3rd Micro D, Fusion, Replacement Disk or Other...

Tagged: microdisectomy

Viewing 6 posts - 1 through 6 (of 6 total)

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pec5002
Participant

May 22, 2018 at 2:38 pm

Post count: 33

#28325

Hi Dr Corenman-

I have been quietly reading your boards for weekse. I initially hurt my back in December of 16 and got so bad I had a micro D in April 17, my pain was 8 at its worst and only on the left side before the Micro D.

I felt 100% for a week until I re herniated a week later coughing. Still felt 75% but my surgeon said if i got another Micro-D I could probably get to 90% better and able to be much more active again. I went with the second mico d in April of this year, never had any relief but didnt feel worse either. 2 weeks later I had an episode one day where I came home from a walk and started to get pain down both my legs and spasming in both legs which I never had before, MRI confirmed a 2nd herniation. Since then there have been ups and down more up than downs, but the biggest thing is I cannot sleep on either side without a really annoying feeling down both legs/hips which seems to be getting worse not better but it could also be my mattress softening up

Biggest things I cant do are lie on my sides OR bend over obviously, back is OK if my head is low enough. Also prior to the surgery my pain was mostly on my left side now it is down both.

Here is what I tried so far and results

1) 3 Epidural injections- first 2 took the edge off,3rd did nothing

2) facet Injection- nothing

3) Physical Therapy- mostly focused on my priformins, made better during and after but then had more sciatica after which progessivly got worse every time- stopped after 3 sessions

3)Ozone Therapy- Into the disc and into the surrounding muscles- 4 weeks ago with no results

5) Did some light swimming, free style/crawl made it neither worse or better

4) SI Joint Injection today- they dont think this is the problem but worth a show

5)Inquired about PRP/Prolotherapy/Stem Cells but was told I am not a good candidate for it as I dont show symptoms of having facet injections and really my paid is do to pressure on the nerves

What I have planned to try next is acupuncture which I will start tomorrow

I wanted to see if any of you had any other options? Here is what else I am considering

1) Physical Therapy Again with a highly regarded physical therapist maybe going very very very easy

2)Foam Rolling or possible a thera gun to loosen muscles as opposed to stretching

3) a third micro d- going endoscopic this time with a laser to seal the annulus (i know you arent a fan of 3 times)

4) a fusion or Artificial Disc but fully noted my insurance wont cover a disc so need to look into that more

5) another option?

6) do nothing and hope gets better on own

Thanks for the help in advance knowing how bad it is, which is maybe a 3.5/4 but also very limiting in my life, should I consider another surgery or just be glad this is only as bad as it is.

Donald Corenman, MD, DC
Moderator

May 23, 2018 at 8:55 pm

Post count: 8660

#28334

After a third herniation (second recurrent herniation), you need a TLIF fusion to remove the herniation and fuse the disc space to prevent further herniations and permanent nerve injury. Artificial discs have no place in this problem in my opinion. All of the other treatments, either proposed or completed will not help other than the epidurals which have already run their course. The pain is most likely from the compression of the nerve roots with a small possibility that you have chronic radiculopathy (permanent injury from three separate compressive episodes).

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.

pec5002
Participant

June 2, 2018 at 10:06 am

Post count: 33

#28433

Thanks Dr. If this is severely limiting my life and I have very healthy discs above, if I do the fusion how much greater strain will I put on the rest of the back. One surgeon said there a 10% chance I will re herniate another disc and the other said there is a 25% chance I will not only not herniate but do it in the first 5 years.

I am thinking about coming out to you all as well.

Donald Corenman, MD, DC
Moderator

June 3, 2018 at 8:18 pm

Post count: 8660

#28459

The numbers for adjacent segment disease that needs surgical attention is 2.5%/year. That is, in 10 years, you have a 25% chance of problems above. I will state that I think the chances of having problems above if your do nothing to the current problem level now is not small either. I don’t believe a good study of degenerative changes above a very degenerative level have been looked at well.

Nonetheless, with three herniations at one level, the chance of a fourth is very high and can be catastrophic if it occurs as the root can develop permanent damage. I do not endorse artificial discs in the lumbar spine while I do in the cervical spine.

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.

pec5002
Participant

June 3, 2018 at 10:31 pm

Post count: 33

#28461

Thanks Dr I appreciate your help here I can’t even put into words how helpful you are and I will be calling your line.

So at the age of 31- would you recommend s fusion now over waiting as I am in some pain which is limiting my life due to the fact that the other discs will have trouble regardless? Or is it better to wait until I get older and see what happens and possibly this will fix itself?

Donald Corenman, MD, DC
Moderator

June 4, 2018 at 5:18 am

Post count: 8660

#28463

If you are going to get another surgery due to continued nerve root compression, you need a fusion in my opinion. If however, you can get by without a surgery (as long as you have no motor weakness), then you can deal with the symptoms you have now and hopefully, these symptoms will improve over time. The presence of modor weakness from root compression dictates a fusion.

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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3rd Micro D, Fusion, Replacement Disk or Other…