Opinion of surgical options based upon MRI & symptoms

Tagged: XLIF failure to decompress the spinal canal

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Calista
Participant

March 18, 2020 at 10:19 pm

Post count: 18

#32326

Well, surprisingly my CT Myelogram has not been canceled. I will let you know the results and try to persuade the radiologist to review with me. Fortunately one needs to inject contrast, so have the opportunity to ask directly.

The NCS will be repeated. Previous test results were consistent/correlated with MRI findings. But it is a simple test to redo.

Thank you again, will let you know when I know the results. Not sure how things will work with COVID-19 restrictions, surgeon offered telehealth for review of issues and results. He already has examined me and viewed MRI – and CT is supposed to resolve concerns over potential artifact that can obscure results. Hopefully I will have less questions and more answers soon.

Thank you!

Donald Corenman, MD, DC
Moderator

March 19, 2020 at 11:26 am

Post count: 8660

#32327

Keep in touch!

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.

Calista
Participant

April 12, 2020 at 3:08 am

Post count: 18

#32427

Hi. My CT Myelogram was canceled due to COVID19, with 427 cases, mostly north of where I live. So rescheduled for 3wks later, with 50k reported cases…makes sense? So have CD, uploaded to my surgeon, but have not seen the report yet.

I have been trying to read it, however my eyes hurt, the resolution on preview is poor, had to use a very old laptop that had a CD drive to upload.

I may see report Monday, if not have call scheduled with the surgeon on Tuesday. I will add here the radiology report and surgeon’s opinion when available.

Thx!

Calista
Participant

April 14, 2020 at 9:44 pm

Post count: 18

#32450

Spoke with surgeon today, I do not have solid fusions at L3-5, and L3/4 hardware is loose and level moves on flexion/extension, plus confirmed bilateral foraminal stenosis, both levels, worse at L3/4 – with residual disc.

He recommends a posterior full decompression with revision fusion and me taking bone density drugs in addition to using BMP. The logistics of removal of hardware is the concern, versus augmenting what is in place, due to small size of pedicles.

Need to have in person consult to review particulars. So now just waiting until in person office visit & when elective surgeries can be performed in NJ.

Donald Corenman, MD, DC
Moderator

April 26, 2020 at 10:36 am

Post count: 8660

#32477

If you have a painful pseudoarthrosis at L3-5, then you do need a revision surgery. I can’t comment on the required revision techniques at it depends upon what the fusion failure looks like and how it failed. You would need to revise the hardware as a loose screw cavitates (erodes the bone around it). Bone density drugs might be helpful.

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.

Calista
Participant

May 16, 2021 at 10:08 am

Post count: 18

#34068

Hi, it’s Calista again.
I am 2.5yrs post XLIF, had CT and I did not achieve a solid fusion. The surgeon who viewed the CT said I have hollowing around the screws used for the lateral plate fixation. Have 2 screw plate by Nuvasive. I also had another MRI. Results are
Results are
The unfused disc spaces are intact
Straightening & reversal of the lumbar lordosis
3mm anterolisthesis of L5 on S1
L3-4 Large disc bulge Mild right and severe left foraminal stenosis
L4-5 Moderate disc bulge and severe facet hypertrophy. Mild right and severe left foraminal stenosis. No spinal stenosis
L5-S1 moderate disc bulge. Mild right & severe left foraminal stenosis. No spinal stenosis.
(Note surgeon confirmed that the herniations are residual disc, not cages ir scar tissue.)
Impression
1) Transitional anatomy
2) Status post L3-S1 fusion. Severe left foraminal stenosis at L3-L4 L4-L5 L5-S1

I cannot stand up straight long, need to lean on right leg, Have severe axial & radicular pain, mostly left side. However right side my leg goes pins & needs numb if sitting more than 5 min, plus pain to lateral side of foot. Unsure if due to pathology or overuse.
Also felt spine pop at likely L4/5, no sound, just internal snap & if f*ing hurts like hell.
I have bilateral groin pain, much worse on left side. I try not to stay in bed, cannot sit long..
New symptoms since XLIF – when standing get pins & needles numbness & pain creeping upwards to almost my rib cage, then it takes several hours at a minimum for pain to subside when laying down to sleep, often I cannot sleep at all, will go 36-48hrs before falling asleep, which is completely unhelpful for pain. Also my legs feel very heavy, feel as if someone us pulling me towards the ground. The symptoms are debilitating & scaring me.

I am at the end of my rope. I am scared of more surgery, but realize I have to get issues addressed. One surgeon recommended open decompression of L3-L5, plus add more BMP to cages and posterior cortical screws. L5/S1 I had posterior hardware removed 18 mos post original fusion, because one screw fractured plus I am very petite & pedicle screws were pressing into skin & formed bursa over all of them. So I realize I have L5/S1 left foraminal stenosis, but the level is fused, unsure about if the level is decompressed again if more screws needed.

I cannot visualize how the cortical screws will fit with lateral screws. Besides being 5ft tall, I have short pedicles for size, go figure? My brother has same issue, also fused at 3 levels, had ASD + XLIF & it was not a good outcome either.

I realize revision of XLIF is not common since new, plus using technique as a revision of choice for many. But since the fusion, I have had rashes & increased joint pain throughout body, and prefer to have XLIF hardware removed, since I have a nickel allergy & thought I was getting titanium hardware as I had previously. When web like rashes appeared on arms & legs, plus increased joint pain in hands, I looked up the Nuvasive Hardware & it contains nickel. I understand the jury is out on metal allergies, but if I have an allergy plus autoimmune disease, it seems dumb to have nickel within hardware since revision is required.

I am going for more consults, but what would you recommend for surgical approach to deal with my clusterF situation?

Note I do not receive pain mgmt because worried stigma if use of narcotics will label me a bad outcome waiting to happen, when already labeled due to amount of surgeries.

Your feedback would be greatly appreciated. Thank you!
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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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