Fusion L5 S1 having lubarization S 1

Tagged: Phrenic nerve and the diaphragm.

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deb60
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August 23, 2017 at 2:36 am

Post count: 9

#26093

It’s been a long time since this post with many things going on. I followed your advice with follow up MRI and also nerve conduction tests. The MRI showed nothing impinging the nerves and the fusion was done well. The nerve conduction test showed much damage. After reviewing the surgery to see what else may have happened I found that the left iliac vein had been cut a a large amount of blood was lost. Which would explain why he ended in the ICU after surgery his blood pressure was dangerously low, I think 29 was the top number I was freaking out. They gave him several units of blood. I think this is the reason for his neurapathy pain and since I last posted he has had a spine stimulator that relieves some of the pain but not all. Thanks for your help in directing me to find the diagnoses it is greatly appreciated! I will be posting a question soon as soon as I get some information together. We have had some pretty bad luck and was in a car accident March 2015. My husband had a cervical fractures that never fused. He now has reverse cervical lordosis found by a bone scan. He had 9 hospitalizations for respiratory failure since March 2016 and seems his bowels have slowed down and his abomin is distended just before respiratory failure. I have wondered if the injury is the cause of this, I can not seem to get his physicians to refer him to a specialist to get him tested and have further imaging done. They just say this isn’t the cause. I can’t just sit and wait because this is life threatening! Thanks again and I will post the information I have soon!

Donald Corenman, MD, DC
Moderator

August 24, 2017 at 8:15 am

Post count: 8660

#26174

The nerve symptoms were probably developed from the original compression of the nerve leading to surgery or from retraction during surgery. The vein tear and blood loss can cause many different problems but nerve injury would be way down the list and unlikely to be caused by the vein tear.

His respiration failure could be from many different disorders such as congestive heart failure, renal failure or pulmonary fibrosis. He needs a good internist or pulmonologist to work him up and discover what is causing these problems.

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.

deb60
Participant

August 28, 2017 at 2:29 am

Post count: 9

#26217

Yes I am sure you are right, I just found the nerve conduction test following surgery and it showed there was damage, at the time they said there was no damage but the document said there was. The respiratory failure is very strange, it comes on very fast and oxygen can’t be brought up with home oxygen. He feels as if he were not sick after the 1st day in the hospital unlike pneumonia. Seems to always happen after doing light physical projects. He gets a low grade fever around 99 then his abdomen swells his pupils are dilated, his oxygen drops the doctors tell me his lungs are clear and with in about 15 to 20 minutes his lungs fill with fluid. His heart is functioning fine, I had him checked out by a heart doctor on more than one occasion because I thought it could be the problem. I have also had him to kidney doctors who have said this isn’t the cause. Pulmonary doctors monthly if not more. 30,000 miles in just doctors care. In the last year and a half. He has so many problems every where in his spine especially the areas where the nerves control the diaphragm. A x-ray 4 months after the accident showed a unchanged fractures in C2 from there I have no idea if they healed as they said they didn’t need to see him again, it also showed central canal stenosis at C4-C5 with disk herniation, diffuse uncinate arthropathy this was July of 2015 so I am sure it has got worse. Since then he has had images done for reasons of his respiratory problems and many new spine problems have showed on them. Reverse lordosis of the neck, several compression fractures in the thoracic region. Loss of disk space height C3 thru C6. 5 images showing decreased bone mineral density,degenerative morphology through out his spine. All images of the lungs show atelectasis which could be a sign of diaphragm dysfunction. I know that his doctors are doing there best, ( I research and find the best doctors) I am just wondering if the accident did more damage than can be seen and is being overlooked along with the decreased bone desity, as the nerves functions the entire body and because of the spine stimulator he feels no pain in his back only some neurapathy pain in his feet as it is hard to reach the foot with spine stimulater’s. This is definitely a complicated case Maybe a internist or vascular specialist could help but I can’t rule out neurological with all the problems in his spine.

deb60
Participant

August 28, 2017 at 2:51 am

Post count: 9

#26218

I should also state the following, In a auto accident with in 2 years after a auto accident with injuries to the cervical spine death is the cause of respiratory failure.

Donald Corenman, MD, DC
Moderator

August 29, 2017 at 6:47 am

Post count: 8660

#26225

If there is a phrenic nerve injury (the phrenic nerve or C2-5 is the set of nerves that services the diaphragm), the diaphragm may have a flat appearance on chest X-ray and inspiration/expiration chest X-rays should have a characteristic appearance where the diaphragm does not descend (pull down) with a deep breath. Cervical stenosis in the upper spine can occasionally cause breathing difficulties but that would be rare. C2 fractures can cause some nerve supply loss to the diaphragm in very unusual cases as the C2 nerve is part of the phrenic nerve.

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.

deb60
Participant

August 30, 2017 at 12:53 am

Post count: 9

#26238

Thanks so very much Dr. Corenman, My husband has been a very unusual case which up until now have had no explanation of all his symptoms, but this is as close as can bee explained so far. Your information has been very helpful and led me to information about Autonomic dysfunction which could explain the changes in his bladder, kidneys, digestion and breathing. At the time of the accident his kidneys and bladder were normal now his kidneys are mildly atrophic and his bladder is distended with wall thickening, his kidney function is on and off. His digestion seems to slow down or stop at times where the stomach area is very swollen and distended. As I said before it always seems to happen after light physical activity which confuses me unless it puts compression on the nerves and triggers it. Of course he would need test to confirm it. Your information led me to this abstract from PubMed.

Autonomic dysfunction in spinal cord injury: clinical presentation of symptoms and signs.
Spinal cord injury and especially cervical spinal cord injury implies serious disturbances in autonomic nervous system function. The clinical effects of these disturbances are striking. In the acute phase, the autonomic imbalance and its effect on cardiovascular, respiratory system and temperature regulation may be life threatening. Serious complications such as over-hydration with the risk of pulmonary edema or hyponatremia are seen. The cord-injured person suffers from autonomic nervous system dysfunction also affecting bladder and bowel control, renal and sexual function. Paralytic ileus may cause vomiting and aspiration, which in turn interferes with respiratory function in those with cervical spinal cord injury. The cord-injured person is at risk to develop pressure sores from the moment of the accident. Two to three months post-injury the cord-injured person with a lesion level above the fifth thoracic segment may develop autonomic dysreflexia, characterised by sympathetically mediated vasoconstriction in muscular, skin, renal and presumably gastrointestinal vascular beds induced by an afferent peripheral stimulation below lesion level. The reaction might cause cerebrovascular complications and has effects on metabolism. Some of the autonomic disturbances are transient and a new balance is reached months post-injury, while others persist for life.
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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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