New MRI and X-Rays

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Crogers01
Member

October 29, 2012 at 10:21 pm

Post count: 6

#7292

Brief History:
Started having “dull” back pain in 2003 at the age of 24. In 2006 it stated getting worse and I was treated very unprofessional by doctors that I visited. Fast forward to 2010, an MRI in Feburary showed a broad-based herniation that have the S1 nerve roots on both side pinched. Underwent a Discetomy in March 2010. Before having surgery I had done multiple injections, PT, Medication, etc. Anything ever offered to me, I did.

After the surgery I was as close to pain as I had ever been in 7 years but after 4 months my pain came back and increasing got worse over the past 2 years. Since my surgery I have had 15 transformainal bilateral injections( 5 series of 3 injections) so actually 30 injections, PT again and exercise over the past 2.5 yrs. I’m currently taking Oxycontin 20mg every 12hrs and Percocet 10/325 4 times per day PRN.

X-Ray Report:
L5-S1 degenerative space narrowing
Grade 1 retrolisthesis of L5-S1 in the supine position.

MRI Report
1.) Mild epidural fibrosis, mild remaining disc bulge without recurrent herniation. 70% disc dessication at L5-S1
2.) Note is made however of increasing type 1 Modic change at the disc level which has been reported in the setting of instability and flexion/extension views may be useful.

NOTE: The report does report the previous surgery changes to the Lamina and Disc due to the surgery in 2010.

My surgery is well-known in this region for neurosurgery and he told me before I had the first surgery that there would be good chance I would need further surgery in the future and that “I would probably become disabled from this and that’s when we would talk about other surgery options.” On Oct 15th I seen his nurse pract and she ordered the X-rays and MRI.

Question is- Am I gonna need a fusion at L5-S1 sometime in the future? Symptoms are extreme back pain, left leg “Shock” with certain movements, and a stabbing pain just to the left of my scare when I bend left laterally.

Thanks for any help.

Chris
Knoxville, TN 33yo

Donald Corenman, MD, DC
Moderator

October 30, 2012 at 1:08 am

Post count: 8660

#7295

You have classic findings for isolated disc resorption of L5-S1. The retrolisthesis of L5 on S1 is typical for severe degenerative disc disease and you have no reported recurrent herniation. You have type one Modec changes of the endplate. These are small fractures of the endplate and trabecular bone from impact and lack of shock absorption.

You do not note detailed current symptoms but I assume you have back pain with activity significantly increased by impact activity (jumping, tennis, vibration as in riding in a car). You also probably have delayed onset pain with activity. That is, pain that occurs 4-8 hours after the inciting activity.

This condition can also be associated with foraminal stenosis. This would manifest as pain the buttocks and legs with prolonged standing or walking. This might explain your left leg “shock” with certain movements.

You could be a candidate for fusion surgery with a TLIF to reconstruct the height of the eroded disc. You should be satisfied with surgery. I am just finishing a paper with patients just like you and a 90% satisfaction 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.

Crogers01
Member

November 4, 2012 at 12:19 am

Post count: 6

#7327

Dr. Corenman,

Thanks for your response, I really appreciate it. A lot of what you said is what I am currently experiencing in regards to my pain. I can feel pretty good some days and then I will play disc golf or play with my daughter and then a few hours later I am almost bed-ridden with sharp pain in my low back and hip area with some leg pain as well. It’s very frustrating and then I have to “chase” the pain with medication for the next 12-24hrs and this is the most frustrating part of this. After my MRI & XRAY results were read by my neurosurgeon, his office called me and scheduled a follow-up visit in 2 weeks to “discuss my surgical options” which I am 99.9% sure this means I am a candidate for a single level fusion.

The fusion surgery doesn’t scare me, it’s the affect is has on my family during the recovery process. I have a 3 yr old daughter and my wife works full-time at the hospital I will be having the surgery at. The post-op pain doesn’t scare me either, I am use to chronic pain, I have been experiencing it for the past 7 years with a 4 month period of pain free after my disckectomy in 2010.

In your experience, what type of post-op pain will someone that has a single level fusion experience? Will I be able to walk around the same day I have the surgery? Do you recommend your patients do physical therapy in a clinical setting or just “at home” walking and other exercises? My job is not physically demanding, I sit for 6-8 hrs a day, how long before I could work again?

I have a great team of doctors that include my Primary Care Dr(which I have her personal phone #), my pain management doctors 24/7 access, a therapist that I went to after I started getting depressed about my chronic pain and then my surgeon’s help. All of these docs have been great and I’m thankful that I have access to so many caring docs that are always willing to help me. I believe they have helped me prolong this pending fusion as long as possible with alternative treatments such as yoga, acupuncture, PT and exercise.

Final question, my pain management docs have tried to get me to get the implanted spinal cord stimulator in the past and just recently at one of my appointments. Is the spinal cord stimulator the last line of defense in someone with clinical findings that possibly warrants a Fusion? I appreciate your answers and your interactiveness on this website is great.

Chris
Knoxville, TN 33 yo

Donald Corenman, MD, DC
Moderator

November 4, 2012 at 6:26 pm

Post count: 8660

#7329

Your symptoms are classic for isolated disc resorption of the L5-S1 disc. A TLIF fusion has about a 90% success rate for your satisfaction after surgery (would you do the surgery again under the same circumstances?). See the section under “Pre & Post Op”, “Recovery information by surgery”; “Lumbar Fusion” to understand my protocol regarding the time frame for recovery.

All individuals can walk around the day after surgery and many walk the very same day. Return to work part time under light duty can take from one week to four weeks. I still cannot predict how quickly one individual can return vs. another. It varies person to person.

An implanted spinal cord stimulator is not indicated in a repairable surgical pathology. The disorder is fixed first surgically. If for some reason, there is no reduction of symptoms, a stimulator can then be implanted but these stimulators are notorious for not being too effective for spine pain. Stimulators are more effective for leg or arm pain, but those are not your symptoms.

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.

Crogers01
Member

November 4, 2012 at 10:11 pm

Post count: 6

#7330

Thank you so much for your responses. My appoint is November 21st and I’m sure fusion is going to be the option. As for the spinal cord stimulator, I keep telling the pain docs that I am going to fully explore all surgical options since the stimulator is not going to do anything to “fix” my problem.

I appreciate the links you referenced and I will look over those in great detail. A spine fusion is something I have been preparing for and I have researched everything I can find and read. I’m so sick of pain meds and pain management gimmicks that I’m 99% sure I will go through with a fusion. Those people that get pleasure out of pain meds have not experienced “real” pain and they would be so sick of them if they had to take them for a real reason or a medical condition that doesn’t respond well to any treatment, even pain meds. Even with meds, I’m usually at a 4 or 5 on the pain scale and if I play disc golf(which I started playing for the exercise) I jump to 6-7.

Thanks again and I will post again once I know exactly what the doc plans on offering me.. (Which approach) Thanks for a great service.

Chris

Donald Corenman, MD, DC
Moderator

November 4, 2012 at 10:31 pm

Post count: 8660

#7331

Please keep the forum apprised of your progress. I think it is great education to allow others to see how the surgical process progresses. Thanks for your participation.

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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