Lower and thoracic spine pain/have neurostim

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Jo Geer
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April 3, 2012 at 6:18 am

Post count: 3

#5946

Dear Doctor Corenman,
I was given your name by someone who thinks you are amazing.

I am 50 years of age and have had no quality of life for 5 1/2 years. I have had microdiscectomy and it got infected, so more surgery for that. Since the discectomy did not help I had a fusion of S1,L4,L5 in 2006. Had to have hardware removed because bone was growing out of the cage(?) and irritating nerve. My dr. decided that I had permanent nerve damage and sent me to a neurosurgeon. They put in a neurostimulator only to cause terrible pain from the time I came home in my T spine area where they achored it. I have had a Facet block, rhizotomy, and medial branch in the area and no relief. My neurosurgeon wants to try an unconventional way of fusion to see if that is the problem and if it is, he will go back and do the fusion permanently. If it doesn’t help, he wants to implant a pain pump. I would be happy for advice or to make an appointment, if needed. I have been on Neurontin, norco, and diazapam for all this time. I am now very overweight, depressed, and very limited in life. I am by no means an athlete anymore. My day consist of showering and trying to do light housework. I can not walk any distance, use my upper body much, or sit for any period of time.
Thank you for reading this. I am ready to have some kind of life back.

Donald Corenman, MD, DC
Moderator

April 3, 2012 at 1:53 pm

Post count: 8660

#5950

I am so sorry to hear of your dilemma. This is called failed spine surgery syndrome and has many causes. Yours started with an infection after a microdiscetomy. Normally with antibiotics, these infections can be cured. Some patients will go on to autofuse the segment and the problem is solved. If there is continued motion of the segment after the cure of the infection, there are rare occasions that the segment has to be fused surgically. That sounds like the next step you took.

Unfortunately, you then had bone “growing out of the cage” which sounds like you had BMP (bone morphogenic protein) used in the cage. If not sequestered, this BMP can cause hetertopic ossification (bone growing out from where it should not grow). This can cause nerve irritation but normally surgery can alleviate this situation.

You somehow then ended up with chronic neuropathy (see website for description) and then had a spinal cord stimulator implanted. This then caused” terrible pain” which I assume was different pain than from before the implantation. I assume you then had the stimulator removed.

Your surgeon wants to perform another fusion. On what? I am not certain that further fusion surgery is your answer. Fusion stops the motion of unstable or painful segments and realigns segments that compress nerves. If you have significant back pain from a degenerative segment or a segment that is compressing a nerve, then fusion might be helpful. Also, if you have a nonunion (pseudoarthrosis), fusion may be helpful.

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.

Jo Geer
Member

April 4, 2012 at 2:01 am

Post count: 3

#5953

Thank you so much for such a quick and understanding reply.

The stimulator is still in. It is giving me some relief in the left leg and foot where the pain was so severe. However, the T9-10-11 is where they want to fuse. This pain began as soon as the surgery to implant the stimulator occured. I had never had any pain in that area and it is exactly where my incision was made for the stim. My neurosurgeon said that a fusion in that area was a 50/50 chance it would help. He did a myelogram, xrays, and ct and could not see for sure what the problem was. Of course, I can no longer have an MRI because of the stim. He said that in his report I responded to the facet injection while under anesthesia. However, I felt no relief from it afterward.

I do not know what to do. If I knew taking the stimulator would help the T spine area I would have it removed. But, since it is helping with the leg and foot pain, I am confused. My neurosurgeion said that he didn’t think it would help the upper back if he took it out. But, I am on more pain meds than ever because of the T spine pain and have a MUCH more limited life. It is really bad. And, the main reason for getting the stim was to help get off of some of the medicine.

I have an appointment with my original spine doctor on this Thursday, so he can look at everything and give me his opinion. As you know, there are not many doctors that do the neurostimulator, so I am having a hard time getting another opinion.

If you thought that you could help me in any way, I would love to set up an appointment.

Thank you again for doing this forum. Most physicians would not take the time to read or give input on anyone that was not their patient.

Donald Corenman, MD, DC
Moderator

April 4, 2012 at 6:28 am

Post count: 8660

#5954

I am not certain why the neurosurgeon stated that you responded to the facet injection if you were unaware of the results. The pain from surgical implantation is unusual and I am not sure what your surgeon is treating by fusing those segments. Get hold of the CT post myelogram report by the radiologist and read it. Certainly have your original spine surgeon comment of the proposed surgery.

You can send me the CT post-myelogram images if you choose.

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.

Jo Geer
Member

April 4, 2012 at 10:08 am

Post count: 3

#5955

I am picking up all of my records and imaging on Thursday before going to my original spine surgeon, (my only doctor for my back before he sent me to the neurosurgeon). I have not seen him since my stimulator surgery in Dec. of 2010. So, about 15 months ago.

I am definitely not rushing into another surgery. I feel like I have not done myself any favors by doing the ones that I have had without another opinion.

I would appreciate you looking at my records, very much. I will send them asap.

As I said before, I was given your name by someone who has great faith in you. In fact, you are doing surgery on her tomorrow. We live in a small town.

Donald Corenman, MD, DC
Moderator

April 4, 2012 at 11:07 am

Post count: 8660

#5956

I think you are making the right decision. Do not jump into any surgery unless you know why the surgery is being contemplated.

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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