Post Fusion- Leg

Tagged: Fusion for recurrent lumbar disc hernations with opposite leg pain after surgery ?BMP inflammation

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pec5002
Participant

September 17, 2019 at 11:18 am

Post count: 33

#31115

Pain has continued to get more severe in the left leg, here is my MRI from yesterday, could you help with reading this and your thoughts?

Exam: MRI Lumbar Spine Without and With Contrast
History: Prior spinal surgery most recent fusion on 8/12/2019- radiating pain
Technique: Coronal T2 weighted sagittal pre and post contrast T-1 weighted proton density and T2 weighted and axial pre and post contrast and T2 weighted images performed on a 1.5T unit
Contrast: 16ML dotarem from a 20ml vial
Comparison: Prior MRI exams most recent 6/4/2019

Findings:
Alignment
Non specific straightening
Mild grade 1 retrolisthesis L5-S1
Vertebrae
Hernatopoietic marrow
No compression fracture deformity or pathological marrow infiltrative process
Underlying bony canal is capacious
Disc spaces:
L1-2 throughout l4-5 no disc bulge, herniation spinal or foraminal stenosis. Disc space heights are maintained and there is preservation of the normal intervertebral disc signal

L5-S1- spinal instrumentation post discectomy Left-sided surgery including facetectomy/foraminotomy/laminectomy with a central left sided interbody fusion device. Mild deformity of the L5 inferior endplate. Minimally enhanced material extending from the central left side of the disc space with minimal deformity of the thecal sac, this could represent a combination of postsurgical change and disc. There is diffuse enhancement of the epidural space most significantly surrounding the left descending S1 nerve root and extending to the posterior disc oriented in the same plane as the interbody device, compatible with postsurgical enhancement. Bilateral L5-S1 pedicle screws and interconnecting rods with artifact. No central spinal stenosis. Foramina free of significant compromise. Mildly narrowed disc space with desiccation.

Intraspinal:
Conus medullaris is normal in appearance and terminates normally at L1-2
Subarachnoid space and cauda equina are unremarkable
Paraspinal
Aorta maintains its normal calber
No evidence of an anterior paraspinal mass
Non specific enhancement within the posterior paraspinal muscles at the surgical leve

Impression:
Interval additional surgery L5-S1, instrumented spinal fusion post discectomy. Minimally enhanced material extending from the central left side of the disc space with minimal thecal sac deformity, currently no compression of the descending S1 nerve root, this likely represents a combination of disc and post surgical enhancement within the disc. Compared to the preoperative study, improved mass effect. No interval disc hernations at other lumbar levels.

Donald Corenman, MD, DC
Moderator

September 19, 2019 at 8:44 pm

Post count: 8660

#31125

The radiologist notes; “There is diffuse enhancement of the epidural space most significantly surrounding the left descending S1 nerve root and extending to the posterior disc oriented in the same plane as the interbody device, compatible with postsurgical enhancement. Bilateral L5-S1 pedicle screws and interconnecting rods with artifact. No central spinal stenosis. Foramina free of significant compromise…..Compared to the preoperative study, improved mass effect”.

He means that you have inflammatory material surrounding your left S1 nerve root. Nerves get “pissed off” if they are inflammed. It seems that your root is significantly inflamed. Did your surgeon use bone morphogenic protein (BMP)? I would consider an epidural steroid injection if your pain is as great as it was before surgery, especially if your surgeon used BMP to calm down the inflammation.

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.

pec5002
Participant

September 19, 2019 at 8:48 pm

Post count: 33

#31127

Thanks Dr. he did you BMO but doesn’t want me to do a steroid yet. In your experience is this something that will just take awhile to heal ?

Donald Corenman, MD, DC
Moderator

September 19, 2019 at 8:55 pm

Post count: 8660

#31130

He used BMP (not BMO)? If so, BMP can be inflammatory to nerves and in my opinion, a steroid injection should be used early.

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.

pec5002
Participant

September 19, 2019 at 9:01 pm

Post count: 33

#31131

Yes , sorry – BMP and apologies for my spelling mistakes. They did give me a second medrol pack which I don’t want to take because of how it makes me feel. Hopefully this will go away over time and I think I am irritating it by sitting at work too long and getting up and down from lying on the couch. Thanks as always. If you have any other advice please let me know I appreciate what you do for everyone in confused and stressed out states.

pec5002
Participant

September 22, 2019 at 12:23 pm

Post count: 33

#31134

Sorry doc last question, why do you think I still get pain down my leg (along the s1 nerve path, down the glute and back of hamstring) when I cough or sneeze. If there is no more disc and rods holding it in place shouldn’t this not happen? Or is the nerve so irritated that and sudden movement can make it angry .

Thanks always in advance
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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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