ct scans post fusion surgery

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Abbeygirl
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June 18, 2013 at 12:02 pm

Post count: 40

#8906

Hi Dr thank you for the great service you provide Ihave had a spinal fusion at the L5 S1 level appox 6 months ago and also I have had two previous surgeries prior to that which were laminectomy at the same level I am still in a bit of pain right thigh numbness lower back aches get pain in both calfs get pins and needles in my two big toes more so on my right foot now I had a ct scan the other day to see if everthing is healing alright I have the report but do not understand it so I was wondering if you could explain it to me please because I do not know why I am still in pain
EXAM CT LUMBAR SPINE
CLINICAL HISTORY L5-S1 FOLLOW UP
TECHNIQUE
Noncontrast CT lumbar spine performed with multiplanar reconstructions
FINDINGS
Comparison is made to 11/12/2012
There is dorsal decompression and instrumentation of the L5/S1 with intervertebral disc spacer and bone graft material .No dislocation of intervertebral disc spacer. Bilateral L5 and S1 pedicles srcews are in satisfactory positions.
Alignment of the lumber spine is unremarkable L1/2 discovertebral degenerative changes are noted.There is bilateral L5 pars defect. There is mild lumbar facet arthrosis.
There has been removal of the surgical drain and reduction in the subcutaneous and paraspinal muscle oedema
At L1/2and L2/3 there is no disc protrusionspinal canal or foraminal stenosis.
At L3/4 there remains mild spinal canal stenosis from generalised disc bulge flavum and hypertrophy.
At L4/5 there is generalised disc bulge flaum and facet hypertrophy also causing mild spinal canal stenious .No significant foraminal stenosis.
At L5/S1 assessment of the central canal is diffcult due to the postoperative changes .There remains the effacement of epidural fat around the bilateral L5/S1 neural exit foramina suggestive of foraminal narrowing.
CONCLUSION
Status post L5/S1 dorsal decompression and instrumentation .interval removal of surgical drain and significant reduction in post operative oedema
No evidence of hardware complication and the appearances are essentially stable since most recent examination
Thank you Doctor

Donald Corenman, MD, DC
Moderator

June 18, 2013 at 7:20 pm

Post count: 8660

#8907

This CT scan reading is unusual in that this radiologist does not mention anything about the fusion mass at L5-S1. This is one of the reasons that a CT scan is performed so I cannot tell you why fusion mass discussion is omitted.

The radiologist also does not mention how significant the foraminal stenosis is at L5-S1. Words like “mild/moderate/severe” are typically used to paint a picture of the severity of the narrowing. The “spacer”or cage is not discussed as to if it has settled into the endplates of the vertebral bodies or if it still creating distraction (which would mean that the foramen are probably still open as opposed to settling which would mean that the foramen are more closed).

How has your pain changed from prior to surgery? Your statement; “still in a bit of pain right thigh numbness lower back aches get pain in both calfs get pins and needles in my two big toes more so on my right foot now” needs to be understood in light of your preoperative symptoms.

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.

Abbeygirl
Member

June 21, 2013 at 6:00 pm

Post count: 40

#8918

Hi Doctor
I went to see my surgeon two days ago and she look at my ct scans and said that the bone has not grown at all and it has been six months since my surgery my symtoms seem worse than they were prior to surgery or should I say that I do not feel any better so I was wondering if you could tell me if the bone does not grow in the next three months what would be the next thing to do I dont think I could go through surgery again because that would mean 4 back surgeries and it would be three within 3 years your advice would be much appreciated

Donald Corenman, MD, DC
Moderator

June 23, 2013 at 8:42 pm

Post count: 8660

#8929

Unfortunately, you have developed a pseudoarthrosis (lack of fusion) at the L5-S1 level. This is generally a rare event. A pseudoarthrosis is usually not dangerous but more likely than not-needs to be addressed surgically to give you some relief.

There are external stimulators that generate an electrical or magnetic field that you wear around your waist for about three months. These stimulators purportedly increase the chance of fusion. I think they may not be as effective as the companies report but should cause no harm and will give the fusion another three months to see if it will fully fuse.

If this does not work, then you will need a revision surgery.

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.

Abbeygirl
Member

July 19, 2013 at 6:49 am

Post count: 40

#9058

Hi Doctor
I say this all the time but thanks for the great service you provide you have been a great help to me that you explain things that i can understand if it was not for your help i do not think i would be hear now any way Doctor my question is when you say revision surgery what would that involve sorry for being a pain thanks again

Donald Corenman, MD, DC
Moderator

July 20, 2013 at 11:31 am

Post count: 8660

#9064

Revision surgery depends upon the original type of surgery, how well it was done and what type of failure you underwent. Most of the time, the revision can be performed from the back of the spine but occasionally needs to also be performed from the front of the spine.

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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