Incomplete Spinal Fusion

Tagged: failed back surgery syndrome, Incomplete Fusion lumbar spine

Viewing 6 posts - 67 through 72 (of 108 total)

Previous 1 2 3 … 11 12 13 … 16 17 18 Next

Author

Posts
sperryguy
Participant

March 14, 2017 at 9:16 am

Post count: 68

#24529

Hi Dr Corenman

This is the latest MRI report

MRI LUMBAR SPINE:

TECHNIQUE: Sagittal: T1, STIR, T2. Axial: T1, T2 (disc cuts L1-S1). Coronal: T2. Additional coronal STIR imaging of the sacrum was obtained.

CLINICAL HISTORY: Back pain, prior fusion surgery, assess interval change.

FINDINGS: Comparison prior lumbar MRI 09/27/16. The lumbar spinal canal is normal in size and configuration. No acute fracture is seen. No intradural abnormalities, bony destructive lesions or paraspinal masses are noted. The distal thoracic spinal cord and conus are normal. No bony or neural anomalies are identified. A small right renal cyst is partially visualized. Coronal imaging of the sacrum and sacroiliac joints is unremarkable.

L1-2, L2-3: Negative.
L3-4: Minimal posterior bulging of the disc annulus and mild facet arthropathy is noted. A small left foraminal disc herniation is causing very mild compression of the exiting left L3 root. No significant thecal sac deformity is seen..
L4-5: The patient has undergone laminectomy, posterior instrumented fusion and interbody fusion. Posterior metallic rods/screws and an anterior disc graft are noted. No herniated disc, spinal stenosis or postop collection is seen.
L5-S1: A small central and slightly more left-sided broad-based disc herniation is noted, causing mild midline thecal sac compression. Mild foraminal deformity of the exiting left L5 root is also noted.

Impression:
1. NO SIGNIFICANT CHANGE SINCE THE PRIOR LUMBAR MRI DATED 09/27/16.
2. SMALL LEFT FORAMINAL DISC HERNIATION, L3-4, CAUSING VERY MILD DEFORMITY OF THE EXITING LEFT L3 ROOT.
3. PREVIOUS LAMINECTOMY, POSTERIOR INSTRUMENTED FUSION AND INTERBODY FUSION, L4-5, AS SIMILARLY NOTED ON EARLIER IMAGING. POSTERIOR METALLIC RODS/SCREWS AND AN ANTERIOR DISC GRAFT ARE AGAIN DEMONSTRATED. THERE IS EXCELLENT DECOMPRESSION OF THE SPINAL CANAL, WITHOUT NEURAL COMPRESSION OR COLLECTION.
4. SMALL CENTRAL AND SLIGHTLY MORE LEFT-SIDED DISC HERNIATION, L5-S1, CAUSING MILD MIDLINE THECAL SAC DEFORMITY. MILD FORAMINAL DEFORMITY OF THE EXITING LEFT L5 ROOT IS AGAIN NOTED.

This is the XRAY of my hip:

History: Bilateral groin pain for 4 weeks, left more than right, no trauma

Technique: XR HIP AP AND FROG BILATERAL

Comparison: 6/24/2014

Findings:

The right and left hip joint are congruent. The joint spaces are preserved. The cortical margins are normal.

There is mild prominence of the anterior femoral head neck junction bilaterally. There is fibrocystic change at the anterior right femoral neck. The acetabular morphology is normal bilaterally.

There are no osteophytes or erosions. There are no aggressive appearing lytic or blastic lesions. The pubic rami, ilioischial and iliopectineal lines appear normal. The bilateral sacral foraminal lines and sacroiliac joints appear normal.

Impression:

There is no evidence of fracture or dislocation or arthritic change in the hips.

————————————————————————————————————

I believe that this will be the last MRI prior to revision surgery. The groin pain continues, Motrin 400MG appears to help along with 1/2 tablet of percoset(lowest dose).

