clarification on cervical fusion

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ashbyboulware
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July 3, 2014 at 10:58 pm

Post count: 11

#11144

GREETINGS DR C.I hope i find you with a well aligned spine. I shared my trials and tribulations of my mis-diagnosis from an auto wreck that left me in shambles. The post was titled professional standards after neurologic deficits are noted. After a failed c5-c6 fusion on september 11,2013, repeated begging for reevaluation from my neuro of which i received no help,a 2nd opinion from another neuro who only pandered for my surgical neuro who referred me to him, who suggested pain management as the only option, i was very fortunate to schedule on my own an appointment with a very very competent neurosurgeon at the university of alabama at birmingham. It took his staff and him 5 minutes to look at the mri ordered by the 2nd opinion neuro to tell me that non union had occurred and a revision was very prudent. He promptly sent me down the hall for a confirmatory ct. I had my revision performed march 18th. DR H told my wife post op that i was a sneeze or two away from a catastrophic event..i.e. death or paralysis. There was no hardware. C5 and c6 had been refractured during the placement of the spacer and the spacer had broken, leaving a sliver of metal to cling to a sliver of bone at c5 and c6. The revision took over 3 hours while the 1st little over an hour. My esophagus was scarred to a vertebrae, causing meat to lodge in it from procedure 1. He cut me open enough to expose c5 and c6 bilaterally. The first doctor had left a large portion of the c5-c6 ruptured disc intact. Additionally, amongst other damaged disc, c4-c5 was ruptured and he cleaned out c4-c5 and decompressed c5. And the coup de grace was he hand cut a beautiful piece of hardware to hold everything in place to fuse, as apparently my first neurosurgeon left the hardware off after apparently refracturing c5 and c6 performing the incomplete acdc. Needless to say a 2 month hiatus turned into 8 from work. The myriad of economic health and occupational issues that arose are incredible. The ct pathology performed before my revision stated, “post surgical changes involving interbody fusion spacer likely from ac/df at c5-c6. Sign of acute fracture. No peri-hardware lucency. Best i can summise, peri means around, and lucency means visible. Basically no visible hardware on ct. I have really struggled with this as not only the wreck side affects have been awful, but the failed surgery nearly killed me amongst other horrible problems. Im not vindictive dr corenman, and i gave informed consent. I know we are all human and things wrong. However after begging for more help and imaging etc and only getting a kick in the a$@ out the door,leaving my life in serious jeopardy, as touchy as this is..is leaving the hardware out not an agregious malpractice issue? Or am i missing something? I was never told about any of this..just that i would do fine. I shudder to think where i would be had i taken his word as the gospel and not been my own advocate. Thank you so much for your time. Ashby

your site is a gift for us cervically challenged

Donald Corenman, MD, DC
Moderator

July 4, 2014 at 1:59 am

Post count: 8660

#11145

Unfortunately, doctors are human and can make mistakes. If another doctor is “a friend” of the first doc, I could imagine that this second doc had confidence that the first doc’s opinion was accurate and there was no reason to question the diagnosis. In this field with such difficult work, your story is not uncommon.

It does sound like you found a good surgeon who questions everything (as it should be) and was able to repair the failed first surgery.

Hardware is not absolutely required. Yes- hardware helps to insure that the fusion will be successful but does guarantee fusion. Not using a plate is not malpractice.

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.

ashbyboulware
Member

July 4, 2014 at 4:49 am

Post count: 11

#11150

As always. Thank you for clarifying doctor Corenman. I was unclear on the necessity of hardware. And i 100% agree with you. We all make mistakes. I gave informed consent. I only regret that he didnt tell me and put a game plan together to revise it. I thought very highly of him and would have let him do the revision as it had to be done anyway. And yes, Dr H is a great doctor…just ask him. He will tell you. Thanks again

Donald Corenman, MD, DC
Moderator

July 5, 2014 at 2:16 am

Post count: 8660

#11152

Your tongue-in-cheek is appreciated.

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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