[Donald Corenman, MD, DC]

#29926

After surgery, if there is preexisting lateral recess stenosis that is not addressed by the initial surgery, the disc will settle allowing the facets to slide on each other. This can make the lateral recess stenosis worse. Scar is only rarely a problem. I will use Amniofix (now RDX) on occasion but generally, it is not needed.

Merry Christmas

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.

[YNA]

#29927

Thank you, Dr. Corenman!

I’m sending my x-rays out to you today.

Is it possible for your injectionist to call me with the cocktail he uses for his nerve blocks? I need to relay the information to my pain management doctor to see if we can accomplish the same thing here.

In regards to getting a L5/S1 CT, is there anything special I need to have ordered? Spiral CT, High resolution CT?

Thank you again. I am literally only able to be on my feet 5 to 10 minutes then I have to lay or sit down. It’s an awful existence.

[Donald Corenman, MD, DC]

#29928

I can have my office manager Lori hook you up with his staff. I’ll let her know and you can call her to get the information. Her number is 970 476-1100. Leave a message and she’ll get back to you.

The CT should be collimated to only include L5-S1. It should be on a 128 slice scanner with 1mm cuts and sagittal/coronal reconstructions.

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.

[YNA]

#29929

Dr. Corenman, is there a particular MRI image number I could look at that demonstrates the fact my S1 nerve roots are compressed?

Also, we talked I in our consultation about the decompression technique. I looked at the basic steps from “Orthobullets:”

1. Remove spinous processes of operative levels with rongeur (save as bone graft for possible fusion)

2 . Remove lamina and identify origin of ligamentum flavum

-Begin with decompression into canal into inferior half of lamina of cephalad vertebrae first with small curette

-Burr lamina and to thin and then complete resection with Kerrison rongeurs

3. Resect ligamentum flavum

-Gently retract ligamentum flavum with woodsen elevator
-Resect remaining lamina and ligamentum with Kerrison rongeur of cephalad vertebrae
-Resect ligamentum from superior lamina of inferior lamina
-Use Kerrison to resect caudad lamina from inferior vertebra

Lateral Recess and Foraminal Decompression

1.  Perform Medial facetectomy
-Decompress medial aspect of facet on each side (2-3 mm of medial facet)

2. Decompress lateral recess

-Locating pedicle key to safe decompression
-Kerrison to undercut medial edge of superior facet of caudad vertebra until medial edge of pedicle visualized
-Identify osteophytes that could impinge exiting nerve root around pedicle
-Undercut remaining superior facet using kerrison rongeur (no more than 50% superior facet should be resected)

3. Confirm exiting and descending nerve roots are well decompressed
-descending nerve root should be visualized

4. Check to make sure no disc herniation.

Dural sac/nerve root may be retracted to see if there is bulging disc is present.

It sounds like the steps are pretty simple. If the spine surgeon uses a microscope and follows the directions, isn’t it a pretty (simple) routine procedure?

Thanks again, I hope to get the CT soon.

YNA

[Donald Corenman, MD, DC]

#29934

The procedure is relatively simple but there are some careful steps. Since you’ve had a prior surgery, there will be scar tissue and great care needs to be taken to lyse the adhesions from the dura. The decompression is bilateral and does not need to have the interspinous/supraspinous ligaments and spinous process removed. Also, the tendency occasionally is to remove too much of the facet on each side which could lead to instability.

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.

[YNA]

#29936

What is your opinion of this paper that discusses the improved long-term outcome of patients who get suction drains, fat grafts, and local steroids with their spinal surgeries. I have already demonstrated that I like to scar.

“Epidural Fibrosis after Lumbar Disc Surgery: Prevention and Outcome Evaluation” authored by Mohamed M. Mohi Eldin and Naglaa M. Abdel Razek

[Author]

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