2 years post-op ALIF (L5-S1)

Tagged: ALIF fusion, Disc osteophyte complex

Viewing 4 posts - 1 through 4 (of 4 total)

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Jbruce
Participant

September 9, 2016 at 7:46 pm

Post count: 3

#22940

Hi Dr. Corenman,
I have a question regarding my new CT Scan results..I am a 35yo male who is 3 years post-op a failed L5-S1 laminectomy/discectomy and 2 years post-op an ALIF at L5-S1 w/instrumentation. My pain never really went away that much after the fusion except I did get some relief of the sciatic pain I was having. I recently went in for a lumbar CT scan and the results were not what I was expecting. It states:
1. “A broad based disc bulge at L4-L5 resulting in central canal narrowing and bilateral neural foraminal narrowing”.
2. “Disc osteophyte complex resulting in central canal narrowing and partial osseous fusion across the L5-S1 disc space”.

I knew the possibility thst the L4-L5 disc might someday begin to break down and possibly bulge or herniate, but now? Only 2 years after the fusion? I’m young, healthy and skinny. I expected this to occur a long tine from now if it ever did. Is this common so early in the fusion process?
Also, the disc osteophyte complex, which I have learned are bone spurs, is this a common occurrence at the fusion site? My pain is still so bad I have to be on opioids..even 2 years later! Now it seems to be getting worse by the day and I’m wondering what you think about these 2 issues the CT scan picked up?
Thanks Dr!! You’re a blessing to so many of us:)
Thanks,
JB

Donald Corenman, MD, DC
Moderator

September 11, 2016 at 8:25 am

Post count: 8660

#22941

The breakdown of L4-5 only 2 years after your L5-S1 ALIF is quite unusual. I would think there was some preexisting degeneration of L4-5 prior to the surgery.

I am unclear what “partial osseous fusion” means. There might be a solid fusion but different radiologists have different meanings for this phrase. I will assume you have a solid fusion at L5-S1.

You still have continued stenosis at L5-S1 (“central canal narrowing”) but the radiologist did not use a modifier (moderate, severe) to indicate the amount of narrowing. This by the way is common with an ALIF as the anterior approach generally does not do a good job of posterior decompression. Your continued symptoms could be from the continued narrowing.

Your symptoms need to be correlated to the disorders found on your MRI. See the section “https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-lower-back-and-leg-pain/” to desire your symptoms.

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.

Jbruce
Participant

September 11, 2016 at 1:52 pm

Post count: 3

#22951

Thanks for the reply Dr.Corenman. To following up with you, my current Dx is: degenerative disc/joint disease, spinal stenosis (lumbar), osteoarthritis and post op the two surgeries I mentioned before. Due to the degenerative disc disease, what you mentioned about having preexisting degeneration to the L4-L5 makes sense. Is that something that should have been noticed prior to the ALIF?
Also, my apologies…the radiologist did say “moderate” central canal narrowing. And yes..I have been told that I do have a solid fusion. The pain is focused directly in the lower back right where the scar/indentation is from the failed L5-S1 discectomy/lamencectomy I had 3 years ago. The reason I say it failed is because the surgeon diagnosed me with Failed back surgery syndrome after that operation left me on more pain than when I went in. The discectomy was done at L5-S1 due to a “Brad based far lateral disc herniation” in that area. Being in so much pain and having stability issues is why a year later the ALIF was performed. The L5-S1 had a lot of degeneration also.
My lower back pain stretches across the entire lower back and is usually a 7/8 on the pain scale. It usually hurts in the morning a bit, then in the afternoon it can sometimes get a bit better, but by the evening it comes back really bad. So bad I have to lay down, sometimes by 5pm. It gets worse depending on my level of activity for the day.

So Dr. Corenman, you think most of the pain stems from the stenosis? Is it possible the disc osteophytes would be causing pain? I know the osteoarthritis can also cause severe pain like this as well. I don’t know what to do to get better, and I’m scared my surgeon will mention surgery again which I can’t handle right now!

Thanks So Much Dr!
JB

Donald Corenman, MD, DC
Moderator

September 11, 2016 at 8:33 pm

Post count: 8660

#22952

Stenosis can cause standing and walking pain that is relieved by sitting and bending forward. If you have a solid fusion at L5-S1, you could have residual pain from stenosis as well as degenerative disc disease and facet disease. A workup including a diagnostic small volume epidural steroid injection at L5-S1 (vs. L4-5) can give diagnostic information and possibly long term treatment.

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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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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