Epidural Fibrosis?

Tagged: epidural fibrosis

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Vin
Participant

March 2, 2016 at 3:32 pm

Post count: 11

#21462

Hi again Doctor!

So I have the results of the MRI / CT Scan. It seems that I have a sequestered piece of disc at the postoperative level (l5 s1) that is within close proximity but inferior to S2. (Right side). That is paraphrased off memory as I do not have the report in front of me atm. I will post word for word later tonight and perhaps you can break it down for me.

My neurosurgeon bumped me up when I called with this report from the hospital so I see him early next week.

I suppose a microdiscectomy revision will likely be in order.

What is your thought on Microdisectomy revisions? I have read conflicting opinions. Some surgeons opt to go straight to fusion to avoid another possibly failed microdiscectomy and thus avoiding accumulation of fibrosis, as this could potentially end up being 3 surgeries (ie. 2 failed microdiscectomy and then a l5 s1 fusion).

Other Doctors say to always try 2 Microdisectomy before going to a much more invasive fusion and do not mention much at all in regards to the accumulation of scar tissue with a worst case scenario 3 surgeries.

1. What is the successful outcome percentages of Microdiscectomy revision surgery? Does the reherniation rate increase from the 10% chance of reherniation with the first Microdiscectomy procedure? Or is it still 10% chance with revision surgery?

2. What are your thoughts on going straight to fusion vs microdiscectomy revision?

3. With either surgery, do you ever have patients wear braces? I also read mixed opinions, some Doctors swear by them to keep the patient conscious of no BLTing…others say it restricts natural motion/ movement and increases chances of significant fibrosis.

Any input or insight is welcome and very much appreciated!

I will of course ask my surgeon these questions but also have a high regard for your opinion.

Thanks!

Donald Corenman, MD, DC
Moderator

March 2, 2016 at 6:26 pm

Post count: 8660

#21463

Generally, a fusion is not warranted with a recurrent disc herniation. The surgery to revise the recurrent herniation is slightly more technically orientated than the first but nonetheless-not that hard.

Now if the pain after the microdisectomy is related to the disc itself and not the recurrent herniation (lower back pain that does not radiate to the side of the recurrent herniation), a fusion work-up might be warranted.

Reherniation rate after the first herniation is 10%.

I always have my patents wear a soft corset brace for the first 4-6 weeks whether it is a fusion or a decompression. I think the brace reminds the patient not to “BLT”. The brace slightly restricts natural motion which is what you want and does not promote fibrosis.

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.

Vin
Participant

March 3, 2016 at 9:55 am

Post count: 11

#21472

Hi, great thanks a lot for the info.

Is the back brace you use similar to this?

Thanks.

Donald Corenman, MD, DC
Moderator

March 3, 2016 at 8:52 pm

Post count: 8660

#21475

The brace I use is somewhat more substantial than that brace but the idea is the same.

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.

Vin
Participant

March 7, 2016 at 12:56 pm

Post count: 11

#21494

Hi Dr. Corenman,

Can you please let me know your thoughts on my CT Scan / MRI Reports overall and also let me know if anything stands out as reason to why I would be getting numbness / sciatica in both legs and feet along with transient numbness in genital / rectum area as well as lower back pain across my entire lower back, both right and left sided?

Thanks again very much. I truly appreciate your responses and insight.

As per my CT Scan Report.

Findings:

The evidence of surgical intervention at lumbosacral level is noted with disk space narrowing and vacuum phenomenon. Limited right sided laminectomy.

Abnormal soft tissue density is seen occupying the right anterolateral aspect of the spinal canal contiguous with the residual, degenerate disk, obliterating the fat surrounding the right S1 nerve root.

Indentation of the anterior aspect of the dura at and below the level of the disk for about 18mm from presumed sequestered residual disk / postoperative reaction.

The left S1 nerve root is spared and nothing significant shown at the more superior levels. The degree of soft tissue reaction is consistent with the intervention with no particular concerns of infection.

*Postoperative sequestered disk material / haematoma / granulation tissue on the right side at the site of intervention obliterating the space around ipsilateral S1 nerve root and indenting the anterior aspect of the theca but not critically so. The left S1 nerve root is spared.

Given the clinical concern and to more precisely depict the extent of spinal canal compromise arrangements are in place for urgent MR scan.

As per MRI Report

Findings:

The MR scan confirms CT findings of abnormal sequestered disk material indenting the right anterolateral aspect of the theca at the operated level (lumbosacral) with extension inferiorly almost to the level of S2.

*The MRI scan has been reassuring and excluded the necessity for critical urgent decompression surgery. However, neurosurgical consult should be planned as soon as possible.
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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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