Failing prodisc l5-s1

Tagged: Lumbar artificial disc replacement failure

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Jeremyg09
Participant

June 20, 2017 at 11:51 pm

Post count: 5

#25247

Hello Dr. Corenmen,

In 2013 I had a tdr at l5-s1 my surgeon used a prodisc 2-L. After the surgery I had relief from pain in my back and down my leg for about 3 months. After this I have gone down hill since 2013 with pain increasing over time. The pain is in my back and down my left leg but the pain at the disc site is far worse then my leg. The best way to describe the pain is that it feels as if I have a constant broken bone that throbs with pain non stop. If you were to touch the area where the AD is it caused an extreme sharp pain followed by an even worse throbbing pain. I’ve been diagnosed with failed back surgery syndrome due to the disc it’s self causing pain. Recently I’ve been told that the disc it’s self is failing. In what way I am not sure at this point. When I move a certain way you can here a mechanical popping and clicking noise coming from the disc location, I feel a very sharp pain when this occurs. I’ve been informed recently that the artificial disc can never be removed from the l5-s1 location due to several high risk including death. So my questions are
Before the questions a quick run down of what has been done to try to relieve pain.
Epidural injection from l2-l5-s1
I’ve had about 15 of these procedures performed since 2013 they all made the pain worse.
Facet blocks left and right l2 to l5-s1. Again made pain worse at l5-s1.
Burned the nerves on left and right side from l2 to l5-s1. This helped my leg pain only. Again making the pain worse at disc location.
It seems as if any time they would begin injecting the pain would become horrible and it seemed to irritate the disc area that already was extremely inflamed and this irritation would last some times up to 3 months before dieing down to my normal pain level. This pain would force me to stay in bed every day all day for 3 months until it let up.

1. Can removing the disc have high risk consequences?
2. How can a prodisc fail like this?
3. If the disc is causing pain what can be done about it?
4. If the disc is having mechanical failures and can not be removed is there a way to fuse the artificial disc or create some kind of cage around the disc to stabilize and relieve pressure?

Donald Corenman, MD, DC
Moderator

June 21, 2017 at 5:21 am

Post count: 8660

#25248

Unfortunately, you are generally correct in most of your assumptions. I don’t advocate artificial disc replacement (ADR) in the lumbar spine due to problems when these devices fail.

The removal of this prosthesis requires a revisit to the front of the spine. The iliac veins are the real problem as these veins have paper-thin walls and can be adhered to the scar that forms off the bone. Trying to mobilize these vein walls can cause a tear (can be very serious) and sometimes they cannot be mobilized enough to clear the removal of the ADR.

All artificial discs can fail as they are mechanical devices and the metal surface of the ADR rests on the bone of the vertebral endplate. Either through endplate fracture or through simple wear and tear of metal on plastic components, the device can become maligned or painful. Since removal can be dangerous or even life-threatening, most of us do not attempt to remove these devices.

The general solution to a painful ADR is a posterior fusion with rods and screws to stop motion of the painful device. It is not a perfect solution but many patients obtain some relief with this procedure.

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.

Jeremyg09
Participant

June 21, 2017 at 12:36 pm

Post count: 5

#25258

Well with this option at least I would have it, instead of being told there is nothing that could be done. Thank you for taking the time to read and respond to my questions. You have been very helpful.

Donald Corenman, MD, DC
Moderator

June 22, 2017 at 4:46 am

Post count: 8660

#25262

Please keep us informed of your progress.

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.

Jeremyg09
Participant

June 30, 2017 at 6:32 pm

Post count: 5

#25361

Hello doctor. Any advice on who I should see about a surgery they could do to reinforce the disc and prevent it from moving? I’m in am extreme amount of pain and can’t go on like this ,Uchiha longer. Imy going insane.

Jeremyg09
Participant

June 30, 2017 at 6:36 pm

Post count: 5

#25362

Hello doctor. Any advice on who I should see about a surgery they could do to reinforce the disc and prevent it from moving? I’m in am extreme amount of pain and can’t go on like this ,Uchiha longer. Imy going insane.
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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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