Help needed to understand my situation

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Susan117
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October 27, 2014 at 4:38 am

Post count: 18

#11606

Again, thanks. I will see what I can do to find a spine surgeon who will do a CT. Hopefully, I am just still in the healing timeframe….next month will be one year!
Noticed you said “if BMP is used appropriately”. I had a TLIF with Capstone PEEK cage, is that an appropriate use for it? I have just heard that it can grow bigger than necessary and cause pain sometimes. Just curious :)

Wish me luck!

Clancy
Member

October 27, 2014 at 6:33 am

Post count: 2

#11607

Hi there, Im not sure if this is where I am supposed to ask about my situation. I had a R)far lateral microdiscectomy at L2/3 due to compromise of my L2 nerve (dorsal root ganglion) 5 months ago. I still have the horrific neuropathic pain in the front and sides of my thigh and am now a “chronic pain patient” seeing a pain specialist. My nerve was compressed for 10 months. In your experience can this pain be from inflammation that will eventually settle and go away. Everything I read about neuropathic pain is rather depressing, stating it will get worse without medications to control it. I also have another small herniation at L4/5 that is displacing my L5 nerve and causing pain down the back of my legs and tingling in my feet and bottom. Does this more typical sciatica type of pain eventually lead to neuropathic pain if left untreated or should I have another microdiscectomy at this level? Will this herniation go away by itself or is it likely to progress if I lift something heavy?

Donald Corenman, MD, DC
Moderator

October 27, 2014 at 12:11 pm

Post count: 8660

#11609

Far lateral herniations can cause permanent nerve injury (chronic radiculopathy) but there is another situation where you can develop either foraminal stenosis or a missed fragment causing continued compression. A new MRI is warranted to discover either of these two situations.

If you have leg pain that changes with flexion (relief of pain) and aggravates with extension (standing and walking), this is more likely foraminal stenosis.

Mild chronic leg pain as found by a smaller L4-5 herniation can be treated by epidurals and SNRBs. Moderate prolonged pain without improvement or relief should be considered as potential surgical pain but that is not absolutely necessary unless there is motor weakness present.

Dr. Corenman

To Susan117- BMP is typically used with PEEK cages but I believe that the BMP should be shielded from the nerve root. This is why I put only the patient’s own bone in the cage and put the BMP “up front” in the disc space and also use a “sealer” like Duraseal in the back of the disc space.

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

October 27, 2014 at 7:18 pm

Post count: 18

#11611

Sounds like you do it right to protect the patient from future nerve problems…..not sure mine was done that way (my own bone was not used, only bmp and operative notes do not mention any kind of sealer being applied). Thanks for the response….I am calling my family doctor today to see if he knows a different doctor that will work wirh him to do a CT.
Woke up a few minutes ago and almost collapsed…my legs are aching and feel extremely week this morning :( thanks again for all of your responses. I really appreciate it…wish you were closer to Alabama….I would definitely try to get in to see you…you seem like a great, compassionate doctor who does whatever it takes to help your patients! We just don’t have that where I live :(

Donald Corenman, MD, DC
Moderator

October 30, 2014 at 12:33 am

Post count: 8660

#11620

I know that there are plenty of good spine doctors out there. Unfortunately, there are other doctors with plenty of issues that spill over into their practice. Finding a good, meticulous, compassionate surgeon is not always easy and I do not have a magic formula to help you find one (although I am working on it).

Do some searches on the internet. There are some services that rate doctors although these might attract negative comments at a greater rate than the doctor deserves.

Keep us informed regarding your eventual outcome.

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.

Clancy
Member

October 30, 2014 at 7:15 am

Post count: 2

#11624

Thanks for your advice. I had a second opinion from a neurosurgeon who said I have permanent damage to my dorsal root ganglion from the delay in having surgery. My type of herniation at this level is rare and the Drs who first treated me did not recognise it, so did not operate at the early stages. He has suggested that a spinal neuromodulator (at the DRG) is the only way to get the neuropathic pain under control. Have you had success or experience with this form of treatment. Have you heard of treatments with stem cells for neuropathic pain?
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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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