ct scans post fusion surgery

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Abbeygirl
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October 28, 2013 at 10:24 am

Post count: 40

#9705

Hi Doctor I was wondering if you could explain my latest ct scans the last scans I had said that the bone had not fused as yet that was at the 8 month stage I am now at the 10 month stage so if I type out my report I was wondering if you could explain it to me also I get cd with my scans so I was wondering if I downloaded them whether you would be able to receive them sorry for being a pain just a bit anxious anyway here is the report
Exam CT LUMBAR SPINE
Clinical History ASsessment of L5/S1fusion
Findings:noncontrast multi detector CT scan obtained through the limbo sacral spine. Multiplanar reconstructions performed and viewed on soft tissue and bony windows.dual-energy technique used to minimise artefact arising from metallic hardware

Vertebral body heights are preserved.

Evidence of previous fusion at the L5/S1 level with rods and screws with associated interbody spacer device noted. Position of the screws appears satisfactory.there is mild curvature of the lumbar spine,convex to the left centred on the L3 level

Schmorl’s node involving the inferior endplate of the L1 vertebral body noted.

There is mild annular bulging noted at the L3/L4 level. This results in mild right-sided foraminal narrowing. The exiting right L3 nerve root does not appear to be significantly compressed however.

At the L5/S1 level, narrowing of the exit foramina bilaterally due to loss of disc height is noted. Central canal remains adequate.

Conclusion:

Satisfactory position of screws post L5/S1 fusion.

Donald Corenman, MD, DC
Moderator

October 28, 2013 at 6:13 pm

Post count: 8660

#9708

This radiologist did not really interpret the quality of the fusion mass at L5-S1. He or she simply stated that there was a surgical attempt at fusion at that level but did not read anything about the amount of bone that crosses the site either at the disc level or the posterior facets/transverse processes.

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

October 28, 2013 at 10:34 pm

Post count: 40

#9711

Hi again doctor so the radiologist has not said whether the bone has fused or not it hadn’t after 6 months but my surgeon said to give it another 3 months sorry for bothering you but still do not feel good in a lot of pain in both calves sharp pain through the bottom of my foot and my lower back just aches I have CDs of my last scans don’t know whether it would be possible to download them on my computer and send them to you I will be honest you seem to be the only person who knows what is going on
Thanks again doctor

Donald Corenman, MD, DC
Moderator

October 29, 2013 at 12:12 am

Post count: 8660

#9713

If you want me to look at your studies, call either (970) 476-1100 or (888) 888-5310 and talk to one of my nurses. They will give you the information to send your images.

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

November 5, 2013 at 4:43 pm

Post count: 40

#9750

Hi Doctor
If possible could you let me know what is the best time to ring one of your nurses about my scans. Also went to see my surgion with my lastest scans and after she viewed them she sent me for a bone scan I was wondering if possible could you explain the report for me please
BONE SCAN +SPECT/CT
A limited bone scanof the lumbar spine,pelvis and hips as well as knees was performed together with a dynamatic study of the lumbar spine.
The dynamic and blood pool studies demonstrate physiological blood flow and blood pooling in the lumbar spine.There was no hyperaemia in the pelvis or hips nor in the knees.
The delayed planar study demonstrates mildly increased isotope uptake atL5/S1.There is equivocally increased isotope uptake involving the left knee.
A SPECT study of the lumbar spine was performed together with a low dose CT scanning for anatomical localisation .There was scan evidence of previous fusion at L5/S1 with rods and screws and associated interbody spacing device.There was moderately increased isotope uptake involving the L5/S1 vertebral bodies.There is moderately increased isotope uptake in relation to the S1 screws bilaterally.There is only equivocally increased isotope uptake in relation to the L5 scews bilaterally.This is slightly more marked on the right than on the left.There were no other focal abnormalities demonstrated
CONCLUSION
1. The previous L5/S1 fusion was noted
2. There is a moderate osteoblastic reaction at L5/S1 vertebral bodies consistent with ongoing discovertebral arthritic change
3. There is a moderate osteoblastic reaction evident in relation to the S1 screws bilaterally. This is of uncertain clinical significance. It may reflect ongoing bony remodelling at the sight of the surgical screws although loosening of the surgical screws cannot be completely excluded.
4.There is a milder osteoblastic reaction in relation to the L5 screws bilaterally and this is slightly more marked on the right. This most likely reflects ongoing bony remodelling in response to the presence of the screws.
5.There were no other significantly active bony abnormalities demonstrated in the lumbar spine.

Donald Corenman, MD, DC
Moderator

November 5, 2013 at 7:16 pm

Post count: 8660

#9751

The bone/SPECT scan is normally not a very useful tool unless there is some thought of infection/tumor. If there is a suspected pseudoarthrosis (lack of fusion), the CT scan and flexion/extension X-rays are always better for this diagnosis in my hands.

This scan indicates increased uptake in the vertebral bodies of L5 and S1. This could be from healing of these structures post fusion but could also mean a lack of fusion. These structures then would see more stress and react to the additional motion. The increased stress at the S1 screws is not a good sign for fusion as a solid fusion should take the stress off these screws.

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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