PLEASE READ mylogram/post surgery

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rojotoni
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September 17, 2011 at 7:30 am

Post count: 9

#4904

Hello Dr Corenman,

I did have the myelogram which was not as easy as I thought it was hard for them to get into the space and one doctor said nerves were most likly in the way. Could you please look this over and let me know what you think. I had surgery on June 13th with Myelogram done on Sept 15

Post operative changes of L4-S1 lumbar fusion and present with transpedicular screws at L4, L5 and S1 levels on the right and facet screws at L4-L5 and L5-S1 on the left side. Disc space cages are in stable position at L4-L5 and L5-S1 levels. There is no evidence of hardware failure.
There are 5 nonrib-bearing lumbar type vertebral bodies. Post operative changes as described above. There is no evidence of hardware failure. The vetebral body heights and disc space heights are well-maintained. Osseous structures are intact. The conus medullaris ends at L2
T12-L1 No disk bulge or protrusion. No central canal stenosis or neural foramial narrowing
L1-L2 Same as above
L2-L3 Same as above
L3-L4 Minimal diffuse disc bulge is present. There is no central canal stenosis or neural foraminal narrowing
L4-L5 Left-sided neural foraminal narrowing dur to a small osteophyte and diffuse disc bulge.
L5-S1 Right-sided moderate neural foramina narrowing with osteophyte arising from the posterior inferior margin of L5 bertebral body.

Please Dr. Corenman is this why I still have pain right lower back into right butt sometimes to right calf and great toe goes numb. Most pain when standing and/or walking for more than an hour or more. When I sleep my great toe will go numb, pain right side when I turn at night. And I only sleep one to two and a half hours of sleep. Thanks again I know the weekend is coming up but if you get let me know as soon as you can. Thank you

Donald Corenman, MD, DC
Moderator

September 18, 2011 at 12:54 am

Post count: 8660

#4905

You are now about three months out from your TLIF surgery. You still have right lower back pain into the buttocks and down to the foot. Your pain is stenotic (worse with standing and somewhat improves with sitting or lying down).

The CT myelogram notes residual compression of the right foramen at L5-S1. There are times that radiologists can “read too much” into the studies but in this case- it might appear that you still have residual compression of your L5 nerve root. You do not mention what the surgeon used for bone graft and that can make a difference. If he or she used only your own bone graft or donor bone graft- your fusion might take a year or more to consolidate. If he or she used bone morphogenic protein (BMP) along with the graft, your fusion may heal in less that six months.

The reason I feel a solid fusion might help is there is still motion in your surgery site. When you stand, the vertebra rocks backwards and compresses the nerve. When you sit down, the vertebra rocks forward and some compression is eliminated. A solid fusion might prevent this motion and the leg pain might improve.

There is a technique to prove that the L5 nerve is the problem child. You could get a selective nerve block of this nerve (see web site) and if you had temporary relief (see pain diary on web site), the L5 nerve is most likely the culprit. This injection might also give you longer term relief. There still is the chance that this could be chronic radiculopathy (see web site) but with pain upon motion, this more likely is still a mechanical problem.

If it is a mechanical problem, you could ask the surgeon to see if he would consider a redo decompression of that 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.

rojotoni
Member

September 18, 2011 at 3:52 am

Post count: 9

#4906

Thank you again. You have been great I have told many people about your site and you. I even had one person thank me because they could understand more. Thanks again

rojotoni
Member

October 19, 2011 at 8:40 am

Post count: 9

#5016

Hello again Dr. Corenman,

I was nice to see you on the program this morning. I wish you had a clinic here. I have gone to a new nero doctor. I had a new MRI and he said the cages at L3-4, L4-5 have move and are pressing on the nerve and I have a spinal leak at one of the levels. He said he can’t say what the doctor did or how much he can repair until he is in there. Also L5S1 will probly not fuse. I do not remember everything because of shock. Do you have some questions I should ask? Thank you again

rojotoni
Member

October 19, 2011 at 8:41 am

Post count: 9

#5017

Is there anyway I can send you MRI and Myelogram?

Donald Corenman, MD, DC
Moderator

October 19, 2011 at 10:07 pm

Post count: 8660

#5024

I am concerned that there are significant problems based upon your report. If the cages are migrating, this means that stability of the spine is compromised somewhat. I am unclear what the surgeons means by the presence of a spinal leak at one of the levels. If there is a “leak”, there should be a collection of CSF (cerebral spinal fluid) in a pocket outside of the dura (called a pseudomeningeocele). Ask the surgeon to point this area out to you on the MRI so you can understand it better.

It might be helpful to have a CT scan to look at the position of the cages, the screws and any fusion bone that has formed. Ask your surgeon if that test would help him or her to further understand the problem.

If you would like to send your images to me, please call either Diana or Sarah at (970) 476-1100 for more information.

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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