Lumbar fusion

Tagged: Lumbar fusion for scoliosis

Viewing 4 posts - 1 through 4 (of 4 total)

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maxsuarez
Participant

January 10, 2020 at 11:18 am

Post count: 3

#31885

Hi,
Thanks for considering my question.
My doctor is recommending a Left L1-4 XLIF and L4-S1 ALIF surgery for my scoliosis. I am 63 years old in pretty good physical condition. I am not in too much pain, I have had no need to take any pain medications, so the surgery is more to prevent getting worse, since my Dad is 88 years old and has very severe scoliosis and his scoliosis progressed very rapidly in less than 10 years.
Below is the MRI report of my lumbar area.
FINDINGS:
Approximately 19 degrees left convex lumbar curvature centered at L3-L4.
Mild acute degenerative endplate changes at L1-L2 and L4-L5. Otherwise, the marrow signal throughout the lumbar spine is mildly heterogenous without significant focal abnormality on the STIR images.
The conus medullaris is normal in caliber, signal intensity and location, located at the L1 vertebral level.
T12-L1:
Mild loss in the signal. No significant disc bulge or protrusion is identified. The neural foramina and spinal canal are normal in caliber.
L1-L2:
A 1 to 2 mm retrolisthesis with 3 mm central bulge. No central spinal canal stenosis with AP diameter measuring 1.2 cm. Patent neural foramen.
L2-L3:
A 1 to 2 mm retrolisthesis with 2 mm bulge towards the right side. No central spinal canal stenosis. Disc extends into the right inferior foramen with no indentation of the exiting right L2 nerve within the foramen. The disc does extend far right lateral measuring 9 mm with abutment of the adjacent psoas muscle. Disc extends into the left neural foramen with abutment of the exiting left L2 nerve without visualized compression.
L3-L4:
A 1 to 2 mm retrolisthesis with 3 mm rightward bulge abutting and possibly mildly indenting the descending right L4 nerve. Disc abuts the exiting right L3 nerve with no visualized compression. No central spinal canal stenosis.
L4-L5:
A Central bulge measures 4 mm with asymmetric right-sided facet hypertrophy with moderate changes also on the left facet. Both lateral recesses are narrowed with abutment of both descending L5 nerves with questionable mild indentation. Moderate to marked right neural foraminal narrowing with mild indentation of the exiting right L4 nerve.
L5-S1:
A 2 mm central protrusion results in no spinal canal stenosis. Moderate left neural foraminal narrowing.
IMPRESSION:
Allowing for significant differences in technique, no interval change.
Approximately 19 degrees left convex curvature centered at L3-L4.
No central spinal canal stenosis.
At L4-L5, mild indentation of the exiting right L4 nerve and abutment of both descending L5 nerves with questionable mild indentation.
At L3-L4, questionable mild indentation of the descending right L4 nerve.
I would like to know if this type of surgery is a good idea at this time. And if it is what will my life be after such a big fusion. Will I be able to stay active after my back heals. Will I be able to hike, bicycle ride, swim and workout. I do not know anyone that had this type of surgery so I don’t know what to expect.
Thanks in advance,
Max

Donald Corenman, MD, DC
Moderator

January 11, 2020 at 7:11 am

Post count: 8660

#31891

When you state “I am not in too much pain”, you must define that statement for me. Do you have only mild pain that is not impairing (won’t stop you from activity) or are you becoming more sedentary with pain onset?

Do you have earlier X-rays to compare with the current 19 degree curve. That is, has this curve advanced in the last 5-10 years or is it stable without need of corrective surgery?

If we assume that you need the surgery, I would be somewhat wary of the planned procedure for a scoliosis. All of this planned procedure is performed from the front (anterior) and I see no posterior pedicle screw planning. These anterior procedures do not have the stability of a posterior procedure and this is probably “too much surgery” for the planned results. I would get a second opinion with a spine surgeon who has experience in these procedures.

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.

maxsuarez
Participant

January 11, 2020 at 3:14 pm

Post count: 3

#31898

Hi Dr. Corenman,

Thanks for the reply.

I am not is much pain now. I do not take any pain medicines. The pain is more frequent when I am sitting, I am a computer programmer so I am sitting a good part of the day. I just move around and it ussually takes care care of the pain which is more of a burning sensation. I have various discomfort’s here and there but they are manageable.

I have X-rays that have shown that the curvature has progressed in the last 5 years. Since it is not too bad now what do you recommend at this time, should I wait a few more years and see how the curvature progesses in the next few years.

Let’s said that the surgery is the only way to go, which surgery would you recommend so I can have an idea when I go for a second opinion. I wish I could be in Colorado to come over to see you, but financially I can’t.

Thanks again,
Max

Donald Corenman, MD, DC
Moderator

January 11, 2020 at 3:25 pm

Post count: 8660

#31899

Pain is generated by discs, nerves and facets. Your pain might be generated from only one or two segments. You might need a full lumbar spine fusion but my bet would be you only need a portion of the spine addressed. Of course, without reviewing the X-rays, I’m just using my experience for a general estimate of your disorder and what needs to be done. Find a spine surgeon (spine orthopedist) for a second opinion.

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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