QUESTIONS PRE-OP AND POST-OP FUSION SURGERY

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mlawler24
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October 9, 2011 at 12:04 am

Post count: 3

#4978

Dr. Corenman, I am going to be having my L5-S1 Fused together hopefully next month. I am only 26, will I have to have more fusions down the road if i start having them now? I have been dealing with my pain caused by my sciatic nerve for about 2 1/2 years, and i have been told by my Nero Surgeon that i am a surgical candidate. I do however have a Kyphosis in my spine as well, can this cause problems with having this type of surgery? I have been going through Phsycal Therapy as well, will this ensure a faster recovery and a better one like my PT doctor has told me? I am just doing some research to make my decision easier on everyone around me.. I am all for the fusion, most people around me are not, mainly because of my Kyphosis. Any Suggestions?? Thanks

Donald Corenman, MD, DC
Moderator

October 9, 2011 at 10:49 pm

Post count: 8660

#4981

At the age of 26, you are planning to have a fusion of L5-S1 next month. You explain that you have had sciatic pain for 2 1/2 years. You also note “kyphosis” but not where the kyphosis is or how it affects the spine.

I have many questions. What is your main complaint? Do you have buttock and leg pain as your greatest pain or back pain as the most problematic pain? If you have leg pain as the biggest complaint, why is a fusion the surgery of choice? Fusion is important if you have an isthmic spondylolisthesis, angular collapse of the L5 on S1 vertebra causing foraminal stenosis or instability from degenerative spondylolisthesis (see web site for those topics). Fusion is usually not necessary if this is just a simple compression of a nerve root from spur or disc herniation.

Where is the kyphosis of the spine? Is it at L5-S1 and if so, why? There are many causes of kyphosis. Some that need to be addressed and some that can be left alone and watched.

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.

mlawler24
Member

October 10, 2011 at 6:30 am

Post count: 3

#4983

Dr. Corenman,
I do have pain running down my leg through my calf, and pain in the butt.

This “isthmic spondylolisthesis” is actually what my surgeon called it. My disk is completely flattened and my 2 vertabres are fractured and pushing on that disk, which is causing the disk to bulge and push on my nerve.

My kyphosis is in my middle back. i have a hump in that area.. not bad enough for rods to be put in my spine though. I looked into that when i was a teenager.

Does this make any sense?

Donald Corenman, MD, DC
Moderator

October 10, 2011 at 7:58 am

Post count: 8660

#4986

You have leg pain from foraminal stenosis secondary to an isthmic spondylolisthesis. The L5 vertebra has shifted forward and the disc has become degenerative (this is typical). You probably also have a pedicle spur that is compressing the nerve root.

If that is the case, then you are a candidate for a fusion. With your pathology, I would suggest a TLIF to restore the disc height (see website).

You probably also have Scheuermann’s disorder (see website) which is causing the kyphosis.

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.

mlawler24
Member

October 10, 2011 at 10:09 pm

Post count: 3

#4988

Dr. Corenman,
What exactly is “TLIF” is that a replacement for the flattened disk?

What exactly is Scheuermann’s disorder? I have never heard of that before.

Do you have any patient that has had the fursion surgery done and was not satisfied with it? or it didn’t work for that person?

I did see the testimonials page on the website, which is great, but is there anyone that has had the fusion go wrong?

Donald Corenman, MD, DC
Moderator

October 11, 2011 at 12:05 am

Post count: 8660

#4989

Please review the website. It is full of answers for your questions and is much more thorough than I can be here on the forum.

A TLIF reconstructs the disc height for fusion purposes which restores the foraminal height- necessary for decompression of the nerve root.

TLIF fusion rate in my hands is 98%. That is not satisfaction rate however. I tell my patients that there is a 90% satisfaction rate for 2/3 relief of pain. The others at least at this point are no worse and most are somewhat better but 10% of patients do not reach the 90% satisfaction rate. The reason is that some patients have chronic radiculopathy from the original pathology (see website) and 2% do not get a solid fusion.

There is always the chance that surgery can make your symptoms worse, but in good hands, that chance is small.

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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