Opinion about my x-rays of spine

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nikserer
Member

September 14, 2014 at 7:28 pm

Post count: 24

#11429

Thanks much dr. on your valuable explanation. As always you give very usefull informations and for sure I will mention this to my surgeon before surgery. I was only wondering can this foraminal stenosis create some urinary symptoms or they are related to my BHP – chronic prostatitis. I am going next week to one smaller surgery which was not planned (recidive/relapse of dermatofibrosarcoma protuberans on my head near previous scar of surgery back in 2007). It is small now (maybe max 2cm) but my plastic/Moh’s surgeon want to remove it now before spine surgery. After recovery of that I am calling my neurosurgeon (as he said me) and we will than shedule scoliosis surgery. I will update you about my news related to spine.
Thanks again on you help and understanding.
All the best
Nikola S. – Mech. design Engineer/Autodesk Inventor&AutoCAD trainer

Donald Corenman, MD, DC
Moderator

September 15, 2014 at 12:58 am

Post count: 8660

#11431

The nerves that control the bladder are S2-4 (sacrum). There is no “nerve” condition other than sacral fractures or massive compression of the cauda equina (nerves in the canal below L1) that can cause bladder dysfunction. Pain and medications can cause bladder problems however.

Make sure that the Moh’s surgery is completely healed before consideration of the scoliosis surgery is performed. An inadvertent infection from the Moh’s surgery into the scoliosis surgery is a disaster. I have patients wait at least 6 weeks before considering a fusion with instrumentation.

Let us know how you do.

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

September 15, 2014 at 3:13 am

Post count: 24

#11433

Hello dr.
This will be mine 8 surgery for dfsp with first false surgery (they thought it was lipoma). First surgery was back in 1994… I never had any infections after this surgeries, and yes I guess that also dr. will advice me that some time (at least after first check) has to pass so I can go to spine surgery.
I am not sure on what you exactly think when you said “An inadvertent infection from the Moh’s surgery into the scoliosis surgery is a disaster”? But as my dr. said, we are not still 100% sure it is dfsp. Pathohistology findings will tell us, but from previous bad experiences with me – he wants to do it under general anesthesia.
When I was asking you for urinary problems, I exactly thought on Neurogenic bledder disorder. I found interesting article about this on Spine universe web site.
For pain I use (more than year): Neurontin and amitriptyline. Can this two medications cause urinary problems? I think that I read somewhere that Neurontin is used for treatment for chronic BHP.

Best regards
Nikola

Donald Corenman, MD, DC
Moderator

September 17, 2014 at 1:25 am

Post count: 8660

#11448

It is not the DFSP that I worry about but the incision healing well before your scoliosis surgery is contemplated. You want to have the Moh’s surgery completely healed without any signs of infection before you contemplate scoliosis surgery.

Yes, Neurontin and amitriptyline can cause bladder dysfunction. This does not appear at first glance to be a neurogenic bladder condition.

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

September 17, 2014 at 2:35 am

Post count: 24

#11449

Thanks dr. for your explanation. Yes for sure I am not going to scoliosis surgery till wound from dfsp is healed totally. Going tomorrow to hospital and for sure will mention your thoughts to my plastic/Moh’s surgeon. I will probably see my neurosurgeon because it’s same hospital. I will also talk with him about planing for scoliosis surgery and will also mention this. It would be great that we are little closer distance so I could come to your office for check, but we are on different continents. Before going to scoli surgery Before scoli surgery I will go to my urologist for check and he will give me advice (size?) for silicone catheter because on previous spine surgery I had UTI from rubber catherer and I am pretty scared about that – more than spine pain.
I will update you with my progress, and once again thanks a lot for your very usefull advices and giving time for me.
All the best
NIkola

Donald Corenman, MD, DC
Moderator

September 17, 2014 at 10:46 pm

Post count: 8660

#11454

A silicone catheter is a good idea. You might have a latex allergy and some of the catheters do contain latex.

Let us know how you do with 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.
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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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