5 months TLIF L5S1

Tagged: 20% per week rule, Early motion after lumbar fusion

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jericho163
Participant

April 4, 2016 at 6:39 am

Post count: 19

#21877

My surgeon also mentioned preop that there is only a 70% chance of a fusion resolving back pain for a single level DDD case with no other structural issues. 30% dont get better.
Do you agree with this number?

Donald Corenman, MD, DC
Moderator

April 4, 2016 at 4:30 pm

Post count: 8660

#21884

That is not my experience. The numbers in my hands are between 90-92% in the appropriately selected patient.

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.

jericho163
Participant

April 4, 2016 at 9:24 pm

Post count: 19

#21886

Hi DR,

This comes to my last question before I go to see my surgeon for 6 month follow up. Hope you can offer some advice.

1. I feel the muscular tension whenever I am standing or sitting, and the muscles(multifidus) fatigue easily in half a day. As long as I am upright, the discomfort is 24/7. This is almost similar to preop. The surgery did remove the disc pain totally. And the midspinal extreme stiffness was gone inmediately. Have you see patients like this? My surgeon thinks this is unusual given that I dont have any other structural issues.

2. What is your advice moving forward, assuming I take a CT scan and it shows expected good bone growth. Should I request for MRI?That will mean looking for other issues which I dont think I have. My pain score was not high to begin with and I had the surgery because of the constant muscular discomfort(of course i tried injections and didnt work). As of now, I also dont feel any real pain, I can bend all the way, even if I bend halfway, I dont feel pain just muscle soreness.
I have read some papers stating that an open posterior surgery can dennervate those back muscles and it can take a while for them to reinnervate if they do and then the back issues resolve slowly. Do you agree with those “cutting muscles” theories. My previous MRI did show some atrophy of the back muscles due to fact that I torn my disc 15 years ago(though constant discomfort only shows up in 2014).

3. Hardware removal. What are the indications. Is it more common for the L5s1 and for skinny people? I sure do not feel the hardware. What are normally the indications for removing hardware assuming food fusion and correct placement of hardware.

Thanks and sorry for being long-winded.

Donald Corenman, MD, DC
Moderator

April 4, 2016 at 9:53 pm

Post count: 8660

#21887

The old “de-innervation” story for “open fusion” is really quite wrong. First, whether you have a midline incision or two lateral incisions (minimally invasive of which it is not), the muscle trauma is about the same. The only muscles that are affected are the local segmental muscles which after the fusion are not required to function as the level does not move.

I am unclear what your indications were for fusion. If your back pain “from the disc” is gone but you are left with muscle pain, this could be an indication that the instrumentation could be causing problems, that the muscles still need time to recover (unusual at a year post-op), your expectations were too high or some other currently unidentified disorder is contributing to your current complaints.

Indications for hardware removal are really yours. Unidentified pain that continues in spite of solid fusion, especially with weather changes (barometric induced pain) or pain from contact (sitting in a hard chair).

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.

jericho163
Participant

April 4, 2016 at 10:08 pm

Post count: 19

#21889

Hi Dr,

I am nearly 6 months post op. But yea the deep muscles around the incision feels the worse whenever I am loaded. The tension can go down and up along the spine. The feeling is like those muscles are trying the stabilize my whole body. Do you mean those muscles around L5S1 are actually not so much needed now that that segment is fused/partially fused?

My indication for fusion was discogenic pain at that disc and alot of muscular tension.So when I sit, I can feel the disc very compressed and then the resultant muscle tension. Now O dont feel the disc anymore, but similar muscle tension all arouns the incision. Goes to the sacrum sometimes.

I guess I can only be patient and do more PT. In the meantime i will take some scans and make sure nothing is wrong.

biofreeze
Participant

April 4, 2016 at 11:29 pm

Post count: 99

#21890

I’m not a Dr. but I would definitely get a CT scan. If you are not fused then you have all your answers. Based on what I’ve read if your surgeon did not use BMP it can take up to 8 months or more just to begin fusing. And even if you begin fusing, is it posterolaterally or in the disc space. I dont’t think you are going to feel better until you have a good fusion in the disc space. Also, how long is your incision ? Best of luck !
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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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