Chronic ridiculopathy after l45s1 tlif

Tagged: Tlif bmp chronic leg pain

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Tlif2015
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September 16, 2017 at 6:17 am

Post count: 5

#26328

Dr. Coreman. I stumbled upon your site recently and would like to thank you for the information posted for back pain patients searching for answers. In 2015 I had a l4/5 5/s1 tlif preformed by an experienced well respected neuro surgeon due to recurring disc herniations. I previously had micro disectomy surgery to address the problems. Both prior surgeries were on the right side and I had terrible right low back and leg pain. The surgeon did a left sided approach to avoid the scar tissue from the previous discectomies. The surgery was preformed using peak cages with bmp.

My right leg pain and back pain were 80 percent improved post surgery however within 5 days of surgery I developed severe left leg pain. The dr asked me to be patient and it would get better over time. After 4 months of complaints he agreed to order an MRI and I had developed seromas at both levels extruding from the disc spacers putting pressure on both nerve roots.

He ordered a myologram which showed minimal if any compression of the snerve roots. Blood work showed no infection. He suggested removing the hardware on the left side but really wanted me to wait for a solid fusion. So I did. Pain Medes and prayers got through the next 5 months until he confirmed solid fusion. He removed the hardware and did a follow up MRI and meg test 6 weeks post op. The seromas were slightly smaller and nerve conduction test showed chronic damage At both levels. He ordered another MRI 6 weeks after that and films showed roughly the same size fluid collections.

The pain is 25% better than before hardware removal. He suggested that any further surgery may not produce any benefits and recommended we let it be.

I haves delt with this since that time and have requested another appointment to see if there is any alternatives to doing nothing. It has been one year since my last appointment. I own a small business and can hardly make it through the day. What would you suggest? did we do the right thing by waiting and is it too late to correct this chronic leg pain?

Appointment is next week, new MRI then appointment.

Thank you.

Donald Corenman, MD, DC
Moderator

September 16, 2017 at 6:53 am

Post count: 8660

#26330

Having a seroma appear when using BMP in the disc can occur not uncommonly. It took me about 2 years to finally figure out the correct dosage and technique to prevent these inflammatory seromas. You can consider an aspiration and steroid injection as I have found that this procedure significantly reduces the root inflammation in many patients.

As far as timing, when I did see nerve inflammation on the side of the TLIF, I would immediately get a new MRI, identify the seroma and would have it aspirated and covered in steroid. I would think that it is never too late to do this procedure but I would think the sooner it is implemented, the better 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.

Tlif2015
Participant

September 16, 2017 at 9:25 am

Post count: 5

#26339

Thank you for the prompt reply Dr Corenman. The aspiration you discussed, would this be done percutaneously or would I have to be opened up again? If done percutaneously I assume the seromas would not be visible under X-ray/ft scan guidance is there any danger of further damage? I would greatly appreciate you sharing the rechnique that you would use.

Thank you again for replying so quickly. I feel I am better prepared for my appointment next week.

Donald Corenman, MD, DC
Moderator

September 16, 2017 at 9:53 am

Post count: 8660

#26341

This would be percutaneous under the visualization of fluoroscopy and be performed by an interventionist and generally not by the surgeon. This is a common procedure and should pose no undue risk. An experienced and meticulous interventionist should find this routine.

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.

Tlif2015
Participant

January 6, 2018 at 5:15 am

Post count: 5

#27244

Dr Corenman,

It has been a few months since your last reply. I had a number of appointments with the neurosurgeon since our last chat. After an initial assessment he ordered a new mri. Mri showed slight improvement in the seroma at both levels. He had the radiologist compared the last 4 scans for a comprehensive report. He feels that although the seromas are still present they are no longer putting pressure on the l4/5 5/s1 nerve roots. He ordered an emg with nerve conduction report. Report showed chronic radiculopathy at both levels. Follow up with neurosurgeon explained there is no active nerve problems and suggested consult for spinal cord stimulator trial as he feels that after 3 years there is nothing that can be done. 4 back surgeries and numerous steroid epidurals have taken their toll on my patience well being.

Do you believe I would be a good candidate for this as the referring dr states it would require another laminectomy for permanent place of the paddles if the nervo stim trial is successful. The referring pain management dr believes further surgical procedures may be more risk than reward as most of his patients who have the implant are back in his office with very little long term improvement. Would it be beneficial to obtain another surgical opinion? Not my first choice obviously. Thank you I appreciate this forum for an unbiased opinion.

Donald Corenman, MD, DC
Moderator

January 6, 2018 at 11:04 am

Post count: 8660

#27247

A CT scan to look for hetertopic ossification (bone where it does not belong) could be helpful. If there is no additional bone formation, then surgery to decompress the roots can still be possible but might have less effectiveness. Stimulators can be helpful in certain cases but not every case. The trial of a couple of days with implant leads can give you a snapshot of what this effectiveness can look like.

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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