Revision Surgery

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mand
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December 10, 2011 at 8:36 am

Post count: 6

#5197

Hx:
1991- Ant/post spinal fusion T11 to L4 age 14 (Idiopathic scoliosis) performed by Dr. Thomas Lowe. Continued active lifestyle until…
2001- injury resulting in Ant/post spinal revision surgery L4 to L5 extension by Thomas LaGrone. Corrected pain.
2010- April. Two children later… Began running and active lifestyle. Felt good with only manageable levels of pain- not enough to stop working out and enjoying life. Came off a plyometrics box about mid-thigh and felt like I was going to pass out. Acute pain.

2010-present. Daily and nightly pain- disabling. Attempts to walk, swim, elliptical, cross country ski, climb stairs, bend, twist, sit… everything seems to agitate the back. Waited to go in due to insurance purposes. Added about 40 lbs. due to extremely sedentary lifestyle. Feels like bone on bone- no muscle no nerve pain. Just intense deep pain that is not ever fully alleviated.

Today- Pain worsened to the point I had to go home from work. Ready to get this looked at. Pain is definitely in what I believe to be the L5-S1 region. Very week hips, stretching hamstrings agitates the injury… never recovered from injury in 2010…

Questions: Do you do revision surgeries with this much going on? I have been turned away by several surgeons within Colorado. If you do not, do you have any ideas on where to go for this type of surgery? Can you recommend good articles or journals to research on spinal fusions that extend from sacrum to Thoracic vertebrae that did not maintain the lordodic curve? Would it be wise to seek the same surgeon as my second revision surgery? Thank you for your time!

Donald Corenman, MD, DC
Moderator

December 10, 2011 at 10:04 am

Post count: 8660

#5198

Your problem is very typical of long term results of this type of surgery. It has been well known that a long fusion down to L4 will eventually wear out the L4-5 level in approximately 10 years. That is exactly what happened. You had a fusion of L4-5 and continued your active lifestyle.

Unfortunately, the L5-S1 level will then eventually wear out and again, that is most likely what happened. The condition is called isolated disc resorption (see website). The pain that occurs is bone pain from lack of shock absorption. Symptoms initially develop with impact activity and after some months to years, delayed deep boring pain occurs some hours after the impact event. Patients will say they “pay” for the activity later. Eventually, night pain can occur that wakes the patient up.

If isolated disc resorption is the problem, the surgery is relatively standard. You may already have hardware in your back which can make the surgery easier. The procedure is called a TLIF and you can view a video of this on the website. If you have a flat back syndrome from surgery, this is a different matter and an osteotomy may need to be performed along with the TLIF. Yes I perform this type of surgery.

You can send your films to the office or you can call for an appointment at (970) 476-1100.

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.

mand
Member

December 10, 2011 at 11:23 pm

Post count: 6

#5201

Wow- thank you so much for your time! I’m not sure how you do it! I’m definitely interested in pursuing and have more specific questions, but I will limit this to few one more.

So, my obvious concern about a fusion from T-11 to S-1 is what part of the body goes next from daily wear? Do you have any resources or long-term studies on hips/knees/ankles? Or, can we assume that the thoracic and cervical vertebrae would be compromised? My goal is to make surgery number 3 my last (I learned my lesson- no more running for me) and get back to an active, low-impact lifestyle.

Regarding films- I have my post surgery films and everything prior from 2001. When I went for a referral, they suggested waiting on finding a specialist before getting any done. X-rays have never shown much displacement or spacing abnormalities. Should I get a CT scan locally to send or should I schedule with you and have it done same/day to review after the appointment? Thankfully, I’m in Gunnison, CO and am thrilled that I may not be looking at coordinating an out of state surgery!

Donald Corenman, MD, DC
Moderator

December 12, 2011 at 3:06 am

Post count: 8660

#5206

If you have a fusion from T11-S1, there are two areas that need to be watched- the sacroiliac joints and the T10-11 level. You can mitigate the wear by doing just what you stated- low impact activities. The spine fusion should not affect your hips, knees and ankles.

Swimming, cycling including mountain biking, hiking (without a heavy pack), rowing, reasonable gym workouts, cross-country skiing and snowshoeing are all activities that in general, would not harm your back.

Intermediate activities that could cause increased wear are skiing groomed slopes, hiking with a heavy pack, heavy weight lifting and water skiing.

Acivities to avoid are all impact activities such as running, tennis, volleyball, basketball, soccer as well as others that increase the load on the back.

Normally, both a CT scan on a 64 slice scanner and an MRI on at least a 1.5 tesla machine are necessary for the workup. In-office standing x-rays with flexion and extension view are necessary.

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.

mand
Member

December 12, 2011 at 10:28 am

Post count: 6

#5213

Thank you very much for your time. I’ve never heard of wear on the sacrum joints as I thought they are already fused. I will do my homework and be calling you soon!

Donald Corenman, MD, DC
Moderator

December 12, 2011 at 11:05 am

Post count: 8660

#5215

The sacroiliac joints have 1-2 degrees of motion when young and get much stiffer when we age. They still have some minimal degree of motion even in the elderly. A long fusion can cause some pain in these joints. Treatment normally is injection therapy and it is extermely rare to consider surgery of these joints.

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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