Help needed to understand my situation

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Susan117
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August 16, 2014 at 4:21 am

Post count: 18

#11283

I am hoping for some guidance. Here is a little background into my situation: I went to my Dr. in September 2012 who ordered a MRI. He went over the results and told me we would watch a couple of segments showing signs of degeneration, gave me medication and sent me on my way. Fast forward a few months, I go to a different Dr. for a second opinion and because he is closer to home. He orders an MRI and tells me I need TLIF surgery for L5/S1. I schedule this and have it done in November 2013. Eight months later, I am still having severe pain and difficulty. The Dr. Who performed the surgery says nothing is wrong. I start researching and receive my medical records from the first Dr. Only to find out that his MRI showed “annular tear and degeneration at L4-5 disc, sacralized L5 producing a Bertolotti Syndrome at L4-5, inter body fusion needed in the future, will treat with meds for now”. The Dr. who performed my surgery here 1) never mentioned this and 2) fused the wrong segment? I am confused and wonder if my L5, which is supposedly “Sacralized” needed to be fused? I am still in a lot of pain and have severe leg weakness and wonder if it is from my L4-5? Thanks for your help!

Donald Corenman, MD, DC
Moderator

August 18, 2014 at 1:55 am

Post count: 8660

#11284

First thing to know is that radiologists and surgeons might call different levels in the face of “Bertolotti’s Syndrome” as the same or different levels. Normally, the level should be called out and explained on the dictation.

Example, “there is a partially sacralized L5-S1 level (that’s what Bertolotti’s Syndrome really is) that will be called L5-S1 to understand the nomenclature).

Did you have a true L5-S1 fusion (a fusion of the partially sacralized segment) or do you have a fusion of the level above? Did you have any work-up to identify the pain generator (discograms, selective nerve root blocks) that identified the level of pain?

Did you have “severe leg weakness” prior to your surgery?

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.

Susan117
Member

August 18, 2014 at 4:13 am

Post count: 18

#11288

Thank you for you reply! The surgeons notes from my TLIF surgery say:
L5-S1 Posterolateral Fusion
L5-S1 Posterior Interbody Fusion
L5-S1 Posterior instrumentation with application of bio mechanical device
L5 Laminectomy
Implants: Medtronic Solera Pedicule screw system with bilateral 7.5 x 35 versus 6.5 x 4mm screws, bilateral 40mm rods with locking caps, capstone PEEK Interbody cage 7x22mm extra small kit infuse bone morphogenic protein, 10 cc Grafto putty

That was the surgery done in Novermber by my “second opinion” surgeon. The first opinion surgeon is the doctor that did my original harrington rod surgery in 1985 and his radiologist is the one who said my L4-5 segment had annular tear and degeneration with sacralized L5. My leg weakness and back pain are worse after surgery and the pain spreads across my sacrum and I also have burning in my toes and feet.

Susan117
Member

August 18, 2014 at 4:17 am

Post count: 18

#11289

Also, the surgeon from November has noted that I am still having pain but says it is from facet arthritis and not offered any type of work up to identify the pain source now. I wish he would! But he keeps saying it is either arthritis or sympathetic pain.

Susan117
Member

August 18, 2014 at 4:19 am

Post count: 18

#11290

Sorry, keep forgetting to add pertinent information! I also gave harrington rods and fusion in my upper back, I believe at level T1 that goes to L2!

Donald Corenman, MD, DC
Moderator

August 18, 2014 at 10:18 pm

Post count: 8660

#11291

OK. To summarize, you have had a prior scoliosis surgery years ago from T1-L2. You then developed lower back pain and leg pain/weakness. You have a partially sacralized L5-S1 level and an annular tear at L4-5. You underwent a fusion of L5-S1 which did not take care of your lower back pain. Prior to surgery, you had leg weakness that is now worse than before. Correct?

Questions have to be answered that have not previously been answered. There must have been some compression of a nerve root to cause leg pain unless you have a spontaneous nerve injury which is very rare. Is there evidence of a nerve compression on your MRI?

You developed lower back pain. The possible sources of lower back pain are degenerative facets, degenerative discs or very rarely, that transverse-alar articulation at L5 (Bertolotti’s syndrome).

Is your fusion solid or might you have a non-union (pseudoarthrosis)? If you have a solid fusion, is the level above causing your pain? That would require a discogram test (see website).

With a prior scoliosis surgery, you probably have some angulation of the lower lumbar vertebra. Do you have foraminal stenosis or foraminal collapse (angulation of one vertebra on the other of greater than 6-8 degrees-see website)?

There are many possibilities here. You need to start at the beginning as I have outlined and figure out what your pain generators are.

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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