operation fusion

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Abbeygirl
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May 23, 2012 at 10:00 am

Post count: 40

#6245

Hi Doctor
Thanks again for the great service just was wondering what are your thoughts on fusion L5/S1 I had a decompression surgery at that level just over 12 months ago but still am in a lot of pain so i have been back to pain management doctor who gave me facet joint injection with no relief so went to a nerosurgion and she found that I have spinal stenious and a prolapse disc at the L5/S1 Level and has said that I need a spinal fusion at that level I have had a second opion he said I might need other levels done but get this leval done first and see how I recover my question is are spinal fusion very successful because at the moment I am in a lot of pain been on oxycontin and endemp for a long time now and I am Scared to have a this operation just in case I came out worse than what I am now even though I am Going Crazy I still get around a little bit just need some advice I hope that makes sense these pain meds make me bit hazy sick of taking them just so I can function Thanks again Doctor for trhis great service

Donald Corenman, MD, DC
Moderator

May 23, 2012 at 10:08 pm

Post count: 8660

#6247

You have to ask yourself what the fusion is going to do for you. First- where is the pain coming from? This requires you to describe your pain. Is it pure lower back pain or is there a component of leg pain? If so, what is the percentage of leg pain vs. lower back pain? Do you have more of one vs. the other?

The reason for these questions is you have to define what you are treating. If you had mainly leg pain and had a new disc herniation causing nerve compression and previously had only one surgery at this level, you would probably be a candidate for another simple decompression.

If you had mainly back pain and a fusion is recommended- what was the work-up that led to the decision for fusion? What do the surrounding discs look like? Is there instability based upon X-rays (flexion/ extension)? Was a discogram performed to determine the pain generator (see website for details)?

There are many unanswered questions.

Let us accept that you need a fusion of L5-S1 and this is the only pain generator. The success rate for a one level fusion performed correctly is about 90% for 2/3 relief of pain.

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.

Abbeygirl
Member

May 23, 2012 at 10:48 pm

Post count: 40

#6248

Thanks Doctor for your response I have had two previous surgeries the first one was 14 years ago a laminotoy which was very succseful on the L5/S1 level then 12 months ago I had decompression surgery on the S1 and have been a mess ever since I have had two steriod injections in my back Then went to see pain managment doctor who sent me for two facet joint injections and felt the same no relief but did not feel worse after those injections just had the same pain then went to a nerosurgion that check me for reflexes and bending forward and backwards and ask where pain was which is in my lower back al the time also numbness front right thigh both legs ache as well but not all the time and at different timesmy big toes go numb as well also my pinky finger and half of my ring finger goes numb on both hands but the numbness in my fingers and my right front thigh have started after tyhe last surgery I had one year ago I am in more pain now then iwas before my last operation the surgion said that it was a quick surgery and I would be right after six weeks so now I am scared to have fusion surgery but then i do not want to live the way i live now but i have been told that fusion surgery is pretty successful the thing that worries me is with the mri i have had post surgery they all come back with that i have a lot of infamation so if i have another surgery will the inflamation bbe worse again because that will be the third surgery on that area

Abbeygirl
Member

May 24, 2012 at 11:38 am

Post count: 40

#6252

Thanks Doctor for your response I have had two previous surgeries the first one was 14 years ago a laminotoy which was very succseful on the L5/S1 level then 12 months ago I had decompression surgery on the S1 and have been a mess ever since I have had two steriod injections in my back Then went to see pain managment doctor who sent me for two facet joint injections and felt the same no relief but did not feel worse after those injections just had the same pain then went to a nerosurgion that check me for reflexes and bending forward and backwards and ask where pain was which is in my lower back al the time also numbness front right thigh both legs ache as well but not all the time and at different timesmy big toes go numb as well also my pinky finger and half of my ring finger goes numb on both hands but the numbness in my fingers and my right front thigh have started after tyhe last surgery I had one year ago I am in more pain now then iwas before my last operation the surgion said that it was a quick surgery and I would be right after six weeks so now I am scared to have fusion surgery but then i do not want to live the way i live now but i have been told that fusion surgery is pretty successful the thing that worries me is with the mri i have had post surgery they all come back with that i have a lot of infamation so if i have another surgery will the inflamation bbe worse again because that will be the third surgery on that area

Donald Corenman, MD, DC
Moderator

May 24, 2012 at 11:17 pm

Post count: 8660

#6253

Your symptoms are varied and not all related to your lower back. The arm and hand symptoms are generated by your neck, shoulders or arms. The lower back pain is most likely from your L5-S1 disc but that is also predicated upon how the other discs and facets look above the L5-S1 level.

You have had two prior surgeries at the L5-S1 level so a simple decompression is probably unlikely to be indicated. Also, decompression does not typically help lower back pain symptoms.

Fusion might be helpful as long as the L5-S1 disc is significantly degenerative (most likely) and the other levels on MRI and X-ray are normal in appearance. A test called a discogram can indicate if this disc is the pain generator (see website). If you are a good candidate for fusion (see section on when to have lower back surgery), then you should be satisfied with this surgery.

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.

Abbeygirl
Member

June 10, 2012 at 9:16 pm

Post count: 40

#6344

Hi Doctor I have not replied for a while waitng to go to nerosurgion to inform her that I will go ahead with surgery fusion L5/S1 but I have now got another problem and was wondering if you could give me your professional opion if this syptom could be coming from my back in the past couple of weeks I get pins and needles in my right foot on the side of the foot when i put pressure example when I take a step not always there but becoming more frequent i hope that is enough information one other thing the two surgions i have seen said that i will still have back pain after the surgery i hope not i am very nervious about this operation thanks again doctor for this great service
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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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