Opinion about my x-rays of spine

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nikserer
Member

January 16, 2014 at 3:10 am

Post count: 24

#10151

Hello dr.
I would like to hear your opinion about my case because I tried several times to upload link to scanned images of my spine but couldn’t.
I have double “S” scoliosis from my 13-teen, and now measuring upper and lower about 55 degrees. I am going soon to my 1 year check after surgery for spondylolisthesis L5/S1 grade II, and as my neurosurgeon told me last time it would probably be needed to extend fusion to T10 or even T3/T4. Can this be done in one surgery, or it will be needed two?
I am 44 years old male with continuing to have pain in lower back going to my backside of left leg on prolonged sitting, standing and walking.
Thanks in advance.
Nikola S. – Mech.design Engineer

Donald Corenman, MD, DC
Moderator

January 16, 2014 at 7:56 pm

Post count: 8660

#10165

There are two problems here. One is lower back pain and the other is a double 55 degree curve scoliosis. They may be related but have to be thought of separately and together.

First, the surgery that you underwent. Was it successful? What were you told regarding symptom relief after surgery? Did the surgery meet these goals?

Has your spinal curve advanced (was it 45 degrees 5 years ago)? When did you know about the curves and what images do you have from 5, 10, 20 years ago?

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.

nikserer
Member

January 17, 2014 at 3:14 am

Post count: 24

#10168

Thanks dr. for taking time to answer to my question. I will try to upload my scans again here.
My scoliosis curve didn’t much rapidly developed in last 29 years. When first noticed (I was 13 years old) it measured about 37 degrees. As I said, I am now 44 years old and curves 54 or 55 degrees. But I think the problem appear when my L5/S1 disc developed DDD. I can say now that some of pain before surgery is gone, but there is still lot of pain which is not giving me to sit, stand or walk longer than 1 to max 1.5h. Sometimes, even it’s worse.
In my opinion only solution is decompression of nerves and fusion of spine. I think that you also explained on your web site that in this cases like mine when one segment is unstable, than spine is like “house of carts” – all goes unstable. I also noticed on lot of spine clinics web sites many adult scoliosis cases like mine – fused (one of those espine.com – dr.Pashman).
Best regards
Nikola
P.S. Try this web address to my scaned x-rays (anglocad.imgur.com).
If this link didn’t worked again, I will contact support here or can I send you on some mail address or Facebook page?

Donald Corenman, MD, DC
Moderator

January 19, 2014 at 6:56 pm

Post count: 8660

#10189

You can send films directly to me by the typical shipping services (FedEx, UPS, DHS). Call my office for details.

Normally, with curves of your size, the problem is asymmetric wear of the discs and facets causing pain from bone-on-bone contact. The deformity can then cause new bone spurs which can compress the nerves causing both back pain and leg pain. Some neurosurgeons are good at deformity but a second opinion is very important in your case.

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.

nikserer
Member

January 19, 2014 at 9:23 pm

Post count: 24

#10191

Hello again,
Thanks a lot for your answer. I can send you only scanned images of my x-rays by mail because I need them on my visits to my surgeon.
I already had first opinion from orthopedic surgeon in another our orthopedic hospital. The problem is that here in Serbia this kind of surgeries (scoliosis) are done only in two hospitals. Orthopedic surgeon told me this: “It is not in your interest to have surgery now”, That was before I had spinal fusion for spondy L5/S1.
After that I went to our best hospital in Serbia (military and civil), and get opinion from neurosurgeon that I should go to fusion for spondy and DDD first, and if pain persist he will fuse scoliosis also. But he mentioned only lumbar curve.
Now, I have two questions for you as an expert in this field:

1. Should I be fused only lumbar scoliosis (problematic), or both (lumbar and thoracic)? What will happen if only lumbar scoliosis is fused?
2. I also have some urinary problems (sometimes frequent urination, and pressure feeling in my bladder region). My urologist said that I have little enlarged prostate and chronic non-bacterial prostatitis.
I am little suspicious about this and I am asking you could it be related to my lumbar scoliosis?
Thanks in advance
Nikola

nikserer
Member

January 24, 2014 at 11:28 pm

Post count: 24

#10229

Hello,
I will try to place links to my scans before and after fusion for spondy and DDD L5/S1. I uploaded them on imgur.com.
I have been in Wednesday to my neurosurgeon check and he ordered new CT and MRI scans. He mention 3 options:
1. Epidural injections,
2. Re-fusion L5/S1 from the front,
3. Long fusion from Pelvis to T10.
In my last X-rays he said that he can’t see fusion well and that probably is not fusing as it could be. I am now 1 year post-op. Please try with this links, just copy them into address bar and you will see images:

i.imgur.com/18Hch2R.jpg
i.imgur.com/T5EtoA3.jpg
i.imgur.com/7491uOa.jpg
i.imgur.com/lpdQe4Y.jpg
i.imgur.com/fdlj3c7.jpg

Thanks in advance
P.S.: Images with implants are taken in lying position.Can you also answer to my previous post questions?
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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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