L5/S1 FUSION NON UNION

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Abbeygirl
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June 1, 2014 at 7:53 am

Post count: 40

#10919

Hi Doctor
Thank you for the great service you provide you have helped me understand what is going on with my condition over the last three years approx It has been 15 months since I have had my last surgery which was a L5/S1 fusion I still do not feel as it has been of much benifit.I have had numerious Ct scans bone scans my pain is in my lowerback I also have numbness in my right thigh I get numbness in my two big toes but not constantly just comes and goes I get pain in my left hamstring and left calf and right calf but not all the time and sometimes when I walk it sometimes feels like a get a shot of electricity shoot in the bottom of my foot I have been sent to another surgeon and he performed L4/5 facet joint injection two days ago still getting the same pain but they have told me too give it a few more weeks to see if it helps.I have the report that the surgeon sent to me and my GP with his findings I am going to type it out to see if I am heading in the right direction PROVIONAL DIAGNOSIS:POTENTIAL PAIN GENERATORS INCLUDE :non union L5/S1 fusion, L4/5 facetogenic pain Diagnostic blocks advised

Abbeygirl
Member

June 1, 2014 at 8:15 am

Post count: 40

#10920

Hi Doctor
Sorry here is the rest of the surgeon report I accidently sent the other post His presenting profile includes 1. current symptoms. Back pain is the number one issue here .He has pain that radiates into the buttocks .He does get pains down the legs as well,more so on the right than left however the back is the primary problem at the moment. 2. Duration of symptoms Many years 3. Pain score 8/10 4. Background history. He had a work related injury about 15 years ago .At that stage he was working as a printer and lifted a heavy pallet, and had an L5/S1 disc herniation.5. Background surgical history. He had an initial discectomy and follow up nerve root decompression with DR at St. Vincents. He had his fusion performed in late 2012 with DR . 6.His health is otherwise pretty good .He has some high blood pressure but apart from that he is a non smoker. There is no Diabetes.
Examination General appearence .He is a male of stated age who is in obvious discomfort.Lumbar Spine. There are seeral midline incisions consistent with previous spinal operations Lower Limbs He has an absent right ankle reflex and some S1 sensory changes Gait antalgic gait pattern favouring the left leg.Straight leg raise 90 left,70 right

5

Abbeygirl
Member

June 1, 2014 at 8:38 am

Post count: 40

#10921

Hi Doctor
Here is the rest of the report
Radiology I have reveiwed the bone scan and Ct scan performed recently Bone Scan. This continues to show quite significant uptake at the L5/S1 articulation.Considering it is almost 18 months since his surgery this is likely to correlate with some form of non union at the L5/S1 level It could also be ongoing osteoplastic reaction. There is also uptake at the L4/S1 facet joints.CT scan This was performed in february 2014. There does appear to be some bone integation at the endplates however it is diifficult to see a solid consistent union through the previously performed PLIF fusion. Plan I am of the opion that Mark presents two likely pain generators 1Non union L5/S1 fusion 2.L4/5 facetogenic pain source. I will ask that he have an L4/5 facet joint injection to see if this provides him with some relief. If it doesn’t then I would be more inclined to think that his pain is arising from an L5/S1 non union.

Abbeygirl
Member

June 1, 2014 at 8:50 am

Post count: 40

#10922

Hi Doctor
Sorry this will be the rest of the report.
If this is the case I would recommend that we redo his fusion via an anterior approach as he has had a number of operations through the back of his spine and redoing the fusion from a posterior direction would be fraught with difficulties.

Donald Corenman, MD, DC
Moderator

June 1, 2014 at 11:47 pm

Post count: 8660

#10927

You have continued lower back pain as your primary symptom with some nerve related symptoms as your secondary symptoms. The report notes a likely non-union of L5-S1 and possible facet degeneration of L4-5 above the fusion. There is consideration of repairing this non-union with an ALIF (anterior lumbar interbody fusion).

How did you do symptom-wise during the first three hours after your facet injections? This is the critical time period that the anesthetic is working. You needed to aggravate your symptoms initially and then record how much (or little) relief that you obtained from the injection using a pain diary (see website). If you did not, then you will not know how much pain these L4-5 facets are causing.

The long term relief that this facet injection might afford is not related to the potential diagnostic data that is needed to determine if the facets are pain generators. You can have a repeat of the facet blocks but this time, follow the recommendations found under “Pain Diary” on the website. If these facet blocks give you substantial temporary relief, you might be a candidate for rhizolysis (see website).

Most likely, if you do have a non-union at L5-S1, this is the cause of your current pain. It might be likely that an anterior approach is needed (ALIF) but repairs can also be performed through the posterior approach depending upon the findings of the CT scan and MRI.

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.

Abbeygirl
Member

November 11, 2014 at 11:06 pm

Post count: 40

#11720

Hi doctor thanks again for this service I have had surgery on my back as I had a non Union fusion at the L5/S1 so I had my surgery on the 30/10/14 so about two weeks roughly the surgery was about 9 hours my surgeon first cut me from behind and took the screws out and also done some work on a compressed nerves and cut some bone out then they turned me over made a incision in my stomach and took the bolts out and cleaned it up and put bigger and thicker bolts and also took some graft off my pelvis then stitched me up then turned me over again then undid the sticking and from what I can understand put a plate in and tighten up the screws then ditch me up it was a very painful experience something I could not go through again just a couple of questions which might seem a bit silly being that the op was not that long a go but my right thigh is very numb and it feels like it is on fire and when I feel it with my hand it feels like it is bruised and the bruised feeling changes place in different areas every time I touch it also this symptom has only started in the last four to five days but seems to be getting worse that being my left bum check is very sore just to touch when I am sitting or even when I try to walk and put my left foot flat on the ground I get a shooting pain in the bum left side my left big toe is numb also got some pain in left calf and on the bottom of left foot get a electric shock numb kind of feeling but the pain in the left bum is really sore sorry doctor for being s pain but this being my fourth back surgery and I am really worried because I can not take much more of this pain just not coping it has been a very long road so I hope it is just everything taking Time to settle down thanks again doctor
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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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