32 years of back,,,

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hmrhded
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March 21, 2012 at 4:28 am

Post count: 9

#5799

Dr. Corenman,
I have been suffering from a L-5/S-1 spondylolithesis for 32 years.In the beginning i tried physical therapy , lumbar stabilization cast , cortisone injections, and anything else the orthopedic doctor suggested.The doctor left the surgery option up to me. So i learned to live with the pain and discomfort.
In the last two years the pain and stiffness in my back has gotten worse.I went to a new ortho doctor last year and had new x-rays taken.The spondylolithesis is still there,but my disc is gone or least smashed down to near nothing.My body also has formed bone spurs from L-5 to S-1 to help stablize the slippage. I think that a MRI would be in order, the doctor thinks injections are the answer.
What’s your opinion?

Donald Corenman, MD, DC
Moderator

March 21, 2012 at 11:45 pm

Post count: 8660

#5802

The treatment answer is based upon how you are functioning with your spondylolisthesis. If you can tolerate the pain and the disorder does not cause significant impairment (you can participate in all the activities you desire), the you do not need surgery. That is considering that you do not have motor weakness from compression of the L5 nerve.

If you have impairment that you cannot live with or you have motor weakness, you most likely need to consider surgery. If you are not sure or are on the fence about surgery, an epidural injection can be helpful for two reasons. First- the epidural can give you some relief and if lucky, the effects may last 2-6 months. Second is that if you obtain good but temporary relief for a short period of days, relief will help you understand what the pain is doing to your life and you may decide to undergo surgery with that goal in mind.

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.

hmrhded
Member

April 5, 2012 at 6:02 am

Post count: 9

#5957

Dr Corneman, I will try to make a long story short.I requested a MRI of my back be taken.Here is the report for the lumbar region.
1. Grade 2 spondylolisthesis at L5-S1 secondary to bilateral L5 pars defects. Moderate central canal narrowing is seen with high-grade bilateral neural foraminal stenosis.
2. Broad-based, shallow central disc herniation at L4-L5 contributing to moderate central canal narrowing at this level as well.
I also had a thoracic MRI taken last week. Have not obtained the radiologist report yet.They were taken on different days. A bone scan was also taken because of three small meningioma’s around the T-3 area.
Bone scan and blood test were negative for cancer.
Can you give me an idea of what i should do next?
Thank you

Donald Corenman, MD, DC
Moderator

April 5, 2012 at 12:44 pm

Post count: 8660

#5960

Well- 32 years of back pain is a long time to suffer. The question is how problematic is the pain? Is the pain intermittent or constant with exacerbations? Does the pain go down the legs? How severe is the pain on a 0-10 scale? What does the pain prevent you from doing? How does it affect your work life/ social life/ exercise life?

32 years of 2/10 pain that doesn’t prevent outside activities is much different from 7/10 pain that prevents walking or any exercise.

The isthmic spondylolisthesis (I presume) grade 2 is a substantial deformity and can cause significant pain, especially with severe bilateral foraminal stenosis. The degenerative changes above are typical in response to the slip below. Depending upon your symptom severity, you may be a candidate for a rehab program, a set of diagnostic and therapeutic epidurals or even 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.

hmrhded
Member

May 15, 2012 at 12:47 pm

Post count: 9

#6214

Dr. Corenman , I had a single injection epidural on 4-9-12,,,I waited three weeks ( no pain relief ) and called back in to their office. They have me scheduled for another injection later this month.
In the mean time my family doctor gave me a referal to a neurosurgeon here in Iowa. I went there expecting to be treated with respect and concern about my spine.
What i got was rude and overbearing treatment from the Dr.,,,he looked at the lumbar mri and then asked to heel walk and toe walk and to bendover and touch my toes. He stated that i walk fine and that i really didn’t need surgery,but , he would for me.
Dr. if he attempts a PLIF at L-5 S-1 i am concerned about the two large bone growths or spurs that have grown between the two bodies on the anterior side. How could they be removed while doing a PLIF?

Donald Corenman, MD, DC
Moderator

May 15, 2012 at 6:50 pm

Post count: 8660

#6215

I apologize for my colleagues behavior. I think there is no room for that type of attitude in this speciality.

You need to go back to some basic questions. Do you have back pain or leg pain or both and by what percentage? Have you failed all forms of therapy? Is the pain incapacitating and intolerable?

Let us assume you have incapacitating back pain with minimal leg pain. I will also assume you have read the section under “treatments”; “when is it time to have lower back surgery” and concur with the conclusions.

The bone spurs in the front of the spine are generally no matter. They form from instability (enthesopathy- see website under lumbar DDD). Anterior bone spurs generally do not need to be removed. A fusion (I assume you mean a TLIF as PLIFs are not performed much anymore) might be the surgery you need as long as you have only one degenerative disc at L5-S1 and the L4-5 disc is normal (as well as all the ones above that).

The anterior bone spurs will generally fade away after some years (Wolfe’s law) but if they don’t, you should not notice them.

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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