9/12/14 I just had a lumbar fusion L4 to S1 w/ Cage

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Rox1919
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October 5, 2014 at 3:47 pm

Post count: 6

#11495

In 2008 I had a laminectomy of L3-4 L4-5. Then in Jan 2013 I was a passenger in a car stopped at a traffic light when a van slams into the back of us. Since then I have had nothing but pain. Finally now and numerous epidural injections,and RF ablaision they decide I need to have a lumbar fusion from L4 to S1 with this new cage thing. Sept 12,2014 I went under and 9/1/2 hrs later I was in recovery I wake up and all I can say is I can’t feel my right foot.no No feeling what so ever. Today is Oct 5,2014 so approx 3 was after surgery and I have not been able to put a shoe on my right foot yet. Dr says he isn’t that concerned about it but I have to say I AM!!! it’s my foot it’s still so swollen like shriek, the sharp shooting pain I get are un bearable. To go back I am a 49 yr old female going to be 50 in 3 days and this was not how I planed to spend my 50th but whatever. I was pretty active, I am a former smoker quit 8 yrs ago I have stenosis, hypothyroidism. I had a cervical fusion , total hip replacement of my right hip. I’m a mess bone wise it seems. I guess anything else you will ask me

Donald Corenman, MD, DC
Moderator

October 6, 2014 at 1:15 am

Post count: 8660

#11496

There are some questions I have regarding your surgery. Why did the surgery take 9 1/2 hours? Did a complication occur such as a dural tear that needed repair? Was the surgery performed from the front (anterior) or from the back (TLIF or PLIF)?

For your right foot, do you have full loss of sensation over the entire foot or when you pay close attention, is it only on the top, bottom or side? Do you have weakness of a muscle group or no weakness? See the section on “Symptoms of lumbar nerve injuries” to understand what each nerve does and how you can tell if one nerve causes weakness.

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.

Rox1919
Member

October 9, 2014 at 1:29 pm

Post count: 6

#11508

Sorry for the late reply, I haven’t been on my email. As for the 9 1/2 hr long surgery I do not know why it took that long. The surgery was don’t from the back and it’s quite a large scar. As for my knowledge of this earlier I was told I was going to have 2 small incisions one on either side of the lower spine. Unless there was something I can’t remember exactly what he said it was but it’s obvious in my case that the something he was referring too was there or happened because my scar is huge right down the center continuing between my cheeks.
I know I was in recovery for more then 6 hrs and had to have a blood transfusion because I had lost too much blood, before the surgery my bloodwork came back that my hemoglobin was slightly low I think it was 11 but they said nothing to worry about. In recovery my BP dropped to 70/31. For hrs remained at the number then finally it came up to 81/49. Then they let me go to a room. As for the operating room if something happened in there no one is talking. When I was in the recovery room and I first woke up all I kept saying was I cant feel my right foot. When they took the cover off to show me my foot I was so startled at the size of my foot. The swelling was unbelievable my small little foot was humongous. As for the feeling or sensation well I’m now 3 weeks after and the swelling has reduced a lot however when I take a shower it immediately starts to swell from the warm water. The feeling I am experiencing is so horrific I am crying while I type. To pull the sheet over my foot feels like I’m being cut by razor blades. This is my entire foot not including the bottom because I can walk on the foot.To pin point it exactly it’s mostly my big toe and toe next to that.those two are severe numbness. When the two toes touch each other it’s extremely painful. The nerve pain I’m experiencing now is my entire shin to my toes.

Donald Corenman, MD, DC
Moderator

October 9, 2014 at 8:06 pm

Post count: 8660

#11510

Your answer has created more questions than answers.

By your original description, the surgeon proposed a “minimally invasive procedure”. While my opinion is not positive on these types of surgery, nonetheless, the question has to be asked as to why this was not completed. A large central incision means that the “minimally invasive” procedure was not initially carried out.

Significant blood loss can also be a harbinger of problems in surgery. Normally for a one or two level TLIF, I will lose about 150cc of blood. For a very large individual with a full scoliosis procedure, I will lose up to 800cc of blood. I use a cell saver to recover this blood to be given back to the patient during the operation. Did the surgeon use cell saver? Did your surgeon discuss why the blood loss?

Your foot pain, numbness and swelling sound like there was a nerve injury during surgery (unless these symptoms were present before surgery). The feeling of “razor blades” and loss of sensation indicates allodynia (painful light tough) which is an indication of nerve injury. Ask your surgeon if there was a dural tear during surgery and if so, how it was repaired. Was there a difficulty with surgery and significant retraction of nerves? This set of symptoms sounds like the L5 nerve.

You are entitled to the operative report which is the surgeon’s dictation of the operation. Read it and maybe some insight will be displayed as to the problems that occurred in the operation. As far as nerve healing, see the section under “nerve injuries and healing” on this website to understand how nerves heal.

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.

Rox1919
Member

October 14, 2014 at 10:26 am

Post count: 6

#11518

I couldn’t believe my eyes when I read your last response. First of all you have given me more insight in 2 responses then my surgeon has in 10 apps. Pre and Post surgery. I have made 3 unscheduled visits post surgery to see him at his office and at an office he works at that is more then 30 miles away from me. In such a desperate need to tell him how much excruciating pain I am in and to show him the size of my foot is with this unexplained swelling I have. Yesterday was one month ago that I had the surgery, I am still dealing with excruciating pain in my foot,severe hypersensitivity as well as swelling and the nerve pain is indescribable. The sharp shooting pain and the electric jolts I get as well as the constant feeling of strangulation around my ankle with the tightness it also includes.the feeling of moving my big toe and it feeling like there is a knife cutting me across the top of my foot constantly is unreal. My tears of constant pain is not only hurting me but my entire, it kills my husband and kids to see me this way. I just spent my 50th birthday at home in tears from pain. This is no way to live, even if I accept to have a surgery done and it requires a long recovery I have never felt pain like this. This has been the worst month of my entire life. Let me remind you this is my 6th major surgery in The past 6 yrs as well as an undetermined amount of minor procedures which require anaesthesia. Thank you so much for all your insight. I will follow up with you soon I am going to get the operative report. I need answers to all these questions. Thank you again Warmest Regards Jane

Donald Corenman, MD, DC
Moderator

October 14, 2014 at 8:49 pm

Post count: 8660

#11520

You need a new MRI to determine why you have such pain. Get the operative report from the hospital medical records section to determine what went on in surgery if your surgeon is not communicative.

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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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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