Brace

Tagged: Lumbar fusion, post-op rehabilitation and braces

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Renee123
Participant

March 16, 2017 at 3:17 pm

Post count: 130

#24539

If you have time can you address the above. Also wanted to ask you your thoughts on gabapentin for the nerve pain.

My surgeon says the contralateral pain I’m having could be from “positioning” on operating table.

Please let me know your thoughts.

thank you

Donald Corenman, MD, DC
Moderator

March 16, 2017 at 7:25 pm

Post count: 8660

#24540

“How could a nerve become stretched by the size of the implant? Left side nerve was not retracted”. The implant typically distracts the disc space. A larger implant stretches the nerve and can (although unusual) create root irritation.

“Is there a way to diagnose and treat canal seroma? They told me n hospital there was none, but just looked at back and felt around”. The way to diagnose a seroma is with a new MRI.

“What do you mean that the screw is “proud?”. This means the screw on the symptomatic side could have breached the pedicle and is irritating the nerve root.

Nerve problems from “positioning on the table” normally refers to the lateral femoral cutaneous nerve (See website). This could cause numbness and discomfort in the anterolateral thigh.

Gabapentin is a good nerve “calming medication” if it works for you. I find it works in about 50% of patients.

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.

Renee123
Participant

March 16, 2017 at 9:40 pm

Post count: 130

#24542

Thank you, Thank you!

1.) I have been reading that contralateral radiculopathy after TLIF is related to asymptomatic stenosis on the contralateral side that is unmasked by the increased lordosis of the TLIF. Do you believe this is a possibility ?

Sounds to me like there could be several different factors playing a role in these new symptoms. Some days are more painful than others: I guess maybe depending on how I sleep, I have no idea why it waxes and wanes.

Based on all we have discussed what would you believe are the next steps in priority to try control the contralateral symptoms ?

The “PA” is suggesting gabapentin 300-900mgs/day for a few days. If that doesn’t work they want me to take 40 mgs of prednisone x 3 days, then 3o mgs x 3 days, then 20 mgs x 3 days, then 10 mgs x 3 days – which seems like a long time to be on prednisone while fusing!

I was thinking perhaps it would be better to just skip over all of the meds and go to a CT scan or MRI to try to get an accurate diagnosis of what could be causing the pain. The PA sais the screw placement from X ray looks good.

Please let me know your thoughts on how to proceed. I would really like to get this resolved as quickly as possible so I can start walking and rehabbing. This is very frustrating to say the least!

THANK YOU AGAIN !!

Renee123
Participant

March 19, 2017 at 1:52 pm

Post count: 130

#24558

Would you be so kind as to address the post above or the question below?

“1.) I have been reading that contralateral radiculopathy after TLIF is related to asymptomatic stenosis on the contralateral side that is unmasked by the increased lordosis of the TLIF. Do you believe this is a possibility?”

Donald Corenman, MD, DC
Moderator

March 20, 2017 at 7:49 am

Post count: 8660

#24561

Generally, the TLIF distracts the disc space (adds height) so any lordosis that occurs with the fusion will be inconsequential. If there is an angular collapse (one side is much more narrowed than the other) and the TLIF is performed on the wider side, I could imagine a possible new foraminal stenosis but I have never seen that scenario and could not imagine that technical error happening.

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.

Renee123
Participant

March 20, 2017 at 9:11 pm

Post count: 130

#24566

Thank you from the reply. Looking at the post surgical X ray, I have good disc height and lordosis. So I will assume at this point that the contralateral back/hip/thigh/leg pain is from surgical positioning or surgical edema as there is really no other explanation. There is no build up of fluid or excessive swelling. Surgical area is pretty smooth. It is not horrible pain; seems to bother me more at night and with more motion/walking during the day.

1.) What is your recommendation for something like this 2.5 weeks out of surgery ? Wait it out a while longer or start prednisone for 12 days now? The answer seems to be subjective.

The gabapentin doesn’t seem to be helping at all after a week, yet I do seem to get numbness in other areas of my body…

2.) If you believe prednisone is indicated at this stage, do you agree with a 12 day taper starting at 40 mgs or would you recommend a shorter taper, i.e. 40mgs x 3days, 20mgs x 3, 10 mgs x 3 ? Also, is 4O the lowest I could start to get therapeutic effect or could 30mgs be sufficient? Prednisone is hard on my stomach.

I’m really trying hard not to do anything to jeopardize the fusion process. I know the prednisone should not be that risky with a short course, but would like to avoid it if possible!

Thank you again!
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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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