Larbral Tear/Shoulder & Spondyloishtesis

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biofreeze
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January 24, 2014 at 11:59 am

Post count: 99

#10221

I have a Labral tear in left should accompanied by grade oone spondy with disc herniation for which I have been wearing a rigid back for the last 3 years….It will not get better, but can walk pretty well with back brace on,,,just not that far and can not stand up for more than 5-10 minutes.

I need to have surgery on shoulder and PLIF on L5S1

1.) why do you suppose I can walk with brace on and but can not walk very far at all without bad pain with it off ?

2.) Which surgery would you recommend having first ? I would like to try to get back to the gym within the next 6 months or so….

Suggestions would be appreciated ….

Thank you

Donald Corenman, MD, DC
Moderator

January 24, 2014 at 4:22 pm

Post count: 8660

#10222

The back brace is a double edged sword. If you wear it constantly, this brace will decrease core strength. This in turn will cause instability of the spine without the brace on. Braces are designed to be worn for crisis situations (low back attacks), fractures, post-surgery and exposure to very heavy loads (weight lifting or workers with high lifting demand jobs).

Between shoulder reconstruction and lumbar surgery, which surgery first? It depends upon how severe the symptoms are for each disorder. You certainly need two shoulders for easier rehabilitation and recovery for spine surgery but a stable spine is much better to rehab a shoulder.

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.

biofreeze
Participant

January 25, 2014 at 12:55 pm

Post count: 99

#10236

Thank you, sounds like fixing shoulder might be a good first step.

I was rear ended and believe whiplash tore pannus. I didn’t have bad back pain until I used inverse table 5 months after car accident. I felt like something snapped in my lower back while going 2/3 way upside down and have been wearing back brace ever since!

1.) what do you suppose happened on the inverse table ?

2.) If pain is now under control 3 years later and I have no symptoms going down my legs, how do I wean off back brace ? I have tried and tried to no avail.

I literally can’t walk 10 yards without back brace, but with it on I can get around ok (within reason). I use a shopping cart at grocery store and can get around pretty well with back brace on, bring groceries in house etc.

3.) Do you think facet blocks or steroid injection would help wean off back brace at this point ?

4.) would you recommend fusion at this point considering the above symptoms? My neurosurgeon believes he can fix it with ALIF or TLIF.

My issue seems to be a quality of life issue at this point, I just can’t be sure if fusion surgery will put me in a better situation. I assume I would still have a weak core after the surgery…

Donald Corenman, MD, DC
Moderator

January 25, 2014 at 8:34 pm

Post count: 8660

#10237

The inversion table is essentially a traction table. When you are “2/3 of the way” upside-down, you have 100 pounds of traction force on your lower back.

The isthmic spondylolisthesis is relatively stable in some individuals as the pannus (the scar and fibrous tissue between the edges of the broken bone) is intact. This tissue is not very strong and can be torn. One of the ways to tear it is to use high traction forces. This is most likely what happened on the inversion table.

You must have some instability of this segment if the only way to ambulate is with a back brace. Even with a back brace, you still need walking aids; “I use a shopping cart at grocery store”.

Pars blocks, facet blocks and epidural steroid injections are all possible therapies but based upon your current symptoms, I don’t believe that these will be too effective. There is however, no penalty for trying them.

It does sound like you are a candidate for surgery. I generally use a TLIF but an ALIF will also work.

Fusion surgery performed well will most likely make you happy. You can then strengthen your core after the instability is resolved by surgery.

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.

biofreeze
Participant

January 26, 2014 at 1:27 pm

Post count: 99

#10247

How difficult do you believe it will be to rebuild core and back muscles after wearing brace for the last 3 years ?

Last thing I want to do is get fusion and then still need brace to walk because muscles are weak.

Thank you again

Donald Corenman, MD, DC
Moderator

January 31, 2014 at 6:16 pm

Post count: 8660

#10278

You have some work ahead of you. Muscles that have not been activated in three years (abdominal wall muscles and lower back extensor muscles) will probably take at least three months and probably as much as six months of exercise to make them “normal”.

It just takes patience and perseverance.

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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