Post Surgery Pain Issues related to Thoracolumbar Laminectomy, disectomy and fus

Tagged: PAIN, spine, thoracic

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Donald Corenman, MD, DC
Moderator

December 22, 2015 at 9:23 am

Post count: 8660

#21061

The advice on this website is obviously free, I do have a service called “long distance consultations” that for a fee, I will take a thorough written history, go over your images that you send me, develop a written report and talk to you on the phone.

Any questions you want answered by text through the internet, I am happy to give you my best information.

When you get your new MRI, you can type the report and I would be happy to help you interpret it.

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.

Jtal19305
Participant

December 22, 2015 at 9:41 am

Post count: 43

#21063

Hello dr Corenman

I’m definitely interested in the long distance fee based consultation. I’m waiting for my new MRI to be approved. But what I can do is send my imaging disks and reports that I do have and then share the new MRI once I have it.
I will pull your mailing address from your website. I really appreciate everything you’ve done so far. Like I said my chief complaints are the stinging burning pain in the left heel of my foot and left calf , neuropathic pain in my outer left thigh and fasiculations in my calves. I occasionally get some minor pain in my genital area. I hope it is recovery related and a matter if time to heal. However, I would be more comfortable with a thorough review of my imaging and reports to rule out anything else.
My goal is to understand what’s happening and resolve any open issues with help from the best specialists like yourself.

Thanks. Jerry

Jtal19305
Participant

December 22, 2015 at 11:30 am

Post count: 43

#21066

Please let me know what I need to do for the long distance consultant. I’m obviously at a point where I’m very concerned due being in almost some form of pain all the time. And the calve fasiculations are bothersome and distressing. I’m very concerned about my situation. I just can’t believe the surgery put me in more pain and discomfort than before. I don’t understand why and if something was messed up. I just want to know what’s going on and if I can expect to get better. I filled out your form online which has my email address, full name and phone number. I feel my doctor has left me and I’m not getting any where with him. I really appreciate anything you can do to help and assist me through this.

Thanks Gerald (Jerry)

Jtal19305
Participant

December 22, 2015 at 2:20 pm

Post count: 43

#21067

Quick question
I’m actually going to just pay for my own mri with contrast out of my own pocket. It’s 373$ I want to know what to tell my PA or doctor for thinner slice mri Imaging. Is a length stated such as 1 mm 2 mm etc or some other terminology. What cut length should I request for mri to get the best imaging given the fact I have instrumentation at T12 L1 with interbody fusion and L2-L3 hemi laminectomy?

Thanks.

Jtal19305
Participant

December 22, 2015 at 8:35 pm

Post count: 43

#21071

Dr Corenman

I know this is discussion is getting long and you have provided so much great information. But something occurred to me today regarding my post surgery pain where I have to ask a basic question. Since you are a surgeon, and I am not, your understanding of the tools and techniques to perform the type of surgery I had will help me understand some things.

In performing a posterior decompression with a full laminectomy, removal of the facet joint, disectomy, placement t of interbody fusion and lateral fusion, I envision a lot of cutting with power tools, grinders, Rongeurs and other tools. What could happen either by normal activity or inadvertent motions etc., to cause a very specific burning pain in the sole of my left foot? I have no idea how accurate the cutting tools are to remove the bone and other tissue, and what could cause this pain to generate? I know we talked about the placement of the interbody cage through the area made in the disk on the left side which might irritate the cord and this could take 12 to 18 months to settle down. The pedicle screws are in the right place as verified by a ct scan. But my concern is if something else could of gone awry? I believe there was not a dura leak or tear as I would have been told or felt a severe headache which I didn’t have. I am at a loss of what could have caused this left foot burning pain. I still have this pain and even this evening as I was trying to enjoy dinner with my daughter I could feel it like a nail in my heel.

I don’t believe I am going to get the nitty gritty details from the doctor who did my surgery. I really would appreciate some of your insights here. I’m very concerned about my prognosis. Thanks
Jerry

Donald Corenman, MD, DC
Moderator

December 24, 2015 at 6:18 am

Post count: 8660

#21072

You need to access the front of the spine in an area where there is spinal cord present and anterior compression. The spinal cord does not tolerate retraction. In older days, this access was performed by an anterior approach (through the front of the chest or abdomen). This approach might entail taking down the diaphragm muscle and had significant morbidity.

The technique now is a lateral approach-sometimes through a midline back incision and sometimes through an off-midline incision. To get to the front of the spine but not so far off center-line, you need to remove the facets on one side as well as a portion of the pedicle. This allows you to visualize the dural sac that the cord resides in and “get around it” without retraction to the front of the canal where the protrusion is narrowing the canal.

I generally do not perform a TLIF at cord levels as I worry about getting the cage into the disc space without retracting the dural-even inadvertently as this can cause some cord irritation symptoms. It is impossible to prove but I assume there was even the slightest cord retraction to cause your symptoms. There is no way to prove this.

The MRI you are to obtain might be a problem. It has to be on at least a 1.5 tesla machine, with and without gadolinium. It has to be a good machine and well maintained as there are many poor machines with less than acceptable images produced. $373.00 is less than the cost of producing good images and the cheapest I have ever heard of. I would be skeptical of quality images.

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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