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Abbeygirl
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September 15, 2012 at 12:23 pm

Post count: 40

#6946

Hi Doctor
I would first like to thank you for the great service that this forum provides your answers have been very helpful in the past i will try and make this short i feel like i have been around the block 1000 times in the last 16 months i had a laminectomy about 15 years again and had a good result the approx 16 months ago had a decompression surgery at the same level I am at this point on oxyicontin 40mg per day endemp for nerve pain as well as trying to keep me sane I have had about 3 ct steriod injections with no relief was sent to pain management doctor who sent me for a mri scan and then I went back to the pain management doctor with results he then said that he would do facet joint injection on both sides L5/S1 level and the level above i had that procedure done went back to pain doctor a week later he ask how i went with the injections i told him that i had no releif at all but it did not make my symtoms worse just a bit sore where the injections went in then he wanted to do radio frequencey treatment but i said if i had no relief from the facet joint injection was it worth doing radio freqency treatment so he sent me to a nerosurgion to see if I was suitable for a spine stimulator had to go back to him before I could get in to see the surgion so I went back to him and he wanted to do the radio frequency test any way to cut a long story short went back to surgion she said not to worry about a spine stimulator that my disc at the L5/S1 level needed to be fused so I went for a standing up Xray a bone scan also a nerve conduction test and back to surgion with the results she said they were good and that she could do the fusion then she sent me for a second opion that Doctor said the same thing only that I should have a discogram done went and had that performed worst pain I could imagine the results fro the discogram are L3/L4 the discogram was signifcantly positive at this level there is a significant defect in the anterior aspect of the annulas which results in contrast tracking into the circumference of the annulus through this defect immediately reproducing the patients low back pain a broad based posterior disc bulge is noted L4/-5 THE DISCOGRAM IS NEGATIVE AT THIS LEVEL A NORMAL DISC IS demonstrated on the ct L5/S1the discogram was strongly positive at this level with symtoms immediately reproduced the ct scan demonstrates that the disc space is significantly narrowed with a posterior disc extrusion demonstrated which contacts the descending nerve roots at this level vacuum phenomenon and annular disc degeneration is noted CONCLUSION Positive discograms at L3-4 and L5-S1 with a normal disc demonstrated at the L4-5 level so went back to the surgion she said that she would send me me the consent forms fo a one level fusion L5/S1 Then the insurance company sent me to one of there doctors he said that i should get the radio frequency done so now i am really confused i am in so much pain just want to get better i do not know what is like in the states but i am very confused not real keen on surgeery but i can not live like this for the rest of my life but if there was a alternative i would do it in heart beat but I have tried just about everything so if you have any ideas I would greatly appreciate it I allso have my discogram on disc not sure if I could send it to you or not ????Sorry for the long topic just really confused and you are the only doctor that makes sense thanks again doctor for this forum

Donald Corenman, MD, DC
Moderator

September 16, 2012 at 9:21 pm

Post count: 8660

#6954

Have you posted before as your identifier is familiar?

You have had facet blocks at L5-S1 with “no results” and a discogram with a painful disc at L5-S1 and L3-4 with a “normal disc” at L4-5. You however do not describe your symptoms. Do you have back pain, buttocks pain or leg pain? Please see the section on the website regarding “How to describe symptoms” to convey a description of your pain.

What level (or levels) were your two prior laminectomies?

For the sake of time, let’s assume that you have strictly back pain only. Facet blocks have a diagnostic window for pain relief. Just like going to the dentist where he or she will inject your jaw and it “stays numb” for three hours, any relief for only the first three hours is important to note. Typically, most injectionists do not have you record a pain diary (see website for instructions) which I think is highly important. If you can remember back to the first three hours after your injection and do not remember any pain relief, then rhizotomies will not be helpful to relieve pain.

Again, if lower back pain is your only problem, you might be a candidate for a fusion of only the L5-S1 level based upon your discogram. You need to understand what a fusion will and will not do for you. Read the section on fusion in the website to get a better understanding. Read “Preparation for spine surgery” and “Recovery information by surgery” for a better understanding of what you can expect.

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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