40year old with 80 year old back

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texasspondy
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April 26, 2012 at 12:36 am

Post count: 25

#6120

Dr. Corenman, appreciate your visual of the 70’s and back surgery’s, that’s puts a little bit of ease in my mind.

I just got a couple of days ago my bone scan report back, that my pain management doctor had requested for further treatment options.

The PMS said that the report shows negative hot spots, so to speak, so it would appear that my facets, or pars area are old issues, I guess. He also said this made sense as to why the two ESI pars injections that I had did not help, because there was no inflammation for the cortizone to reduce. His thought process was that the nerves exiting the L5 canal are some bigger ones going to the legs but also some very small ones that he called “sensory” nerves and he is thinking one of these is getting aggrivated on the left side and that is what is causing my muscle spasm/tightness/pain in the low left back. He also suggested a nerve block in the facet area to try and hit that nerve for pain relief, if it worked, he wanted to do a RF procedure in that area to put that nerve to sleep, cook it, whatever. Your thoughts??

Here is the report from the bone scan, I also was glad to see the hemangioma is not active….

CLINICAL INDICATIONS: lumbar radiculitis

SE (LOCATION)
CLINICAL COMMENTS:
Pregnancy Information:

EXAM: Whole-body bone scan and nuclear medicine SPECT imaging.

CLINICAL INFORMATION: Lumbar radiculitis.

COMPARISON: MRI lumbar spine of 10/04/2011.

TECHNIQUE: Approximately 25 mCi technetium 99m MDP given IV. Delayed anterior and posterior whole-body images obtained. Additional SPECT imaging of the lumbar spine were performed for further evaluation.

FINDINGS: No abnormal focal radiotracer uptake is present, specifically of the lumbar spine. No focal intense radiotracer uptake is present within the L5 vertebral body related to benign lesion of vertebral hemangioma.

IMPRESSION: Negative bone scan and SPECT imaging.

Donald Corenman, MD, DC
Moderator

April 27, 2012 at 6:57 pm

Post count: 8660

#6130

A bone scan would probably not have indicated significant changes as this is not a new fracture of the pars but a very old one (probably occurred when you were 12-18 years of age). Bone scans tend to light up if the fracture or bone injury is less than six months old.

Normally, the facets are not pain generators in an isthmic spondylolisthesis as they are unloaded. That is, the fracture of the pars disconnects the facets from the body of the vertebra and the stress is shifted to the disc. The facets, being unloaded typically do not cause any pain.

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.

texasspondy
Member

October 17, 2012 at 10:40 pm

Post count: 25

#7179

Dr. Corenman,

First, I’d like to say (while it’s fresh in my mind), it was an absolute pleasure to meet you during my appointment 10/16/2012. Your knowledge and personality were just as I figured, second to none. Your staff was, very nice and quite helpful. Your PA, (sorry don’t remember his name), was also very knowledgeable and I enjoyed meeting with him, and of course the surrounding view is a narcotic itself.

I knew there would be other questions after I left your office. With my Mri and xrays, do you think it is of any value to persue what my PMS had wanted to do next, a nerve block, or RF? I gathered from our meeting that my discomfort is coming from the pars fracture themselves, possibly a hair from the slight l4-l5 bulge. So I’m guessing nerve endings in the pannus are what’s actually behind the discomfort and nerve block won’t do anything to alleviate that?

Just thought I’d see if you thought that would be of any use or if I should just maintain for now (in my new office job), until I have the procedure done by you.

Thanks again, (The aircraft Mechanic)

Donald Corenman, MD, DC
Moderator

October 23, 2012 at 6:46 pm

Post count: 8660

#7234

Nerve blocks can be valuable to reduce symptoms until a surgical procedure can be performed. I do not think that RF (radio-frequency ablations of the facet nerves) would be valuable.

By the way, I have two PAs, both named Eric (one spells his name Ehrich).

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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