Donald Corenman, MD, DC
Moderator

March 15, 2017 at 10:32 am

Post count: 8660

#24532

OK-your groin pain could possibly be from the foraminal disc herniation on the left at L3-4 (“A small left foraminal disc herniation is causing very mild compression of the exiting left L3 root”).

The L5_S1 disc is still an unknown in my mind. It does have degenerative changes (“L5-S1: A small central and slightly more left-sided broad-based disc herniation is noted, causing mild midline thecal sac compression. Mild foraminal deformity of the exiting left L5 root is also noted”) but I cannot tell from this reading if I would recommend fusion. Probably fusion will be helpful but the L3-4 disc has some degenerative changes which will increase stress on this level.

The hip might have femoral-acetabular impingement (FAI-see https://neckandback.com/conditions/femoral-acetabular-impingement-syndrome-fai-hip-impingement-syndrome/). That can be diagnosed with an intraarticular hip injection (see pain diary; https://neckandback.com/conditions/femoral-acetabular-impingement-syndrome-fai-hip-impingement-syndrome/.

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.

sperryguy
Participant

March 16, 2017 at 11:43 am

Post count: 68

#24535

Hi Dr. Corenman

Thank you so much for your findings. I will relate this information to my surgeon. He did mention the L3 could be causing the groin pain. He was equally suspicious that the hip is also the culprit. The surgeon did explain to me why the L5 must be fused, though I dot recall all the details. Only that he saw on the imaging that I am very unstable and he found nerve compression. If L5 must be addressed and fused, what would you suggest to do with the L3?

Thanks

Steven

Donald Corenman, MD, DC
Moderator

March 19, 2017 at 7:54 am

Post count: 8660

#24555

First, I would find the source of the groin/thigh pain. This would be an intraarticular hip block and then a selective nerve block of L3 keeping a pain diary (https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic/, https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections/).

If the hip is the pain generator (thigh pain relief from the hip injection), leave the L3-4 level alone. If the L3-4 level is causing pain, there is a decision to be made. If L5-S1 has to be added (and at this point, I still need some more convincing), the L3-4 will be further loaded and has a higher chance of wearing out. You can have a microdiscectomy at this level but that will further weaken this level with a somewhat higher chance of recurrent herniation due to the two level fusion below. You can fuse this level as well as L5-S1 leaving you with a three level fusion and the necessary further activity restrictions that a three level fusion requires.

If your L5-S1 level can be left alone, leave it alone. If not, use the algorithm above.

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.

sperryguy
Participant

March 19, 2017 at 11:07 am

Post count: 68

#24557

Hi Dr. Corenman

I just had a l3 l4 block. In addition, I will be meeting with my new surgeon this coming Friday. I will communicate all your advice to him. I’m very concerned at this juncture. My thought process is as you are communicating. The need to address all the issue’s and best outcomes are to me critical. Another symptom that is becoming more prevalent is urination issues. The constant feeling to go has been getting worse. Don’t have prostate issues, stones etc… Initially I attributed to my age (60). I will communicate to you the surgeon’s thinking on the l5 and thoughts on l3 issues.

All The Best and thank you. Steve

Donald Corenman, MD, DC
Moderator

March 20, 2017 at 7:53 am

Post count: 8660

#24562

Did you keep a pain diary for the first three hours after the block? If so, what were the results?

Urination problems rarely are caused by compression of the nerves in the lower spinal canal (cauda equina syndrome). In your case, the MRI report does not substantiate compression of the cauda equina necessary for urinary dysfunction. At age 60, the problems certainly could originate from the prostate even though undiagnosed. Pain can also cause urinary dysfunction.

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.
Author

Posts

Viewing 6 posts - 67 through 72 (of 108 total)

Previous 1 2 3 … 11 12 13 … 16 17 18 Next

You must be logged in to reply to this topic.

Donald Corenman, MD, DC

Average rating:

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel