off labell use of BMP-2

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tres
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December 30, 2013 at 1:00 am

Post count: 43

#10013

hi dr,in 2010 i had fusion at l3/4 l4/5 with the BMP-2 product.wich my surgeon never explained the serious complications linked to infuse,all he told me he would do two of the same procedures weekly.he said the recoup time is faster than the conventional way,three years later chronic back pain,radiculitis both legs ,l5/s1 fracture ,osteoporosis of the spine,excess bone growth on spine.the fusion he did was through my back and r/oblique wich is nubm.this procedure was aproved by FDA only anterior aproach.i would of gone the conventional route last year he asked to consider apliying for ssd wich mentally killed me now seeing a phsyciatrist for anxiety and mdd at 50 yrs old no other health problems besides my physical and mental three weeks ago had a break down one week in the psyic ward. why would he not explain the serious risks? i know no dr intentionally wants to hurt a patient but all i get from him how sorry he is.

Donald Corenman, MD, DC
Moderator

January 3, 2014 at 1:17 pm

Post count: 8660

#10040

BMP is a remarkable product if used properly. The FDA has only “approved” it for anterior use due to a study by Zdeblick that was performed as an anterior approach only. In this study, the success rate was very good and complications were limited.

Once the FDA has approved a product, the physician can use it any way that he or she feels it will be effective. In the case of BMP, this product has been very effective to almost eliminate pseudoarthrosis (lack of fusion) and has accelerated fusion to the point that most individuals fuse at 6 months. Before BMP, fusion has at least a 10% pseudoarthrosis rate and took about one year.

The risks are with nerve irritation and additional bone growth. This product can irritate nerve roots and its use has to be modified to reduce this irritation.

I am unclear as to why you have lower back pain, leg pain and extra bone growth. It sounds like he performed an XLIF (far lateral approach) and posterolateral fusion. I do not understand why you had so many complications.

Can you expand upon what happened, why you had surgery in the first place and what new symptoms you have?

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.

tres
Member

January 4, 2014 at 4:31 am

Post count: 43

#10049

hi dr,as far as the ops report it was an anterior interbody fusion via DLIF approach.but he only went through the back and r/side wich till this day is still numb from incision site to groin/buttocks wich surgeon said is not normal.as far as what happened in 2009 i was unloading a trailer of different size boxes the heaviest bottemed out i felt extreme pain low back and head when i fell back against the wall of the truck hitting head /whole back i was actually falling from pain /weakness conclusion failed cevical fusion ulnar nerve damage,failed back fusion worse than before surgery before lumbar fusion all findings were just l5/rad r/side with non approved treatment to see a neuorosurgeon till 2010 at wich time i was having same pain on l/lumbar new emg showed 2011 l5/rad on left side.new symptoms extreme numbness down to feet shooting pains down legs both bottucks sharp stabbing pain front/ back thighs some light urine leakage at nite using guards ed problems wich dr said could be caused by new finding interval extruded posterior disc herniation l5/s1 deforming the thecal sac with cephalad migration of the disc material posterior at the l5 vertebra.possibility of asequestered disc fragment not excluded.moderate bilateral foraminal stenosis at l4-5 with border line central stenosis.mild dxtroscoliosis /spondylosis.1/2/14 emg diagnosis lumbar disc dsplacement,why after the fusion is all this happening?thank very much for your input dr.

Donald Corenman, MD, DC
Moderator

January 5, 2014 at 1:41 am

Post count: 8660

#10055

You underwent a DLIF at L3-4 and L4-5. This is an anterior fusion through a side approach. The incision goes through the abdominal wall on the side and through the psoas muscle. The nerve bundle is located here and since this approach is performed in a blinded fashion (the surgeon cannot see the path taken), nerve stretch injuries can occur and apparently did in your case.

You note that you also had a “back incision”. I assume that was to decompress the spinal canal but you did not supply details of that surgery.

You need a failed back surgery syndrome (FBSS) protocol to determine what is causing your current symptoms. This includes a new MRI, a new CT scan to look at fusion mass from your old surgery, flexion/extension X-rays, a thorough physical examination and a careful evaluation of the symptoms that occurred prior to your first surgery and what you have currently.

It does appear that the new HNP (herniated disc) at L5-S1 is significantly contributing to your current symptoms. The fusion at L3-5 means that these discs (hopefully) do not move. The L5-S1 disc then can and did herniate. The percentage of symptoms contributed by your FBSS vs. your L5-S1 herniation can be made by this thorough work-up.

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.

tres
Member

January 5, 2014 at 9:36 pm

Post count: 43

#10067

hi dr,for the nerve damage during DLIF 2010 is thier treatment. any reason why he did not do surgery the way it was FDA approved? the back incision was made during same dlif surgery.prior to surgery 2009/only symptom on back was r/lumbar with rad,8 months later l/lumbar pain non rad,wich surgeon said was normal due to compensating for r/side.2011 emg finding l5/rad left side same symptoms as r/ side 9/13 mri findings osteoparotic spine t7/t8 herniation with stabbing pain mid back invulantary jerkig of body ,l5/s1 fracture.on 1/14 emg disc displacement is this the same l/5 disc? any reason he would not let me know of the serious risks with bmp2 i find alot of info on the spine journal,in 2009 when he reviewed the mri he said healthy spine beside the l5/rad on r/side.where do all these other complications come from post surgery,if i had to do it over i would the conventional way.knowing of potential deadly risks with bmp2 never! i am not saying it is the source of my problems but just to know of these potential added problems no way!thank you dr.

Donald Corenman, MD, DC
Moderator

January 5, 2014 at 11:21 pm

Post count: 8660

#10068

FDA approval is only for an anterior approach using an LT cage with BMP. There is no one in the land that I know of that uses this technique anymore. The FDA is always steps behind current usage so do not concern yourself regaining alteration of the approved technique.

Most likely, the nerve injury did not occur from BMP in your case but from the DLIF technique which is performed through an anatomic nerve zone that is known to have this injury pattern.

I am having trouble following your discussion as your writing style is difficult to interpret. You mention L5-S1 fracture and EMG results of an L5 nerve problem.

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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