Dura Deficeincy

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leo42ray
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November 30, 2012 at 11:22 pm

Post count: 3

#7506

What could a person expect in the way of symptoms in the event of a long term dura deficency? Say 7 months or more. I had a spinal fusion surgery in 1997 (11 vertebrae 6 discs). Ten years later had some minor events occur. Found rods broken in the thoracic region. After an auto accident started suffering major muscle spasms & weakness, trunk to both legs numbness, falling down as well as other issues. MRI and CT scans showed normal. Only thing obvious was where the rods broke. Surgon decided he would repair the spot where the rods were broken. During the operation he discoverd the dura in fact was gone. He removed the vertebra to get where the dura was missing and placed a patch over it and reinstalled vertabrae using bone grafts and new hardware. I am now having MS symptoms with MRI of brain showing few hypointensities (very small)no white matter. EMG normal. Neurologist gave up after that and told me to go to the Mayo Clinic. Perscribed 6 months of physical theapy. Therapist (who works with a lot of MS patients took one look atme and I should be on disability becase I had MS. Help!!!!!!!!!!!!!

leo42ray
Member

November 30, 2012 at 11:26 pm

Post count: 3

#7507

Failed to mention the Spinal MRI also showed an empty thecal sac with adhesive arachnoiditis in the Lumbar region

Donald Corenman, MD, DC
Moderator

December 1, 2012 at 12:52 am

Post count: 8660

#7511

The dura is typically never deficient. The dura can be scarred to the walls of the canal from prior infection, surgery or immune disorders making the dura “look” deficient.

You had a fusion of your spine 15 years ago but do not mention why. I assume you had a fusion for scoliosis with 11 vertebra and 10 discs fused (two vertebra typically share one disc). X-rays noted broken rods in the fusion region. I assume you had no symptoms prior to the auto accident you describe. You note “MRI and CT showed normal” but I also assume that there was an undiagnosed pseudoarthrosis (lack of fusion) as the normal reason rods break is a pseudoarthrosis.

A surgeon typically would “not repair the spot where the rods were broken” unless there was a lack of fusion. If the surgeon was repairing the pseudoarthrosis, I am unclear why he or she performed a decompression of the canal at the same time as the fusion repair unless there was also a narrowing of the spinal canal (stenosis).

You appear to have developed arachnoiditis from the initial surgery “Failed to mention the Spinal MRI also showed an empty thecal sac with adhesive arachnoiditis in the Lumbar region” This may well be why the second surgeon could not find the dura as it was adhered to the walls of the canal. This also may be why you had lower extremity symptoms prior to the second surgery.

Your Multiple Sclerosis was not caused by either of the two prior surgeries. MS is an autoimmune phenomenon where your immune system attacks the myelin of the nerves.

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.

leo42ray
Member

December 1, 2012 at 2:14 am

Post count: 3

#7512

Thank you for the quick response.

The concern when going into the second surgery was a dura tear. The rods broke in the thoracic region. The surgeon found the dura was missing from the area where the rods broke. He had to remove the vertebrae from that area and place a “patch sealed with fibram adhesive over the area with the area. Used bone grafts to rebuild the area of the spine and installed new hardware. I now have MS symptoms with no definitive acknowledgement of such. I am wondering if the unprotected nerves could have suffered enough trauma to cause me to have these issuses. I am still working but this condition makes it very diffucult. The neurologist that I have seems to think that it is all in my mind. I really do not know what to do. I feel I may further injure myself try to maintain my work status pushing my body when it is not able to. They are telling me that it can not be MS beause I do not have sizable white matter on the current MRI of the brain and spine. EMG normal. Those were the only tests they have performed before telling me to do physical therapy and to go to the Mayo clinic. This is not an ordinary/ normal spinal issue. I just do not know what to do and what to do from here. I would be able to send you some of the records and the surgeons operative notes if need be.

Again, Thanks for your input.

Donald Corenman, MD, DC
Moderator

December 2, 2012 at 9:57 pm

Post count: 8660

#7523

If you have symptoms in your upper extremities as well as lower extremities, this could not have been caused by your pseudoarthrosis and “dural deficiency”. If however, your symptoms are only in your lower extremities, the severe arachnoiditis you noted can cause some of the symptoms to mimic MS.

You need another very experienced neurologist for a second opinion to help you understand what disorder you have and the appropriate treatment necessary for this.

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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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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