POTS

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john123
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May 20, 2013 at 1:56 pm

Post count: 30

#8719

Hi Dr. Corenman:

I posted last August but could not find my last post.

As mentioned, I was rear ended 3 years ago. I have a grade one spondy with major disc herniation at L5,S1. Since the accident I have experienced exercise intolerance which, after a tilt table test, indicated that I have mild orthostatic intolerance or POTS for which I was prescribed medicine.

I can walk short distance with a rigid back brace. Without it I can not walk very far at all.

1.) Is this an issue of simply rebuilding my core to replace the brace? PT has not helped very much in the past.

2.) Will spinal fusion surgery exacerbate POTS symptoms ?

3.) I am 39 yr old male and would prefer not to go through stomach. What is your preference for spinal fusion (one level) – ALIF or PLIF?

Thank you

Donald Corenman, MD, DC
Moderator

May 20, 2013 at 11:55 pm

Post count: 8660

#8720

Three years after injury with continuing disabling symptoms would mean you are a surgical candidate. A grade one isthmic spondylolisthesis with a disc herniation should be handled with a TLIF-a posterior surgery. This will stabilize the disorder and remove the disc herniation which will decompress the nerve roots.

I am generally not a fan of an anterior approach.

Generally, spinal fusion will temporarily aggravate orthostatic hypotension as the fluid shifts from surgery will cause some temporary swelling. You can have anesthesia “run you dry” during surgery which might help as some patients with heart failure need to be run.

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.

john123
Member

May 21, 2013 at 3:34 am

Post count: 30

#8721

Thank you kindly.

“You can have anesthesia “run you dry” during surgery which might help as some patients with heart failure need to be run”

1.) Can you please elaborate on the above? It sounds as though pots could effect my rehab/walking, any specific instruction ?

2.) what is difference between TLIF and PLIF ?

3.) I have one surgeon that wants to make incision through right side of my back where disc herniation is to clean out disc space, then do laminectomy (remove pars defect) and use bone from laminectomy to put in cage for fusion. Does this sound accurate or would you suggest a different method?

sorry for all the questions !

Thank you

john123
Member

May 23, 2013 at 11:30 am

Post count: 30

#8736

DR. Corenman:

sorry to keep bugging you. would you be so kind as to explain the below in a little more detial?

“You can have anesthesia ‘run you dry’ during surgery which might help as some patients with heart failure need to be run”

Thank you

John

Donald Corenman, MD, DC
Moderator

May 23, 2013 at 8:46 pm

Post count: 8660

#8737

The term “running you dry” means that when under anesthesia, the anesthesiologist will limit the fluids given to your while you are asleep. Normally. an anesthesiologist will give much more fluid than you eliminate, as much as three to four liters. This fluid overload keeps the kidneys safe but you will need to eliminate this fluid the day after surgery.

Some patients are incapable of fluid elimination (such as patients with a bad heart- congestive heart failure) and the extra fluid would end up in the lungs-a bad thing. These patients are “run dry” to prevent this problem called “third spacing”.

This could be the same technique that could be applied to you. “Running you dry” could prevent extra fluid from building up in the semicircular canals (the balance area of your brain) to prevent POTS from exacerbating.

TLIP and PLIF are similar but PLIF requires exposure of both sides of the nerves which increases the chances of nerve irritability.

You need a central incision to expose both sides for pedicle screw placement (or bilateral incisions). A unilateral (one sided-not central) incision is not adequate in my opinion to allow the best result of surgery.

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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