Kyphosis causing lower body problems

Tagged: Kyphosis and bowel/bladder dysfunction from Gibbus deformity due to TB infection

Viewing 6 posts - 1 through 6 (of 6 total)

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RJT
Participant

April 26, 2023 at 12:03 am

Post count: 3

#35626

HISTORY:
Hello Sir, I’ve had back surgery after it was found my backbone was melting(part of D12, L1 and L2) due to Pott’s spine. Total 3 surgeries were done, one of back where it was about to break and they used plate and wire to support my back in 2007 and 2 other to surgeries were of my stomach from where pus was drained around 1.5 liters. My 4th surgery was done in 2010 because my back implant had started causing infection so they had to remove implants. Now my d12, l1 and have completely fused.
PROBLEMS:
1. From several years I’ve been suffering from constipation which is still increasing. I had consulted gastro doctors. They have performed several procedures such as colonoscopy, anorectal manometry, barium defecography, biofeedback, etc but none of them helped or found anything.
2. I have to use some power while emptying my bladder. Procedures done by uro doctors were urine culture, abdomen ultrasound, uroflowmetry, rgu/mcu xray, uds. Doctor diagnosed nurogenic bladder as it was found that bladderneck is not opening properly.
3. Minor jolt like in left leg, some part of left leg skin sensation is gone. Waist pain most of the time and sometimes its unbearable and Kyphosis. Doctors gave some medicines like zosert 50, anxit 0.25, etc. He also advised me to do spinal extension exercises 3 reps, 3 times per day. Until now nothing had helped. Doctor also said spine fixation surgery is not a guarantee that it will fix my problem since nothing conclusive was found in mri so I’m still waiting for medicines to work.
MRI REPORT Impression:
“1. Complete fusion of the D12, L1 and L2 vertebral bodies resulting in a gibbus deformity and causing indentation over the conus medullaris as described.
2. Mild disc bulges at L4-L5 and L5-S1 as described.”

Please share your review regarding my case. Also if surgery is required please tell what will be the best way to do it.
Thanks

Donald Corenman, MD, DC
Moderator

April 26, 2023 at 11:42 am

Post count: 8660

#35627

You note “Complete fusion of the D12, L1 and L2 vertebral bodies resulting in a gibbus deformity and causing indentation over the conus medullaris as described”.

Tuberculosis (Pott’s Disease) causes erosion of the front of the spine allowing the spine to “get stuck” in the bent forward position (Kyphosis or Gibbus formation). This “bent forward” position tethers the end of the spinal cord (the conus medularis) and causes malfunction of bowel, bladder and leg nerves (“Minor jolt like in left leg, some part of left leg skin sensation is gone. Waist pain most of the time… suffering from constipation which is still increasing…Doctor diagnosed neurogenic bladder as it was found that bladder neck is not opening properly”).

While no guarantees are available from surgery results, it would seem that the better chance of having a more reasonable life might be an osteotomy and refusiom of your deformed thoracolumbar spine. A surgery here is not without some significant risk due to scarring. Try and find a major university program who would agree to see you.

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.

RJT
Participant

April 26, 2023 at 1:07 pm

Post count: 3

#35628

Thanks a lot for reviewing my case Sir. I’ll follow your suggestion!

Donald Corenman, MD, DC
Moderator

April 26, 2023 at 1:42 pm

Post count: 8660

#35629

Please keep the forum in touch with your progress.

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.

RJT
Participant

April 30, 2023 at 3:28 am

Post count: 3

#35630

My current doctor who is Neurosurgeon said that surgery in this case is very risky which doesn’t guarantee helping in my constipation and bladder problem because Myelopathy and nerve compression could not be seen in mri. So the safest route of surgery could be just straightening of spine with medical hammer and other tools and then use titanium rods to fix the position of spine. Osteotomy is very risky in my case since I already went through spine surgery twice and the nerves around spine maybe glued around my spine due fusion of bones. Sir what should be correct procedure in my case? Thanks for your reviews Sir.

Donald Corenman, MD, DC
Moderator

April 30, 2023 at 10:44 am

Post count: 8660

#35631

Your surgeon is correct regarding the dangers of straightening the kyphosis with the prior infection and surgeries. There is no guarantee that surgery will return your lost function and complications can and do occur. If however, your surgeon is not experienced with osteotomy, he or she might not be the person to see. Maybe a second opinion would be helpful.

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.
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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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