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

Tagged: PAIN, spine, thoracic

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Jtal19305
Participant

December 27, 2015 at 7:24 am

Post count: 43

#21084

What would one look for in the mri? Would this start as a burning pain in the sole of left go if right after surgery? I hope it is not arachnoiditis. I did have a post op MRI with and without contrast which was reviewed by many doctors and no one mention arachnoiditis. I just wake up every morning and have the same nerve pain in my left foot calf and outer thigh.

Donald Corenman, MD, DC
Moderator

December 27, 2015 at 2:49 pm

Post count: 8660

#21086

I cannot describe on this forum how exactly to interpret an MRI for arachnoiditis or the path of the cage that was placed. Those interpretations would be an acquired skill.

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 27, 2015 at 4:41 pm

Post count: 43

#21089

Okay I understand. To get a complete diagnosis of my current condition should I see a neurosurgeon, orthopedic doctor, neurologist or other medical speciality? I have lost faith in my orthopedic surgeon as I believe he has not provided honest feedback, timely feedback and does not seem to care very much.

I have no issue mailing my imaging and reports to you for review and analysis including the new MRI that I’m working on having. I understand there is a fee involved but from what I can gather from your reviews and background, you have a great amount of experience and appear pretty successful with your surgical outcomes. I would not be so inpatient if I did not have my body screaming at me all the time. Maybe it’s just the way of spine surgery and I should just wait and see. However If there is a small detail that was overlooked and it can be corrected I’d rather do it sooner than later. Yes I understand that more surgrry especially in the area of t12 l1 is risky but there could be overlooked issues at l2 L3. Also I had one neurosurgeon say it would not be too difficult to get those beak like bone spurs out on the edges of the T12 L1. Yes I could wait for them to “dissolve” away hopefully and even eventually which would open up more space for my cord. However if they can be removed and I could get better faster, I would be interested. I would need a surgeon with a great reputation to recommend and perform any additional surgery. It’s not a fun thing to go through. My spine somehow had found a way to get by with all the spurs, disc bulges and stenosis. I feel at times surgery may have upset the delicate balance my body created, and the leg weakness could have been a warning sign because of some of the things I did just prior to its development (use of an inversion table, chiropractic adjustments and weight lifting). I think I was going down a road towards needing surgery and should have been seeing a spine special for years. Hindsight is 20/20. I have to know find a path forward based on the decisions I made and the situation I am in now.

Donald Corenman, MD, DC
Moderator

December 28, 2015 at 4:53 am

Post count: 8660

#21091

I think a new consult with a spine surgeon or neurosurgeon who has experience with these disorders would be the next step. A neurologist would not be the next step in my opinion. The spurs at the T12-L1 level are not “as easy to get to” as the individual you saw commented on.

It is unlikely that the L2-3 level has anything to do with your foot pain.

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 28, 2015 at 9:21 am

Post count: 43

#21093

Yes I agree with you. I’m also not eager to go under the knife again unless I have concensus and it’s done by the best surgeon I can find. I’ve been looking for a new doctor and I’m still waiting to hear back from the University Miami neurosurgeon who is among the “best” I’m told. I was told my ortho surgeon was good too so just being told someone is good doesn’t make it so. Although he may be a good surgeon I am disappointed he performed such as risky procedure on me. I think there were safer approaches that could of been taken from the side by removing a rib and then having access without compromising the neural elements, although I could be wrong. One spine specialist said the bone spurs were there for a while and may not be a problem while another said my spinal cord is “bending” away from the spurs and protruding annulus at T12-L1 and that a partial corpectomy would be needed to fully Decompress. I was told not to do this procedure by another doctor. So there is a lot of differing views and I am looking for a new spine specialist to get a definitive opinion. This has not been easy because many doctors do not see patients who have had surgery unless it’s been 1 or 2 years. I’m at about 6 months. I did get the Miami neurosurgeon to agree to look at.y case but I’ve been waiting several weeks and the holidays too.

You mentioned bone spurs can melt away by the body. If this does happen how long does it take? Is there anything I can do to speed up the process? Drinking Apple cider vinegar? I know it may sound crazy but I’ve read people ingesting a dilution of it for foot spurs. In my surgical report the doctor stated he was able to get a posterior lateral fusion in addition to the interbody fusion. Is this where bone graft is placed in between the pedicle? Would it be evident on a cat scan? I did not see evidence of bone in between the T12-L1 laminectomy. If I chose to have the hardware removed in the future, will my spine be as stable without it? Are the holes filled in with bone or cement? My thought are if the hardware us not needed after a point in time removing it my take some pressure away from the neural elements in that area. However if it can lead to more scar tissue or other issues, I may leave it there. I really don’t notice it but I will tell you it just feels different knowing you have this mechanical metal in you. I would rather not have it in me.

The nerve pain in my left foot has moved from the whole sole to the heel area. Is this how nerves heal?

I agree that a new work up by a very good, objective and experienced spine surgeon who understands the nervous system and would go along way to helping me out. Until then I have to be patient.

Thanks jerry

Donald Corenman, MD, DC
Moderator

December 29, 2015 at 5:46 am

Post count: 8660

#21096

Do not remove the instrumentation until there is proven fusion bone between the vertebra. This is revealed by a CT scan.

“The nerve pain in my left foot has moved from the whole sole to the heel area. Is this how nerves heal?” Yes

You cannot change the chemical environment to cause bone spurs to recede. It is only a matter of time and loading (or unloading).

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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