opinion about discogel?

Tagged: Discogel

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James
Participant

March 8, 2017 at 11:00 pm

Post count: 1

#24475

Donald Corenman, MD, DC wrote:

Discogel is a material that is inserted into the disc space to attempt to restore the nucleus (the jelly in the jelly-filled donut). The hope was that replacing the nucleus would restore the height of the disc and reduce back pain.

There are two problems with this surgery . One is that the annulus (the outside “donut” wall) is not restored and still has the tears that occurred with the initial degeneration. The discogel insertion will not restore the integrity of these walls and they can remain pain generators.

The other problem is that this gel material has to stay confined within the center of the disc space. The tears in the disc wall have to be through and through to insert this material into the center of the disc. This entrance hole can also be the exit hole for this discogel material and this material can act as a disc herniation to compress the nerve root. A new MRI will be necessary to determine if this complication has occurred.

Dr. Corenman

Dear Dr. Corenman;
Can’t agree more in terms of “the annulus is not resotred, and still has the tears………………..”, even I wonder it’ll lead to leak of implant.
And my question is what if any suture technique together with hydrogel implant treatment, do you think it works?
Thanks for your time and answer in advance. Looking forward to hearing your reply soon. Thanks.

Have a nice day
James

Donald Corenman, MD, DC
Moderator

March 9, 2017 at 5:49 am

Post count: 8660

#24478

The “million dollar question” is how to repair the back annular wall when a full tear occurs. We have tried suturing, “gluing”, applying chemical treatment and metabolic inducements to try and get the wall to “heal”. Unfortunately, nothing has been successful. You have to remember that the nerve root lies right on top of this tear and any attempt to repair the wall will also affect the nerve root. Inflammation-which is required to “heal” tissues is the bane of the nerve root.

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.

Constantin
Participant

October 5, 2017 at 8:36 am

Post count: 1

#26533

Hell Dr. Corenman,

I am a 33 year old patient and had a discogel injection 2,5 weeks ago due to a L5S1 hernia i had. Was suffering from lower back pain on the left side. After 2,5 weeks the pain in my left lower back side is done i think but i have a small pain on the right lower back and my left leg hurts like i have some electricity in it and burns sometimes until my toes. The weird thing is that before the injection i had no pain on my left leg. Is that normal?Also is it normal that after 2,5 weeks i haven’t seen huge results?i m still in pain.

Thank you in advance

Constantine

Donald Corenman, MD, DC
Moderator

October 9, 2017 at 9:19 am

Post count: 8660

#26548

I am confused about your treatment. You had a disc herniation at L5-S1. You then had surgery to remove this herniation and then had discogel packet placed into your disc space? Is your leg pain better after surgery? Is there new leg pain or did you leg pain not change from preop to now?

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.

Dhanbeer
Participant

December 16, 2018 at 9:00 am

Post count: 1

#29882

Hello,

I have Discogel done 1 month ago (spine; L4-L5). For 2 days after the surgery I did not feel any pain at all. But later on the sciatica pain came back and it is the same as before, sometimes it is even much stronger leg pain than before Discogel. I am aware that there can be “a recovery burning pain” in the back – I had it a few times, but sciatica pain is the same, or worse.

I am worried if it means Discogel did not help me and I will have to go under another surgery? I cannot find anyone after Discogel who suffered sciatica like me.

Donald Corenman, MD, DC
Moderator

December 16, 2018 at 9:51 am

Post count: 8660

#29883

Sciatica is not directly related to the use of Discogel. The root can be inflamed by a seroma (collection of fluid that can occur after surgery), simple nerve inflammation that can occur after removing the herniation, a recurrent herniation or extrusion of the discogel. The annulus that initially had torn allowing the herniation is still torn possibly allowing the discogel to extrude.

If you were my patient (considering I don’t use discogel), I would try an oral steroid and if that did not work, I would consider a new MRI.

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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