20, 2013 at 7:51 pm

Post count: 8660

#7781

By your description, the SI joint has failed to fuse. The IFuse device is designed to have the bone grow directly into the metal “pins”. After this ingrowth, bone should grow across the joint first at the area where the pins cross and then at other areas.

The CT scan should show bone growing directly into the edges of the “pins”. If there is any evidence of a halo around the pins (an area of thin black space outlining the pins), this indicates these pins are loose and the fusion attempt has failed. If the fusion has failed, you will need a revision.

The pain in the thoracic spine is probably not related to the pseudoarthrosis of the sacroiliac joint.

If the SI joint fusion has failed, there are surgeons who are good at revision of the failure of the SI joint fusion. Search around for someone in your area to determine who you would want to garner a second opinion.

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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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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