Not Sure What To Make Of All This...G.P Told Me It's Fibromyalgia

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massimo
Member

September 13, 2013 at 11:22 pm

Post count: 11

#9369

Hello,

The question below is open to anyone viewing this forum…

Has anyone had an X-STOP procedure in their lumbar spine…and if so what were the results afterwards?

Thanks Massimo

Donald Corenman, MD, DC
Moderator

September 15, 2013 at 8:32 am

Post count: 8660

#9376

You pose a number of question and statements. I’ll do my best to answer.

X-stops are quick surgical procedures to wedge a metal “blocker” between two spinous processes to force the vertebral segment into kyphosis (flexion). This is performed to “open” the spinal canal (the canal enlarges with flexion). I do not recommend this procedure as this metal device erodes into the spinous processes and the relief is short lasting. It would be better to decompress the canal in the first place than to place a “blocker” between the spinous processes.

You have Scheuermann’s kyphosis of your thoracic spine. Your overall kyphosis curve is not too abnormal (51 degrees-normal is 20-14 degrees) but these segments can be painful especially at the apex of the curve. For example, if four segments of the thoracic spine (T8-T11) measured 45 degrees and the rest of the entire thoracic spine measured 6 degrees, this focal curve would be significantly pathological. If the curve was not focal but instead distributed throughout the thoracic spine, this would not be too abnormal.

Just the other day, I fixed a 42 degree kyphosis of T10-T12. The rest of her thoracic spine was actually lordotic (curved backwards-the wrong way) to compensate for that curve. This means the global curve she had prior to surgery was about 39 degrees which was within normal limits but her deformity was very painful.

Bertolotti’s Syndrome generally does not cause pain as the partial sacralization of the L5 segment is normally stable and not painful. There are some very rare exceptions.

Baastrup’s Syndrome (kissing spinous processes) is almost never a painful condition. I see it all the time without these articulations causing pain.

You report “degenerative changes at multi-levels of my Lumbar Spine with mild to moderate foramina stenosis exacerbated by osteophytes, hypertrophic facet disease and ligamentum flavum hypertrophy”. This can cause lower back pain and leg pain, especially with standing and walking.

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.

massimo
Member

September 16, 2013 at 11:25 am

Post count: 11

#9393

Thank you Doctor Gorenman for your insight on the X-STOP Procedure and it’s consequence on the spinous process. Decompressing the canal sounds like a fundamental approach.

I have researched both Bertelotti and Baastrup Syndromes and I understand that rarely are these problematic. Unfortunately the pain derived from my lumbosacrial/pelvic region and it’s restriction in mobility in fact may be multifactorial.

During the growth stage of my spine the pseudoarthrosis of the transverse process to the ala of the sacrum caused what seems to be a raised sacrum with it’s enlarged sacral crest.

The diseased Facet Joints and enlarged spinous process are affected with a moderate degree of Osteochondrosis. Not only are the spinous process touching, however, multiple levels are actually slightly overlapping each other (noted in the 3D CAT SCAN study). More significantly the L5 spinous process and the medial sacrial crest are straddling each other causing the spinous process overtime to actually twist. The anomaly (Bertelotti Syndrome) with Baastrup’s Syndrome have been exasperated in a multi faceted way. Unfortunately the lumbosacrial region appears very crammed and overtime has become more problematic and pain has definitely increased.

My ignorant perspective with the X-STOP was to create additional space in between the vertebral lumbar levels and canals. In addition alleviating the bone to bone contact of the spinous process.

Doctor Corenman, will the constant bone to bone contact increase the level of Osteochondrosis and further narrow the canals making my leg issues even worse?

If a resection of the transitional articulation (transverse process) was performed do you think the drop of the sacrum could create more space for the canals and less bone to bone contact in regards to the spinous process?

How many vertebral levels were fused in the 42 degree kyphosis that you corrected and what hardware did you use?

With Thanks,
Massimo

massimo
Member

September 26, 2013 at 6:51 am

Post count: 11

#9472

Hello Doctor Corenman and Forum Readers

I have recently researched a surgical institute that performs “GEL FIX IMPLANTS”.
Has anyone had this procedure performed?

Thank You

Donald Corenman, MD, DC
Moderator

September 26, 2013 at 5:47 pm

Post count: 8660

#9477

GelFix implants are yet another iteration of the X-stop. This is an implant device like the Coflex designed to wedge between the spinout processes to distract these structures. This distraction produces flexion of the vertebral segments which is undesirable.

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.

massimo
Member

September 27, 2013 at 1:18 am

Post count: 11

#9485

Hello Doctor Corenman,

As always, I appreciate your advise. I would like to commend you for your compassion and dedication in part of myself, and your forum readers. You are the modern pioneer to the yesteryear horse and buggy Doctor which devoted his or her life to the principals of medicine.

Respectfully, I can understand your opinion as to the “Gel Fix Implant”. Upon research, I realize that this device is in fact a parallel to the X-STOP in attribute. As you past mentioned the X-STOP Hardware can be erosive in part to the spinous process. This is how I have come to investigate the “Gel Fix Implant”. This procedure seems more compatible and less destructive to the bone structure of the spine.

Changing the natural curve and producing “flexion” in the vertebral segments may in fact be undesirable in a somewhat normal spine. The pain I experience in my lumbosacral/pelvic and legs is more than undesirable. It may be due to the fact that this segment is not normal in a multi faceted way. I realize that there is no easy fix to this situation. Creating additional space by raising the spinous process may in fact be like shoring the foundation to a problematic building structure.

Doctor Corenman, I am a simple person with a great desire to live life with less pain and perhaps to be able to sleep through the night and not be awoken because of pain. In search of this measure I am just trying to make sense from the ground-up “so to speak”. May I inquire…

(KEEPING IN MIND)
The posterior lumbosacral segment of my spine are rather crammed in part of the sacrum being raised due to the transverse process being sacralised (Bertelotti’s) along with the enlarged facet joints and spinous process with multi-level degenerative disc changes.

1) How is the kyphosis of the thoracic spine affected if additional flexion is applied to the lumbar spine …keeping in mind that I do have a Scheuermann’s with a rather more visible curve at the apex of the spine (T7-T9).

I an just trying to make sense of the fundamental issues throughout my spine. Trying to rewire and replumb a house may not be a starting point in trying to salvage a dilapidating foundation. I see this parallel in my spine. I have great concerns as to the underlying soft tissue degenerative changes throughout my cervical, thoracic and lumbar spine. At times, I wonder if in fact this degenerative reason is due to a structural concern…

Than You,
Massimo
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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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Not Sure What To Make Of All This…G.P Told Me It's Fibromyalgia