Abdominal distension after spinal fusion surgery

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rmore
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October 28, 2012 at 4:17 am

Post count: 3

#7272

Hello All!
I had a spinal fusion surgery about two months ago after an accidental fall that fractured my L1 vertebra. The surgery involved making a cut on my left side just below the rib cage. Things have been going good so far pain-wise but I am puzzled by the bloating on the left side of my abdomen. The distention is such that my navel is offset by an inch or two to the right.
Can anybody please tell me why this bulge in my left abdomen has occurred…will it ever go away….what should I do to make it go away? i am a 29 year old healthy male and I generally do not have much fat on my belly. I also used to be able to breathe in deeply and pull in my stomach doing thus….but now after the surgery I cannot. This distention is very uncomfortable and gives me a very ‘tight and stretched’ feeling in my abdomen.

Thanks in advance for the replies and advice.
Rmore

Donald Corenman, MD, DC
Moderator

October 29, 2012 at 1:45 am

Post count: 8660

#7273

You had an anterior approach to the spine. An incision on the left requires cutting some abdominal muscles and these muscles will not heal and function as before the surgery. This abdominal wall weakness has two separate consequences.

One is that the opposite side muscle will continue to pull with regular strength and the surgical side muscles will have less “pull” (strength is diminished by the incision). This imbalance will pull the midline off center (as marked by the umbilicus or navel).

The second consequence is that the abdominal wall on that side will bulge somewhat with the complaint of “bloating”.

“Core” therapy work to try and rebalance the abdominal wall may yield some symptom relief. Make sure you have a consult with the original general surgeon who made the initial incision and approach to make sure there is nothing wrong (abdominal wall hernia).

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.

rmore
Member

January 31, 2013 at 9:15 am

Post count: 3

#7865

Thank you Dr. Corenman.

I had a consult with the surgeon who actually made the side incision. He said everything looks fine (!) and that there is no hernia.

So after searching and reading over the internet I have gathered some knowledge which seems to match with what you say. I now understand that some nerve is cut during the making of the incision (intercostal nerve?) which leads to denervation of the flank. (I have lost a lot of sensation around the incision). This also leads to weakening of the flank muscles and they lose their contracting ability. Hence the flank bulge.

Sure there must be something to ‘take care’ of this bulge? It is very inconvenient and unsightly and a nuisance when I am up and about. My surgeon recommends to go see a plastic surgeon.

Would this be a good move? Can a plastic surgeon resolve my bulge issue by an abdominoplasty or something?

Was there a worthwhile reason as to why my surgeon preferred to go thru the sides and not the front? I feel going thru the front would not have caused any bulge issue while still being able to put the required hardware in me.

Regards,

Rmore

Donald Corenman, MD, DC
Moderator

January 31, 2013 at 10:04 am

Post count: 8660

#7866

First, give the abdominal wall some time to heal. The muscles can recover and the nerve can also recover. After about one year if you are not satisfied, you might consult a specialist surgeon for an abdominal wall consult. I am not sure that a plastic surgeon would be the one. There is a condition called rectus diastasis which might be repaired by this type of specialist and this condition might be somewhat similar to the type of repair you might desire.

Since in the typical anterior approach, only one nerve is “stretched”, this should not weaken the entire abdominal wall. The wall is innervated by six nerves. One nerve should not cause too much 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.

rmore
Member

January 31, 2013 at 11:23 am

Post count: 3

#7867

Thank you so much, Dr. Corenman. I really appreciate you taking out time to reply to my questions and decrease my anxiety.

One last question though – Is it possible to injure the nerve (one or some of the nerves that innervate the abdomen flank muscles) without the incision? The reason I ask this is because after my accident (I fell down 20 ft and the spinal canal was compromised 80%) and BEFORE the surgery, I once noticed that I had heavy spasms in my left abdomen. I also saw that my left abdomen had bulged. At that time I attributed the bloating to the Naproxen dosage that the ER gave me.

So is it possible that those nerves would have been hurt by my fall which led to the bloating? And the surgical operation just aggravated the bloating?

Thanks a lot.

Rmore

Donald Corenman, MD, DC
Moderator

January 31, 2013 at 8:02 pm

Post count: 8660

#7870

I have never seen 3-4 thoracic nerve roots injured all in a row without a cord injury but I guess anything is possible. I would highly suspect that there might be something else going on with the abdominal wall such as direct trauma to the muscle.

Do not be too impatient with this. Give it some time and you might be surprised by the results.

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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