Failed Fusion

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Shirley Tinney
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October 14, 2013 at 9:38 am

Post count: 2

#9577

1. Complete laminectomy at L4 and L3 with partial laminectomies L2 and L5.
2. Medial facetectomies and foraminotomies bilateral L2-L3, L3-L4 and L4-L5.
3. Posterior segmental spinal instrumentation with Xia rods and screws, L3-L5.
4. Posterior lateral fusion L3-L5.
5. Posterior lumbar interbody fusions L3-L4 and L4-L5.
6. Placement Unite cages L3-L4 and L4-L5.
7. Left posterior iliac crest bone marrow aspirate for transplantation.
SURGEON OF RECORD: , M.D. 10/2004
11/14/2005: Lumbar hardware removal.
Patient released to work Full Time 12/2005. injured 10/28/2006 MVA: Vaulted from sleeper berth compartment of: Semi Tractor-53’Trailer:80,000 gross vehicle weight.
upon 55 mile per hour impact collision with vehicle illegally parked in highway traffic lane. Suffered “High Energy Blunt Force Trauma” to lower spine.
11/2006: At Post MVA Examination, Dr refused to order MRI to check lower spine for possible soft tissue injury resulting from MVA; Diagnosed patient with torn muscles and ligaments, prescribed physical therapy treatment.
Short term physical therapy had no positive results, patient released back to work full time.
Patient continued experiencing severe pain in lower spine.
Dr. ordered MRI: 09/17/2009 MRI results of herniated disc L5-S1.
New Dr., MD ordered MRI, 09/04/2013: Small left paracentral focal disc protrusion L5-S1, contacting the left S1 nerve root.
Dr. also ordered CT-Scan and Flexion X-ray.
09/12/2013: Dr. consulted with patient notifying patient that prior fusion surgery 2004 was a Failed Fusion and advised patient to undergo “Re-Do Spinal Fusion Surgery of L3-L4
and L4-L5 with repair of L5-S1. She is being scheduled for this surgery soon.
Need another Expert Opinion PLEASE?

Donald Corenman, MD, DC
Moderator

October 14, 2013 at 6:48 pm

Post count: 8660

#9578

First-please keep this site anonymous-no names.

You underwent a TLIF fusion of L3-5 and unfortunately suffered a high force accident some years later. The new work-up revealed a disc herniation at L5-S1 on the left. Apparently, the CT scan revealed a pseudoarthrosis (failed fusion) at L3-4 also.

You report lower back pain as your complaint. Does that mean you have no leg or buttocks pain?

The new surgeon’s plan is to “repair” L3-4 and I assume also proceed with a TLIF at L5-S1. Is this correct?

You pain generator or generators have not yet been defined by your explanation. Is the pseudoarthrosis level at L3-4 painful (do you have pain at the top of your old surgery site)? Is your pain lower at your belt line (more likely the L5-S1 level)?

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.

Shirley Tinney
Member

October 15, 2013 at 12:14 pm

Post count: 2

#9583

Pardon name usage. I do have quite a lot of extreme uncomfortable pain at the top of the fusion site. I also do have pain in both my lower legs, ankles and feet; more in the right leg. I also began experiencing neck pain at top of my shoulders while driving a lot; I have to pop my upper neck by pulling my head down forward with my hands from the back of my skull to alleviate it for a short time, on a fairly constant daily basis. I feel like I’ve had a meat cleaver buried in the middle of my spine at the upper levels of the surgical area since I forcefully landed upon my buttocks in the truck wreck. I was literally vaulted forward into the air towards the windshield/ dash area; my back was facing in a down position towards floor with my head first going towards the driver’s cab section of the truck. My co-driver/spouse (seated in driver seat) put out his right arm and caught me by my right shoulder: his hand pushed me down- directing the inertia of my body’s flight onto the cab floor. When the vehicles came to a rest, I was flat upon my buttocks, legs spread flat against the floor, my back was against the gear shifter which protrudes up from the floor. I felt instantaneous severe pain in my lower back at the area of surgery and I felt andrenaline coursing through my body. I didn’t receive any medical care from paramedics because my verbal pleas were ignored due to the circumstances of my being a truck driver involved in a fatality wreck. Both of us (driver’s) were ordered away from the vehicles by the highway patrol officers at scene. Paramedics didn’t respond to my injuries until after the county coroner removed the other party which was ascertained after many hours of scene investigation that the other party (deceased) was 100% at fault for causing the MVA by illegally parking his vehicle in traffic lane blocking motorist and not using any lights or hazard warning devices to warn motorist of its presence in the roadway. This pain in my back has remained there every second of my conscious life since the night of October 28, 2006. I’ve driven hundreds of thousands of miles throughout 48 states and Canada doing my best to ignore this terrible pain. I’ve been off the road since March 15, 2013 hoping to fix it somehow if possible? Hmm? What’s your estimated opinion of the possibility of at least reducing the amount of pain I endure through some sort of medical procedure? You’re the expert. I only drive trucks. I want to feel better so I can have some enjoyment of my life. Thank you Sir.

Donald Corenman, MD, DC
Moderator

October 22, 2013 at 7:58 am

Post count: 8660

#9660

You had a failed fusion of L3-4 but at the time, it was asymptomatic (non-painful). This is not an uncommon event as 50% of the failed fusions are not painful (until a new trauma activates the pain). The pain at the top of your fusion should be generated by the pseudoarthrosis (failed fusion) and repair should help alleviate the pain. This is assuming that the level above this is normal.

The level below at L5-S1 with the disc herniation is a question mark. You have a disc herniation at this level but the herniation is on the left and most of your leg pain is on the right side. There must be more to this story as the pain generation is not congruent with the MRI findings.

I cannot comment on your cervical spine pain as many disorders can cause the symptoms you note.

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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