L5, S1 isthmic spondylolisthesis

Tagged: isthmic spondylolisthesis

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Renee123
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December 14, 2015 at 11:17 pm

Post count: 130

#21038

Dr. Corenman

I was reading that when L5,S1 is fused and the segment is “re-aligned” that the re-alignment can cause pain as the rest of the spine has been accustomed to being “out of alignement” for so long.

Can the new alignment of the L5,S1 fusion create more pain from having the deformity corrected ?

Thank you

Donald Corenman, MD, DC
Moderator

December 16, 2015 at 5:51 am

Post count: 8660

#21041

Generally with a fusion of an isthmic spondylolisthesis at L5-S1, the segment is not fully reduced “back in place” as this would stretch the L5 nerve and potentially lead to a foot drop. The “rest of the spine” generally “welcomes” the reduction and fusion as these segments above and below were designed for normal alignment. These segments have to compensate for the malalignment of the slip and this malalignment places more stress on them than if the L5-S1 segment was normally aligned.

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

January 9, 2016 at 1:55 am

Post count: 130

#21154

I spoke to an ortho and a neuro regarding TLIF and ALIF.

Locally, it seems that the reason why most surgeons do the ALIF or the ALIF with the back up screws is because the vascular surgeons does most of the work through the front.

I think TLIF is a great option but requires a very, very skilled surgeon such as yourself to retract nerve roots, include BMP in the front of the spinal canal and actually get successful fusion. Unfortunately, not many surgeons have the expertise with TLIF as it can be seen that some of the fail.

1.) TLIF – my ortho says the incision will be 4-6 inches for a one level fusion. The is a lot of cutting. I see your incision in only 2 inches. Does a 6 inch incision sound right to you ?

2.) TLIF – for pars fracture, the surgeon says he only take hald of the lamina off and uses just the bone for fusion, no BMP in cage or alongside screws and rods. He says there will be enough bone.

What are your thoughts on the above please. I just don’t want to go for surgery and get hacked up !

3.) Is the pain after recovery easier with a ALIF than a TLIF ? This is what I am being told.

Thank you

Donald Corenman, MD, DC
Moderator

January 9, 2016 at 6:04 am

Post count: 8660

#21155

If your area has no good TLIF surgeons, you might have to accept an ALIF. I am not a fan of the ALIF for most patient but geographic experience has to be respected. A good ALIF is better than a “bad” TLIF.

A 6″ incision for an ALIF is about right. For the L5-S1 level, they should use a Phannensteal incision (the incision along your belt line which is more cosmetically acceptable).

The unusual thing is that your surgeon states he is going to make a posterior incision also to perform a Gill procedure. This means he will already be in the back of the vertebra and remove the fractured fragment for bone graft and then place screws in the pedicles. He has then already done 3/4 of the TILF and then needs to perform an anterior surgery. I don’t understand.

ALIF and TLIF are about equal for post-op pain but with two incisions, it seems that you might have more post-op 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.

Renee123
Participant

January 11, 2016 at 12:27 am

Post count: 130

#21158

Thank you

What I was also asking above was regarding the 4-6 inch incision for a one level TLIF ? My surgeon says the incision will be 4-6 inches in length and he does not use BMP, just the bone from the lamina to fuse.

I wanted to get your opinion on the length of the incision being vs. yours that is only 2.5 inches with the use of BMP. Will this size of the incision make a difference in my surgery and my the duration of my recovery ?

Renee123
Participant

January 11, 2016 at 12:29 am

Post count: 130

#21159

PS – sorry for the grammatical errors !
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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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