Incomplete Spinal Fusion

Tagged: failed back surgery syndrome, Incomplete Fusion lumbar spine

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Donald Corenman, MD, DC
Moderator

March 20, 2016 at 4:56 pm

Post count: 8660

#21650

Opposite side radiculopathy due to foraminal stenosis secondary to a TLIF is generally rare unless a scoliosis surgery is completed in addition. The reason this opposite side radiculopathy generally does not occur is that the cage placed in the disc space distracts the two collapsed vertebral bodies. This enlarges the foramen (the nerve exit hole) so that foraminal stenosis generally does not occur after a TLIF.

However, if there are posterolateral fusions without a TLIF (as occurs in the upper levels in a scoliosis surgery), the angular change of the vertebrae can compress the root in the foramen or even stretch the root somewhat. It is still somewhat rare (less than 5%) but could occur.

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 21, 2016 at 8:03 am

Post count: 68

#21653

Hi Dr Corenman

Thank you again for so much patience with my issues. In a nutshell, your saying that “Opposite side radiculopathy due to foraminal stenosis secondary to a TLIF” isn’t very unlikely? I apologize if my frustration is showing. I have scheduled yet another appointment with a noted Orthopedic surgeon part of the HSS/NYU Langone system. My symptoms are as follows, intense back pressure at around the surgical site, achy, dullish pain>that then progresses to achy leg pain>then to tingling and numbness in the left side of my left foot. There is also dull pain primarily on the lower left side of my back. Any “nerve” pain is a result of pressure in my back. Walking seems to help, though the pins and needles and numbness will remain. Sitting can be uncomfortable , favoring the left leg. I do take one low dose percoset, split in two as needed. That must be masking some of the pain. Im hoping that the next consult will uncover something from the imaging studies. I was told that the reports aren’t enough to make a diagnosis.

Thank you Again, and will continue to keep the forum informed.

Steve

Donald Corenman, MD, DC
Moderator

March 22, 2016 at 7:28 am

Post count: 8660

#21661

The imaging studies need to be coupled to your symptoms (through a complete history) and verified by a meticulous physical examination. Please let us know what the consultant says.

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 23, 2016 at 10:40 pm

Post count: 130

#21673

This might sound like a stupid question, but is it possible Steve has a seroma pinching a nerve ?

Donald Corenman, MD, DC
Moderator

March 25, 2016 at 10:35 pm

Post count: 8660

#21735

BMP reactions occur due to handling, dosage and technique. I have reduced BMP reactions to about 1% and these are generally mild. The old technique of a spine surgeon and neurosurgeon operating together is not continued as either specialist should be expert enough to do the surgery by themselves. Neuromonitoring should be standard of care in todays world.

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

September 7, 2016 at 11:57 am

Post count: 68

#22920

Hi Dr C

After a long hiatus in reporting my lower back status, much has happened. As you suggested, I have made an appointment to see yet another surgeon to discuss my outstanding issues. To summarize, intense pressure and pain post bike riding or simply being very active. The symptoms can vary, front leg achenes, numbness and tingling of the left side of my foot. At times difficulty twisting while looking over my shoulder when pulling out my car. All in all, very difficult excising without pain. I should note that the pain surfaces 24 hours post workout and increases in intensity over a 72 hour period. Then reduces as long as I’m not doing strenuous activity. All the consulting doctors and the operating surgeon recommended another bone scan. Here are the results:

1) Irregular uptake is seen at the site of his lumbar surgery(l4/5)
spect-ct imaging of the lumbosacral spine shows increased activity in the fusion mass on both sides. the most intense activity being adjacent pedicle screw with much less activity neat the L5 pedicle screw and more symmetric uptake along the upper portion of the fusion mass bilaterally. No abnormalities are seen in the facet joint below the site of the surgery.
Impression: Activity is seen in the fusion mass on both sides of the surgical sites. It is unusual for activity persist this long after surgery, the symmetry of uptake makes it difficult to determine the significance of this activity.

As I mentioned, I will be seeing a noted surgeon this Friday who specializes in difficult revision surgeries. In addition, I am scheduled to see a PT specializing in only the spine issues (PHD ).

Could you interpret these finding for me?

Thanks you so much

Steven
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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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