Incomplete Spinal Fusion

Tagged: failed back surgery syndrome, Incomplete Fusion lumbar spine

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Donald Corenman, MD, DC
Moderator

May 5, 2017 at 4:58 am

Post count: 8660

#24729

Your hips are not perfectly normal (“There is mild prominence of the anterior femoral head neck junction bilaterally. There is fibrocystic change at the anterior right femoral neck”). This could be femoral/acetabular impingement and could cause some hip pain. See https://neckandback.com/conditions/femoral-acetabular-impingement-syndrome-fai-hip-impingement-syndrome/ to understand this syndrome.

Where is your leg weakness? Is it all in one myotome (the muscles that are innervated “connected” by one nerve) or are multiple myotomes involved? Is there pain inhibition present (the muscle when activated “hurts” preventing you from contracting that muscle fully)?

A simple way to rule out the hip is to inject some numbing medication into the hip and look for temporary pain relief.

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

May 16, 2017 at 8:25 am

Post count: 68

#24798

Hi Dr. Corenman

The doctors (as a team) are now quite confident that the source of the hip pain is coming from the back. I went through presurgical testing, and was sent for a neuro consult as per the surgeon. Very thorough exam. Thank goodness no nerve damage, the doctor said mechanical in nature. Any last minute instructions?

Thank You!

Steve

ps: The procedure will be an open revision TLIF L4 through S1

Donald Corenman, MD, DC
Moderator

May 18, 2017 at 6:27 pm

Post count: 8660

#24808

A positive selective nerve root block (numbing of the nerve with temporary relief of hip pain) will confirm that your back is the cause of your hip pain.

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

August 16, 2017 at 11:07 am

Post count: 68

#25996

Dear Dr Corenman

Update on my surgery

Summary: I had a Open Tlif revision, L4-S1 (l5/s1 was new). The surgeon found “No Fusion whatsoever. Severe compression at the L5 level. He also decompressed the L3 without a fusion. I received excellent care and spent 7 days in the hospital due to severe pain and excessive drainage. The first 2 days there was a discussion with the doctors regarding being sent to a facility since I was unable to move my legs without assistance. I was very adamant in PT and never allowed the staff to miss sessions. Things improved. Constipation was a severe issue. At some point I asked for “Movantik” for the issue which did help. Still hospitals “Do Not” give the correct meds to help the patients. Patients must be there own doctors. I have been home for about 3 months. Recovery has been a challenge but I am improving quite nicely. I am fortunate to be working from home until I’m strong enough to travel to my office. To anyone going for such a surgery, beware that it is difficult and exhausting. Quite different that a MI operation. The older one is the greater the challenge. Go for PT with a therapist with extensive spine experience. My PT started in house and after 6 weeks started in office therapy. One very important finding regarding avoiding nausea post op. I was given a scopmaline patch. I was Rx it for almost 4 weeks due to other meds causing nausea(even Tylenol). The withdrawal from this drug is horrific!. Avoid it if you can, find alternate treatment. I found not doctors, PA, Nurses, and remarkably Pharmacist were aware of the withdrawal effects. My pain management doctor was aware and said he never Rxs med. Im sorry for the long report. The journey continues, 60-70% of my pain has been relieved. I hope it continues. Thank you Dr C for all your help!

Steve

Donald Corenman, MD, DC
Moderator

August 17, 2017 at 10:13 pm

Post count: 8660

#25999

OK-so the L4-5 failed fusion level was obviously not fused. The L5-S1 level sounds to have been nerve compressive (but that should have been known by the imaging-CT or MRI). Your statement “regarding being sent to a facility since I was unable to move my legs without assistance” worries me unless you had previous weakness that was the same as previous to surgery. You should not have had increased weakness after this surgery.

The recovery from this surgery should have not been too difficult and certainly not any more than an MIS surgery. Did you have a dural leak?

Glad you have had at least 60-70% relief. Have you regained your strength?

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

November 12, 2017 at 6:36 am

Post count: 68

#26808

Hello Dr Corenman

Just checking in with you and the forum. These are the latest xrays from my l4-s1 revision TLIF
Study Result
Impression

IMPRESSION:

Status post L4-S1 posterior and anterior column fusion with further incorporation of the dorsolateral L4-5 bone graft and no evidence of hardware failure.

There is no subluxation, normal alignment with neutral, flexion, and extension images.
Narrative

History: Lumbosacral spinal fusion follow-up

Technique: XR LUMBAR SPINE AP AND LATERAL WITH FLEXION AND EXTENSION 4 VIEWS

Comparison: 8/15/2017 lumbar spine radiographs

Findings:

There has been posterior spinal rod and pedicle screw fusion from L4 through S1. The pedicle screws are intact with no evidence of pathologic surrounding lucency. The spinal rods are intact. There is no subluxation, normal alignment with neutral, flexion, and extension images.

Dorsolateral bone graft is visible at L4-5 bilaterally. It appears to have undergone further coalescence since the prior examination.

There has been interbody cage placement at L4-5 and L5-S1. There is bone graft within the L4-5 interspace, visible anterior and to the right of midline without definite incorporation into the adjacent vertebral bodies. The L5-S1 interbody graft appears to have resorbed.

There is mild intervertebral disc height narrowing at L3-4. L1-2 and L2-3 disc height is preserved. There is no fracture. There are no osseous destructive lesions.

I am post op 6 months. I still some issues, and occasional groin pain, nothing like previous to the surgery.
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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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