32 years of back,,,

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hmrhded
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August 4, 2012 at 3:12 am

Post count: 9

#6658

Dear Dr Coreneman , I wanted to update you on my surgery. I had what was suppose to be routine PLIF on 6/26/2012.
It turned out to be anything but routine , due to the very large anterior osteophytes the spondylolisthesis was not repaired at all.A Gill laminectomy ,bilateral foraminotomies, pedicle screw fixation, and lateral mass fusion took place.
People if your doctor won’t listen to you , get up and leave! Find another doctor that will listen and go over the procedure with you. I provided MRI’s and x-rays twice to a neurosurgeon , and he still didn’t look at them until he couldn’t open the interbody space between L5/S1.Then it was too late , to remove the bone spurs , according to the surgeons assistant.
Out of four doctors ,Dr Corenman was the only one to correctly diagnose my condition! I wish i had taken the extra time to visit and get treated by Dr Corenman .

Donald Corenman, MD, DC
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August 6, 2012 at 10:21 pm

Post count: 8660

#6669

I have to define what certain surgeries are by their initials to clear up any confusion.

A TLIF is a transforaminal lumbar interbody fusion. This is a procedure where the facet on one side is completely removed to allow access to the disc space. This allows fusion of the disc space along with fusion along the lateral gutters. The removed facet is recycled as bone graft. The lateral gutters are the location of the transverse processes and the opposite sided facet. The TLIF procedure allows a front and back fusion from just a small posterior incision. There is no need to make an incision in the belly.

The PLIF is a posterior lumbar interbody fusion. It is a similar procedure to the TLIF with one small incision in the back and also allows fusion of the disc space. The difference is that the approach to the disc space occurs on both sides of the back of the spine. This requires retraction of the roots on both sides. This is now unnecessary since the advent of the TLIF and this procedure is somewhat out of vogue.

The PLF is a posterolateral fusion and can be confused with a PLIF but they are two very different procedures. The PFL is a posterolateral fusion. This procedure fuses only the back of the vertebra (lateral gutters as noted above) and this procedure is useful for patients with less need for a strong construct or those with multilevel needs. Older individuals and those with the need of multilevel level fusion (scoliosis or kyphosis reconstruction) will utilize this procedure.

Your procedure sounds like a PLF. This can be successful for a spondylolisthesis but is generally not recommended as the rate of success is less than if a TLIF was performed.

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

August 7, 2012 at 4:41 am

Post count: 9

#6676

Dr Corenman,
I will type it as it appears on the hospital report.
Indication for Admission: this is a 47 year-old gentleman with chronic back pain for 32 years. He has had increasing leg symptoms in recent months. He has a grade 2 spondylolisthesis at L5/S2 and is being admitted for a one level decompression posterior lumbar interbody fusion.

Operative summary:The patient was prepped and draped in a routine fashion in prone position, and a midline incision made. sharp dissection was used to expose the spinous process and lamina in the lower lumbar region in the sacrum. the O-arm star was then attatched at L4 and images generated. Pedicle screws were placed at L5 and at S1 bilaterally without great difficlty using 45 x 6.5 mm and 35 x 6.5 mm screws. con,,,

hmrhded
Member

August 7, 2012 at 5:06 am

Post count: 9

#6677

con,, These were inserted under O-arm guidance and then tested electronically with good placement and no evidence of nerve root impingement. once this was accoplished , i did a complete gill laminectomy. once i had exposed the disk space , i attempted to open this up with interbody spreaders , but it was clear that the large anterior osteophyte and the collapsed disk has essentially fused the disk and i really could not open it up even getting spreaders and i simply was breaking the bone, but was not opening up the interspace. at this point ,i simply widened the foraminotomies out as far as i could and decompressed the nerve roots.there had been a small central tear in the dura when doing the gill laminectomy where there was inflammatory tissue stuck posteriorly.This was closed with a single 4-0 Nurolon suture. con,,,

hmrhded
Member

August 7, 2012 at 5:13 am

Post count: 9

#6678

con,, the wound was thoroughly irrigated.Floseal used to control minor oozing. The dura was then covered with duraseal, and a hemovac drain brought out through a seperate stab incision.Grafton and native bone were then morselized and placed in the lateral gutter.the wound was irragated and closed in layers.
Hope that helps explain it better,,,

Donald Corenman, MD, DC
Moderator

August 7, 2012 at 8:46 pm

Post count: 8660

#6680

The fusion bone graft included Grafton which is a bone substitute. The success of this operation will depend upon two factors. One is the graft itself which has to fuse the transverse processes of L5 to the ala of the sacrum. For your surgical construct, expect this to take between 9 months and 14 months.

The other factor to consider is the opening of the nerve holes at L5-S1 (the foramen). If the disc space is not distracted (it was not), the nerve holes might remain somewhat narrowed. As long as you do not have leg pain, this is not going to be a factor.

The dural tear is not typically a complication but if repaired well, should not be a problem in the future.

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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