L4/L5 Herniation: TLIF

Tagged: herniated disk, sciatica, TLIF

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Shermdaddy
Participant

July 30, 2016 at 1:11 am

Post count: 5

#22693

I’m a 46 year old male that isn’t overweight. In 2011 I had a bone chip removed from my sciatic nerve with a small Microdiscectomy. I had a true herniation of the disk in November 2015. I went through PT and a series of epidural injections twice with little help until I had another microdiscectomy the Thursday before Memorial Day 2016. I was making great progress but the disk reherniated to extreme pain and I had another Microdiscectomy two weeks later. Seven weeks post op from the third microdiscectomy it reherniated with pain so bad I had to go to the ER. The MRI shows a bulge pressing on 95% of my nerve. Based on the initial results and progress of the last two operations it seems they were technically successful. My surgeon now wants to do a TLIF on L4/L5. The rest of my spine is healthy with nothing else remarkable.

Does a fusion seem reasonable?

Does a single level TLIF without back pain and only sciatica generally do better than a condition with two plus levels and/or back pain?

How many fusions should a surgeon do for proficiency?

How many should they regularly perform to maintain their skills?

I understand your opinion is just that without seeing me but I would appreciate any insight. I’m trying to get a second opinion. However, anywhere I call appointments are three weeks out and my situation is emergent. The pain meds barely work and something ne ends to get done sooner tha that. The only barely comfortable position for me at this point is laying on my stomach with my legs hanging off the side of the
side of a bed but my knees not touching the floor. Any input is greatly appreciated.

Donald Corenman, MD, DC
Moderator

July 30, 2016 at 12:24 pm

Post count: 8660

#22694

In reality, you have had three decompression surgeries at the L4-5 level.The “bone spur” surgery makes me think of root compression due to degeneration. The reason that surgeons generally want to perform a fusion after the third herniation (or compression) is that the nerve root cannot easily tolerate multiple compressions without damage. We have “picked” three as the most intolerable compressions but it might simply be two in certain circumstances and maybe four in certain selected circumstances.

I think a TLIF is indicated for L4-5 due to your multiple nerve compressions. A one level TLIF is better than two levels. You are not having a fusion due to back pain. I believe that individuals are predetermined or “wired” to have back pain. I have lumbar degenerative changes without back pain so I am blessed with a “stupid” back. You have had past surgery due to leg pain so it is unlikely that you will develop back pain in my opinion.

Surgeon proficiency is difficult to ascertain. There are surgeons with great skills and ones who are proficient only with multiple surgeries and experience. How to tell the difference is difficult. I do have a section of questions that you can ask the surgeon to gain some inside of his or her experience and meticulousness. See https://neckandback.com/treatments/best-questions-to-ask-when-interviewing-a-spine-surgeon/.

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.

Shermdaddy
Participant

July 30, 2016 at 7:40 pm

Post count: 5

#22696

Dr. Corenman,

Thank you so much for your opinion. I happen to work as a Med device manager and had the opportunity to fully vet the surgeon. The questions page you sent me to confirmed my choice. I was able to get referrals from two surgeons suggesting this surgeon, who is a Neurosurgeon doing only spine work. I talked to patients of his and some of the staff that works around him. His complication rate is one of the lowest in the area I live. He provided his personal cell making himself available anytime I need him. He has been very open and takes as much time to answer any questions I need.

He fits all the criteria you provided. The piece of mind being able to communicate with you provides such a valuable service. Thank you so much! I can’t tell you how much better I feel and how you have impacted me Even though I’m not in your time zone. Thank you again!

Donald Corenman, MD, DC
Moderator

July 31, 2016 at 6:17 am

Post count: 8660

#22697

Please keep the forum posted on 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.

Shermdaddy
Participant

August 8, 2016 at 7:01 am

Post count: 5

#22723

I had my surgery four days ago and as anyone can imagine after three procedures there was some challenges. I could bare make it to the hospital. I had to have some friends help me out of my room and house then into the car. I definitely had scar tissue involvement, which posed some challenges. I needed some patching towards the back of the veterbrae and annulus. There was probably more annulus removed than in a first time surgery but the area was prepared and enough allograft material was placed before the insertion of the cage. The was enough of my bone left to fill the cage adequately.

There is no more pain in my left leg, which was the problem. I do have some numbness and “sleepy” feeling in the right leg. I assume this is from the nerve being manipulated during the procedure. My lower back hurts from the actual surgery and is very weak.

Technically, everything seems a success and as I heal then I will get a better idea how I’m functioning. I know this is a long process and the fusion of the veterbrae never looks like the animations online. I’m happy to have a plan moviving forward and doing all I can to speed my recovery.

Donald Corenman, MD, DC
Moderator

August 8, 2016 at 3:52 pm

Post count: 8660

#22749

Glad to hear you are on the “other side” of surgery. Important that your left leg pain is gone. The right sided new symptoms are probably from nerve manipulation and should disappear over time. Please keep us informed as you recover.

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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