Post op TLIF L5-S1 back to original pain

Tagged: TLIF

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THR
Participant

November 17, 2020 at 2:16 pm

Post count: 5

#33377

I had a TLIF performed on L5-S1 on October 2, 2020. After most of the surgical pain and different feelings created by the surgery and incision healing had subsided, I have the original pain I started with. The muscles on the right side of my back stiffen and I still have the sharp pain I had pre op. I still avoid BLT and wear my brace when I am out of bed to help avoid BLT. I was told the results of the discogram I had indicated disc L5-S1 was my pain generator but I do not remember anything from the procedure. I do not know any information on how my L4-L5 reacted during the discogram. I do understand my muscles will have quite a bit of changing to do when I get to the physical therapy phase of recovery, but do not understand why the pain has returned in my right lumbar. It occurs when lying and sitting as it did before. What could be occurring? I have read how some surgeons do not remove the entire disk when placing the spacer with BMP, could some of the disc that was causing pain still be within the L5-S1 cavity and be irritated by the bone growth of the fusion? I am currently upset with myself for even having this performed as I have had no success with any treatment we have tried throughout the years. Thank you for your time.

Donald Corenman, MD, DC
Moderator

November 17, 2020 at 7:04 pm

Post count: 8660

#33378

I will assume that you had an appropriate work-up and that L5-S1 was the discographic pain generator and L4-5 did not cause any pain.

You are only 6 weeks out from your TLIF. It takes at least 3 months for the bone graft to “get sticky” and start to adhere the two vertebra together. Especially if you pain was endplate generated, the cage sitting on your endplate is only going to create discomfort. Give it six weeks to start to bond and please report back here.

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.

THR
Participant

November 18, 2020 at 2:34 pm

Post count: 5

#33385

Dr. Corenman thank you for your reply. I do understand what you explained, I wouldn’t have worried so much if this would have been mentioned post op. I will follow up with my progress. Again, thanks for your time and explanation.

THR
Participant

January 11, 2021 at 5:26 pm

Post count: 5

#33523

Dr. Corenman,

I wanted to follow up with you on how I have been feeling. I am working on scheduling my 12 week visit, I have to send in my imaging this week. The pain that I have had hasn’t changed, it has become more sharp. The last appointment I had in office with your PA he sent me home with a physical therapy script. I started physical therapy the same week and have been going 1-2 times a week (December 18 I started). My right leg thigh muscle has been going numb since December 28th, it was off and on the whole week up until New Years. Starting 01.06.2021 it has been numb continuously, it isn’t bad enough I can’t walk but I do feel like I have a phantom leg because of it. I will see if the office will schedule me to have an appointment with you, but I haven’t had any luck and only get the PA’s.

Thanks for your time.

Donald Corenman, MD, DC
Moderator

January 13, 2021 at 8:38 am

Post count: 8660

#33528

PAs are OK as I discuss everything with them and during Covid, I have to wait until my vaccine catches up to see patients.

Based upon your symptoms, a new MRI is warranted.

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.

THR
Participant

September 26, 2021 at 6:49 pm

Post count: 5

#34416

DR. Corenman,
I’m not sure if it is appropriate to continue on this or create a new thread. October 2 will be my one year anniversary for my TLIF L5-S1. I am continuing to have pain. When I lay down it is still prominent on my right side. Sitting and working it will vary on which side. Currently sitting in my recliner with my right leg crossed over my left I feel the pain in my left side. (Lumbar where my original pain has been). I still avoid sitting as it triggers the pain, in my vehicle I use a purple brand seat cushion to raise my tailbone to be more level with my knees. With or without using it the pain is still the same.
At work I will take my lunch break in my service truck and after 30min when I get out of my truck my lower back muscles are on fire and I am very stiff. I don’t let it slow me down, moving is still the best thing to keep the pain at bay or minimize it. I still struggle to fall asleep at night due to the pain. I do not know if my muscles are the cause of this pain. After surgery one of my prescriptions was Diazepam 5mg. This seamed to settle my muscles. I used it very sparingly because my body has a tendency to somehow block the effects of medication over a short period of time. I did have my family doctor to refill my prescription and use it when I’m about ready to loose my mind at work because of the pain or when I absolutely can not fall asleep at night. (We have tried prescription sleep medications up to higher doses and the effectiveness wears off after a week).
I do remember the term “tennis elbow of the buttocks”, the pain has never radiated that low. If I am standing in a control room waiting for instructions from an engineer I will sometimes have episodes where I either get a sharp pinch where I slightly “bob” down due to the pain. I had this issue pre-surgery as well. I will tense up my back muscles and twist or bend side to side and normally get a pop and some relief.
I do feel sturdy and not weak in my fusion area, but my muscles or something is still not working correctly. I am very active (not as in sports) walking up ladders silo/tank stairs +/-100′ climbing piping, equipment and walking around facilities all day with an average round trip commute of 2 hours pavement and dirt roads. Since being released back to work on May 11 my work days are a minimum of 10 hours with longer days being 16 hours.

Thank you for taking the time to help all of us who have been struggling with chronic pain.
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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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