Incomplete Spinal Fusion

Tagged: failed back surgery syndrome, Incomplete Fusion lumbar spine

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sperryguy
Participant

March 11, 2016 at 10:52 am

Post count: 68

#21524

One additional thing, my surgeon did call me to tell me all look good and some fusion is now appearing around the inter body device. He said my pain could be some arthritis (just a bit) at the L3/L4 which could be resolved with an epidural injection. He is reluctant to order a Bone Scan. sounds like I should be right as rain? Is he missing anything? The pain and discomfort continues.

Donald Corenman, MD, DC
Moderator

March 12, 2016 at 12:12 pm

Post count: 8660

#21533

It looks like your fusion at L4-5 is solid so one less thing to worry about. You do not have any root compression according to the myelogram so there are two possible explanations for left leg weakness. One is that you have a peripheral neuropathy (the nerve is getting caught in a tunnel in your leg-see peripheral neuropathy). The other possibility is that the root was injured prior to your surgery and the decompression was successful but the root did not heal.

I don’t think you need a bone scan as much of that test information could be obtained on the STIR images of an MRI.

Pain in the back could be from either level above or below (L3-4 or L5-S1). I assume you have completed a full rehabilitation program and there is no strength deficit or range of motion limitation.

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.

Renee123
Participant

March 14, 2016 at 10:46 pm

Post count: 130

#21551

Just curious, I’m sure he will ask, but where does Sperryguy from here ? It sounds like his fusion started late so does that mean he will get better from here. Or would you suggest oral steroids to reduce nerve root irritation.

Donald Corenman, MD, DC
Moderator

March 15, 2016 at 4:19 am

Post count: 8660

#21552

Steroids can be helpful, even for a chronic radiculopathy but the longer a root is symptomatic, the less effective oral or injectable steroids are. I have seen some remarkable results occasionally but consistently, these medications take the edge off but generally do not cure in the chronic phases. Late occurring fusions are helpful for lower back pain and possibly for nerve pain due to instability but not for chronic radiculopathy.

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 15, 2016 at 7:39 am

Post count: 68

#21558

Hi Dr Corenman

Thanks you again for all your guidance. My surgeon/s and my pain doctors are discussing the possible
peripheral neuropathy, and possible issues at the L3. I have been a regular at PT and despite the issues, am active. They are still considering the Nuclear Bone Scan. They are still concerned that fusion is still ongoing and “work to be done”. My Pain Doctor wasn’t happy in the least with the Mylegram results. So, I am still in a quandary. Thanks goodness, the debilitating pain is no longer an issue.

Regards

Steve

sperryguy
Participant

March 16, 2016 at 11:15 am

Post count: 68

#21561

Hi Dr Corenman

I found this compelling Case report on Contralateral radiculopathy after transforaminal lumbar interbody fusion by Travis Hunt Æ Francis H. Shen Æ Christopher I. Shaffrey Æ
Vincent Arlet. Due to its length, this is not the proper venue for discussion. Just copied a bit of the Case study:

Abstract: Transforaminal lumbar interbody fusion (TLIF)
is an effective treatment for patients with degenerative
spondylolisthesis and degenerative disc disease. Opposite
side radiculopathy after the TLIF procedure has been
recognized in this institution but has not been addressed in
the literature. We present a case of opposite side radicul-
opathy after the TLIF procedure. We believe that this
complication is related to asymptomatic stenosis on the
contralateral side that is unmasked by the increased lor-
dosis of the TLIF. The authors recommend increasing both
disc height and foraminal height when choosing an inter-
body graft, and possibly decompressing the opposite fora-
men when preoperative MRI demonstrates foraminal
stenosis.

I dont know how relevant it is to my case, but I did recognize(without a medical background)some similarities to my situation. Do you think i should bring this study to my doctors attention? I very much value your input

Regards

Steve
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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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