facet joint in low back

Tagged: degenerative spondylolisthesis of L4-5 with spinal stenosis and foraminal stenosis

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carolns
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September 20, 2017 at 10:41 am

Post count: 88

#26409

Hi Dr Corenman, I am doing well since I had my c2 c3 c4 done in 2014 thanks to you.
My problem now is severe spinal stenosis in my facet joint from arthritis in lower back. The Doctor said it looks like a dog’s breakfast. I am waiting for a facet joint injection that is guided. Never had this before. Saw here how they put dye in, then inject. Can you tell me what I have to do to prepare or if after do I go home right away. Thank you so much….Carolns in N.S.

Donald Corenman, MD, DC
Moderator

September 20, 2017 at 7:50 pm

Post count: 8660

#26416

Somewhat confused as to the disorder you describe. Severe spinal stenosis does not occur “in the facet joint” but does occur in the spinal canal. You might have severe degenerative facet disease that causes spinal stenosis (see https://neckandback.com/conditions/degenerative-spondylolisthesis-or-spondlylolysthesis/) or you might have severe degenerative facet disease without spinal stenosis.

I have never heard of the spine called a “dog’s breakfast” but I love the term and will start using it. The facet joint injection can be found here (https://neckandback.com/treatments/facet-blocks-and-rhizotomies/).

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.

carolns
Participant

September 22, 2017 at 1:14 pm

Post count: 88

#26435

Dr Corenman, There is grade 1 anterolisthesis of L4-L5. There is degeneration of the disc with loss of disc height,vacuum phenomena and severe diffuse disc bulge. There is bbilateral facet osteoarthritis. There is severe spinal canal stenosis due to the bulging annulus and hypertrophy of the ligamentum flavum. There is moderate to severe bilateral foraminal narrowing due to the anterolistthesis, disc bulge and facet hypertrophy.
L5-S1 There is grade 1 anterolisthesis of L5 ON S1. Thre is degeneration of the disc with loss of disc height, vacuum phenomena and moderate diffuse disc bulge. There is moderate bilateral facet osteoarthritis. There is moderate bilateral forminal narrowing due too the anteroarthritis disc bulge and facet hypertrophy.
thank you Carolns in NS.

Donald Corenman, MD, DC
Moderator

September 23, 2017 at 7:27 am

Post count: 8660

#26436

So you have a degenerative spondylolisthesis of L4-5 with spinal stenosis and foraminal stenosis. You also have a slip at L5-S1 which is probably also a degenerative spondylolisthesis with IDR (isolated disc resorption) and foraminal stenosis. With both back and leg symptoms, you can try conservative care including an epidural spinal injection (ESI) but with the report of severe spinal stenosis (and no report of the stability of the spine which is found on flexion/extension X-rays-not on the MRI), you might be looking at surgery to decompress the nerves and stabilize 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.

carolns
Participant

September 23, 2017 at 9:23 am

Post count: 88

#26449

Thank you Dr Corenman, I have had many(EPI) from 2 doctors in OR but nothing helps. Pain down both legs, pins and needles, numbness, left leg worse. Using my walker when I go out. Never had flexion/extension on back.
Three yrs ago you helped me with c2c3c4 and thank you as they wanted to fuse my whole neck but you encourage to get a second opinion and I did . My neck is wonderful. fusion and decompression with screws etc
Six months ago I saw the doctor in Halifax and he said try not to have a operation on my back as we just got your neck fixed up.
Is there a keyhole operation that would help? Is there a chance operation on my back would mess up my neck?
Maybe my facet joint might help? Thank you for caring. carolns in NS

Donald Corenman, MD, DC
Moderator

September 23, 2017 at 3:43 pm

Post count: 8660

#26468

The back operation should help your neck. If you have back and leg pain with the findings on you MRI, you probably need a fusion, not just a decompression of your lumbar spine. The history and physical examination along with image review would help to determine which procedure you need.

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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