opinion about discogel?

Tagged: Discogel

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Donald Corenman, MD, DC
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October 23, 2016 at 3:40 pm

Post count: 8660

#23252

Discectomy is effective 95% of the time for leg pain relief from a disc herniation. Depending upon the circumstances, discectomy is about 50-70% effective for relief of lower back pain. Discogel is a small “packet” of viscous material that is inserted into the disc space to try and reproduce the nucleus of the ruptured disc. I am not a fan of discogel as the packet can rupture and recreate the disc herniation with the synthetic gel. In addition, if this packet shifts, it can cause abnormal loads on the disc space.

I would consider a discectomy but not Discogel insertion.

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.

WEARY
Participant

October 23, 2016 at 5:25 pm

Post count: 1

#23257

Except for the notation that Discectomy being 50-70% effective in regard to lumbar herniation,I,m still compiling stats for cervical Discectomy,(hopefully as or even more favorable).Nonetheless,thank you for logical explanation of Discogel and risks.

Donald Corenman, MD, DC
Moderator

October 24, 2016 at 5:22 am

Post count: 8660

#23258

Cervical discectomy without fusion was a procedure that was performed about 30-40 years ago by neurosurgeons. It was a disaster. The removed disc allowed the level to collapse and then fuse in many cases. This narrowed the nerve exit hole (foramen) and many of these patients had continuing arm pain. The ACDF procedure restored the height of the foramen and relieved pain so much better that the discectomy without fusion was left in the dustbin of surgeries.

You misunderstood me regarding discectomy success rates in the lumbar spine. The procedure is almost 100% effective in removing the protruding disc. If the patient has leg pain, the discectomy is 95% effective for leg pain relief. If the herniation causes back and not leg pain, discectomy is 50-70% effective in eliminating the back 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.

JSP
Participant

October 24, 2016 at 11:35 am

Post count: 2

#23261

I’ve been reading about discectomy and found out that there’re different techniques for performing a discectomy: there’s an automated percutaneous discectomy, there’s a microdiscectomy and a micro endoscopic discectomy. Which one is the safest and the most efficient?

finsfan
Participant

November 2, 2016 at 10:24 am

Post count: 1

#23338

I get your points about Discogel.

But I have a failed L5/S1 disk, one that I herniated a while back, then herniated again, and now its basically flat. Two neurosurgeons feel like fusion is not an option due to the amount of scoliosis, arthritis, and other disk problems I have (and might lead to a “domino effect” of more problems & fusions). I am mobile, and relatively active, so I don’t think I’d want fusion anyway. And removing part of the disk isn’t an option because its not really herniated now, just flat and protruding into the nerve.

The laser spine institute offered to remove the protrusion, and somehow cauterize the rest of the exposed disk, but I’m not convinced that’s a good solution. Who knows how the disk will respond, or what other problems will occur even if the surgery is successful.

A pain specialist offered an injection, but pain isn’t the problem – its the protruding disk and partial feeling loss in my leg and foot. And it’s not really a bulge where reducing the swelling would help, its just flattened over time.

So, as you can see I haven’t found any great options for a tough problem – do you know of any options someone in my situation could look into? I’m not asking for a diagnosis or personal treatment plan, just hoping for an expert to point me towards some potential options I haven’t found yet.

While I’m ok for now, my back is getting worse by the week, and I’m only 52.

Thanks.

Donald Corenman, MD, DC
Moderator

November 5, 2016 at 9:46 am

Post count: 8660

#23362

Your disc at L5-S1 sounds to be IDR-isolated disc resorption (“a failed L5/S1 disk, one that I herniated a while back, then herniated again, and now its basically flat”). This level probably has almost no motion to it. You can check by looking at your flexion/extension lower back X-rays and measuring the motion from one to the other.

Without motion of this level, a fusion can be performed without any significant changes of stress to the levels above.

You have had 2 previous decompressions and if you now have another compression of the nerve root (for a third time), the recommendation is a fusion. This is due to the inability of these roots to tolerate multiple compressions without damage. The fusion will stabilize this segment and prevent future episodes. I would recommend a TLIF type fusion.

Be very careful taking advice from Laser Spine Institute-enough said.

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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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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