On my way to a potential 3rd back surgery

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netburgas
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January 16, 2019 at 2:31 pm

Post count: 3

#30065

Hello Doctor Corenman,

I’m Marta, from Barcelona, Spain. I live in Portland, Oregon. I am 36 years old and I am a graphic designer. I came to the United States to fulfill my American dream 7 years ago and here I found a place to be happy and grow professionally.

We connected around 2 years ago when I had my snowboarding accident. I broke my L1 vertebra and you were the doctor who helped me to take the decision to finally get surgery and I’m really thankful for that.

As a reminder, March 2017 I broke my vertebra L1. After 5 days at the Emanuel Hospital in Portland, Dr. David Adler, he decided not to proceed with surgery (spinal fusion) and to wear a brace for 8 weeks at home. The same thing said a second neurosurgeon in the same hospital.
With your opinion and seeing that the pain increased and having in mind to go to get it in my country as my family is there, I sent the medical tests to Spain to Dr. Joan Molet who said that surgery was necessary too.
I got a fusion of T11, T12, L1, L2, L3 with 2 rods and 8 screws.
Back in Portland and after 6 months, and after receiving MRI, X-rays, bone scans and intense pains, they found that the two screws of the L3 (the lower ones) were loose.
I was told that the lower part is the one that receives all the stress of fixation and that sometimes happens after an arthrodesis operation. Also, my pedicles are very small which makes it more difficult for the screws.

This time I visited a neurosurgeon at the OHSU Hospital in Portland who told me that he should NOT have had surgery done since he could have healed by itself.

But the screws were loose and something had to be done … so I went back to Spain, leaving my job and my life here in the USA to get back to the same neurosurgeon who operated and who took the decision to remove all the metal from the back and return to merge this time one level below T11, T12, L1, L2, L3 and L4. This time he used longer, thicker screws + a bone regeneration paste DBM
Orthoblast (biological bone substitute).
After 6 months of recovering from the second operation and being in a lot of pain, I went to Spain this past November to see doctors there and do the corresponding tests. The screws of the lower part, this time those of the L4 are loose again and the prosthesis suffers with the movement.

Right now I have 4 diagnoses from 2 different doctors in Spain and 2 in USA:

• Dr. 1, who has already operated twice, has checked with his team and orthopedics and says that the broken vertebra is healed and we could try to remove the metal from the body and see how the column reacts without it. Would it be possible to take everything out? I feel like my body rejects metal being honest and I think this could be the best solution if it’s possible.

• Dr. 2, who said that the metal does not support the spine and is forcing the whole back since the broken vertebra does not have enough support with the superior and inferior vertebra. Suggests replacing the broken vertebra with a “false / fake” (metallic sheath). Open on the side of the body to replace it and reopen at the back and put 2 rods and screws for 1 vertebra above T11 and two below L2, and L3. He says that it is a very risky operation and not 100% sure that it will work.

• Dr. 3, at the OHSU Hospital in Portland diagnosed that there might be a possibility to remove the prosthesis/metal as long as BMP was not used in my last operation. If it was used, then it means that my bone does not regenerate and I would have to proceed with the same last operation that I received. First make a test of the quality of the bones (Dexa Scan). If the bones are of good quality, re-fix the 6 vertebrae with 2 rods and 10 screws plus the BMP bone regenerating paste and see if the screws do not re-release. (Back to do the same operation?). If the bones have poor quality, start a bone strengthening treatment with medication for 6 months and then proceed with the surgery.

• Dr. 4, at Barrow Neurological Institute, said the screws and prosthesis are fine and fixed and I just need to start PT again for the pain.

I’m only 36 years old. I have been without physical activity for 2 years and living with horrible pains that do not allow me to do normal life.
I know it’s going to be difficult to be the same active person than before but I need someone to be able to operate and find a solution. Please…
To have to go through a third operation is to redirect my life back to the unknown and I would like to receive your opinion as a doctor.

I have all the test I got and I can send you via email to review as I need to take a decision as soon as possible. I can’t deal with this pain any longer…

I would also appreciate if you could recommend me to the best doctor in Spain and the best doctor at OHSU in case I can’t be on your hands in Colorado.

Thanks so much.

I really appreciate.
Marta
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Donald Corenman, MD, DC

Average rating:

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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