New MRI and X-Rays

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Crogers01
Member

November 5, 2012 at 1:59 am

Post count: 6

#7336

Will do. Thank you for your “hands-on” approach in your forum, it’s rare that people can “speak” with a Doc without having to make an appointment and get some education about a particular subject. Thank you, it’s really helped me understand what I am really dealing with and looking at in my quest for spinal fixation and pain relief. Google can be a little confusing and searching through useless websites that say the same thing is very time consuming.

Thanks again,

Chris

Donald Corenman, MD, DC
Moderator

November 5, 2012 at 4:20 am

Post count: 8660

#7345

Thanks.

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 23, 2012 at 4:31 am

Post count: 6

#7484

Had my appointment with the Neurosurgeon yesterday(Wed Nov 21st) and was told that I was a candidate for a single-level fusion. I knew going into the appointment that would probably be the case and I was ready to do something else in quest for some relief.

Here are the options and explanations that I was given at the appointment:

1.) ALIF- Anterior Fusion through the stomach
I was told for my particular case this would give me the best chance for relief because of the following. Less muscular disruption than posterior, no rod or screws because my “slippage” wasn’t causing enough instability and the chances of reducing my back pain would be greater this route. He said in his practice that the success rate was near 100% for a successful fusion. Also, less time spent in the hospital. Probably go home the next day after surgery.

2.) TLIF- I was told this route had a greater risk of not alleviating my back pain because of the rod/screws and because of the muscular disruption and also because of more invasive work on the bones, facets, lamina, etc.

So, I was expecting to be offered a TLIF and to my surprise a ALIF was offered instead. I have a friend that had an ALIF performed about 1 yr ago by the same surgeon and she is mostly pain free, but she hasn’t lived with chronic back pain for 6 years either.

I’m scheduled for the ALIF on Dec 20th. Any comments or suggestions are welcomed. If I can reduce the stabbing/shooting pain by 50-75%, reduce the medication intake, enjoy sports again play with my 4yo daughter and be able to walk more than 50ft without wanting to cry, I would consider any surgery a success.

Thanks again for all your knowledge and education.

Happy Thanksgiving,

Chris
Knoxville, TN 33yo

Long time back pain sufferer- Since 2003
2010- Discectomy L5-S1
Pending- Fusion Single-Level L5-S1

Donald Corenman, MD, DC
Moderator

November 23, 2012 at 6:06 am

Post count: 8660

#7485

Every surgeon has their own personal experience regarding the success rate of fusion; from the front (ALIF), from the back (PLF) or TLIF (really a 360 fusion from the back) and a true 360 (from the front and then from the back).

My experience is that an ALIF has to go through the abdominal wall and disrupt some muscles. The chance for an abdominal wall “bulge” as well as dysfunction from this incision is not so small. The success rate is for fusion good for an ALIF, probably almost as high as for a TLIF. Will the surgeon be using BMP?

“Muscular disruption” from a small posterior incision is minimal for a TLIF and you must remember that these small muscles (multifidi, transversalis and rotators) are unisegmental muscles. The fused levels will not need these muscles to function after fusion.

You should go with what the surgeon is comfortable with as you do not want to push him or her out of their normal comfort zone and perform a surgery they are unfamiliar with. An ALIF is a tried and true procedure. As long as you know the potential complications, it is an acceptable procedure.

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 23, 2012 at 12:54 pm

Post count: 6

#7486

Dr. Corenman,

I appreciate your reply. I’ve done a ton of “research” online, if you want to call that research, and with what you and I have briefly discussed here on your forum, I was prepared for him to offer me the TLIF or another posterior approach and really he didn’t “tell me” which method I must do. He offered me either posterior with rods/screws or anterior w/o rods/screws since I didn’t have significant “slippage” and he gave me and my wife all of the associated with each method and it seemed the ALIF would possibly give me the relief I wanted. My exact comment to him was, “I want to do what gives me the best chance at success in relieving my back and leg pain”. He knows I do my own “homework” and that my wife works at the same hospital and I feel confident in his abilities as a surgeon. The main factor that made me go with the Anterior approach was he said that there was a chance my back pain might not be relieved or reduced with the posterior fusion in my case. I know there’s no guarantees with any spine surgery but that was kind of the deciding factor plus he said I would have to stay in the hospital probably 2-3 days and with the Anterior I should go home the next day. Maybe it’s an insurance thing?? One other thing, a family friend who is 58 yrs old had the same problems as I do had the same surgery, same level, same doctor and has done very well. No surgical complications and her symptoms were 99% eliminated, another factor that I considered into this decision. But I do think he’s more comfortable with the Anterior approach and from what he said, his patients have had excellent results with it. I guess if “it’s not broken, don’t fix it” type mentality and if his patients receive good results then why change.. I’m not really sure.

He said he will be using Bone Graft/BMP and 2 Lumbar Tapered Fusion Cages and a general surgeon assisting in the surgery. Medtronic is the cage company I believe.

At the end of the day, it doesn’t matter to me which approach is used as long as I have the highest probability for success and a reduction or elimination of symptoms. Like I stated earlier, a 60-75% reduction in symptoms would be a “success” in my opinion. I wish I could give you a better medical reason why he recommended for my particular case the anterior approach but I can’t.

Once again thanks for all your input. It’s greatly appreciated.

Chris

Donald Corenman, MD, DC
Moderator

November 23, 2012 at 6:05 pm

Post count: 8660

#7487

He is using up to date procedures with (most likely) Medtronic LT cages and BMP. The L5-S1 anterior approach is one of the more “safe” approaches and if you know he has had good results in a prior patient, that is one of the better recommendations.

Please keep us posted regarding your surgery for our own education.

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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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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