MIS TLIF

Tagged: MIS TLIF

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Renee123
Participant

October 8, 2016 at 11:24 am

Post count: 130

#23146

I met with a surgeon for grade one isthmic spondy recommended MIS TLIF over open TLIF. Surgeon says he is going to use steerable titanium cage that sits well in front of spine. He is going to use small dose of BMP in front of the cage. He says new titanium give better bone in growth and bone does not attach itself to peek cage.

Two small 1 inch incisions on either side of the spine. He is going to removed the bi lateral pars fracture each whole. Says blood loss, hospital stay and recover are better than open.

He does not do posterolateral fusion because he can not procure enough bone, however there are many surgeons that are able to fuse non tlif gutter.

What are your thoughts? Surgeon says as long as we can get decompression and fusion I should be in good shape.

Thank you

Donald Corenman, MD, DC
Moderator

October 8, 2016 at 1:20 pm

Post count: 8660

#23147

I think a MIS TLIF would probably be adequate for a grade I isthmic spondylolisthesis for decompression and fusion. This is if the surgeon is good and meticulous. I would disagree with his presumption of less blood loss, hospital stay and recovery. I endorse using BMP and his decompression bilaterally.

I cannot understand his position on the lack of posterolateral fusion. The amount of bone procured is significant with this procedure and more than enough bone to perform a posterolateral fusion. I normally have almost too much bone. I agree that if a fusion and decompression occurs, you will be in good shape but a posterolateral fusion is important to achieve a high fusion rate.

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.

Renee123
Participant

October 8, 2016 at 2:12 pm

Post count: 130

#23149

Thank you.

I’m not too enthused with not having a posterolateral fusion.

1.) You only do posterolateral fusion on non tlif side correct? Do you use BMP ?

2.) What are your thoughts on retractable boomerang cage ?

I was just reading about sperry guy’s non fusion story on here regarding his non fusion with MIS TLIF using retractable cage. Doesn’t sound like it is worth taking the risk.

Donald Corenman, MD, DC
Moderator

October 8, 2016 at 2:34 pm

Post count: 8660

#23150

I would agree with you regarding the lack of posterolateral fusion.

In a “standard” TILF (one without an isthmic spondylolisthesis) I only perform the posterolateral fusion on the non-TLIF side. This is because I use BMP mixed with the bone graft and want to prevent BMP contact with the nerve root. This sequestration is easy on the non TLIF side as there is facet, lamina and ala all there to “hold” the BMP/auto-bone mixture away from the nerve root. There is not enough bone graft to cover both sides generally.

However, in an isthmic spondylolisthesis, there is an abundance of bone graft due to the entire lamina which is separated from the pars. The lamina here has no function so it is removed and used for graft. What I do is place the BMP/bone mixture on the non-TLIF side where the remaining S1 facet is present to sequester the bone. With all the extra bone that is not mixed with BMP, I place this bone on the TLIF side. Generally, I get a fusion here but there is no BMP to irritate the nerve.

Any cage that has a retractable mechanism is a problem in my opinion. You want as much surface area of bone as possible to expose to the two endplates. These mechanisms “take up space” that is valuable for biological fusion. There is no need for these mechanisms in my 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.

Renee123
Participant

October 8, 2016 at 3:22 pm

Post count: 130

#23152

I believe there is a lack of bone for posterlateral fusion with MIS TLIF because surgeon is not removing the facet joints as in the open TLIF. The surgeon jsut removes the pars fractures on either side.

Does this sound accurate ?

IF you read sperryguy on your forum he had non fusion for the same reason. No gutter fusion and retractable cage was used. Kind of a stupid way to do the surgery in my opinion, Why take the risk?

In any event, when you start questioning details of the surgery like this with a surgeon they generally get angry and try to get rid of you. I have found that spine surgeons do not like to be told how to do the surgery. Even the most reputable.

Your method of open TLIF is the most conservative and logical that I have found. I have found couple other surgeons that do the same and they have great results.

Donald Corenman, MD, DC
Moderator

October 8, 2016 at 6:42 pm

Post count: 8660

#23154

Surgeons are creatures of habit and many have learned a technique and have “stuck with it” during residency or fellowship. I would argue for my technique just as those surgeons would but I have had to use trial and error for many years to figure out the most effective technique. This included opposite side surgery, the microscope during the decompression and TLIF cage insertion, the O-arm, small midline incisions and the use of BMP.

If you don’t remove the facet joint, you cannot decompress the L5 root on either side. I would assume that they at least remove the facet but don’t remove the lamina.

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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