SI Joint: Update and Question

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SpinelessWench
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October 20, 2012 at 1:23 am

Post count: 38

#7194

Dr. Corenman,

First, I want to thank you for your input and explanation regarding SI Joint Dysfunction, as well as your adamacy in exercising discretion when firming up or seeking definitive diagnoses. Just a quick update, and question..

Yesterday, 10/18, I had an amazingly productive and educational consult with a surgeon here in NC who’s certified / trained in the “iFuse SI Joint System.” He’s performed over 40 of these procedures (MIS vs traditional anterior invasive approach), with an 85-90% success rate in patient recovery and eradication of symptoms. One of his patients, a female about my age (48), is not fusing well, and her recovery isn’t progressing as expected… He indicated he’s still working adamantly to solve her issues..

At the clinic, he ordered standard films of just the SI joints… While SIJD is largely undetectable via MRI or X-rays, he indicated that both of my SI joints revealed deterioration and signs of “wearing out”… He conducted a ~thorough~ physical and neurological exam, and repeated the 5 provocative joint maneuvers. He reviewed every aspect of my medical and surgical history, and asked relevant and pertinent questions geared toward specifically diagnosing (or ruling out) this condition. He stated that while many patients arrive at his practice with what they suspect is SIJD, only about 25% are actually confirmed with a definitive, confident diagnosis. Upon completing his exam, he indicated with a “high degree of confidence” that my pain and symptoms are due to an advanced stage of SIJD. My prior 9 spine surgeries, which include 3 multi-level fusions, to S-1, are also highly correlated with my SI degeneration, which he said was fairly severe hypermobility dysfunction.

I am being scheduled for bilateral fusions via “iFuse”, and will be having the first one done in about two weeks. After 6-8 weeks of healing, I’ll then be scheduled for the right side fusion.

While a firm diagnosis was relieving beyond belief, he told me I could ride my Harley-Davidson about 3 months post-op IF I behave and follow all recovery protocol. One is to stop smoking immediately, as this impedes healthy bone fusion. He rides a Harley, so I nearly hugged him upon realizing he understood my concerns… I did, however, forget to ask him one important question:

While I’ll be able to ride my motorcycle again 3-months post-op, how long would you recommend waiting before driving a vehicle? In my excitement about the bike, I completely failed to remember that I also drive a truck. Your input would be greatly appreciated.

Thank you again, as always..

S.W., NC

Donald Corenman, MD, DC
Moderator

October 21, 2012 at 12:49 am

Post count: 8660

#7202

Well- I’m glad to hear you found someone you trust and has experience. Every surgeon’s protocols are different. Some require you to wear a temporary brace called a hip-spica. Others feel that just reduction of activity is enough. Part of the decision process is made during surgery. If the implants have solid purchase and the bone seems strong, there is less need to use bracing and less restrictions are necessary.

Let the forum know how your progress goes after surgery.

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.

SpinelessWench
Member

October 24, 2012 at 1:20 pm

Post count: 38

#7244

Dr. Corenman,

While at my iFuse surgical consult, my orthopedic surgeon ordered a few views of just the SI Joints themselves… He spoke with me about his impressions of the films during my clinical exam, and also included his impressions from the X-rays within his dictated clinical notes. There’s one small part of his impression that I was hoping you could explain. His notes read, in part:

“SI joint views show bilateral degenerative changes with sclerosis, evidence of joint space incongruity, and some early suggestion of gas formation / intra-articular nitrogen.” His diagnosis and assessment reads, “Severe bilateral sacroiliac joint disruption, probably secondary to effects of previous lumbar fusion surgery … Essentially every sacroiliac joint evaluation is severely positive for reproduction of typical concordant pain, including Gaenslen’s, posterior thigh thrust, Patrick’s testing, and compression testing.”

QUESTION: I understand everything within this assessment except for the remark concerning “early gas formation and intra-articular nitrogen” … I’m assuming from the language, there is gas accumulation within the joint spaces, but can you explain why this is remarkable, and what it means or suggests? The left SI fusion is Nov. 3, followed by the right in February…

Much appreciated, as always..

S.W., NC

Donald Corenman, MD, DC
Moderator

October 24, 2012 at 6:31 pm

Post count: 8660

#7246

Joints are typically filled with synovial fluid and are distensible. This means that no matter what the position of the joint, there is always synovial fluid that fills the entire joint. When the joint (or disc space for that matter) wears out, there will be certain positions that increase the joint space that the synovial fluid cannot fill. This will create a vacuum and something has to fill that vacuum.

What fills the vacuum is nitrogen gas. This gas is pulled out of solution similarly to opening up a can of soda and watching the gas bubbles form out of the liquid.

Good luck with the surgery. Please report your progress to allow forum members to see your progress.

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.

SpinelessWench
Member

October 24, 2012 at 9:02 pm

Post count: 38

#7248

Dr. Corenman,

Thank you for the quick reply and answer to my question. The neurosurgeon who “caught” this by carefully listening and following his instincts will be traveling 3 hours to observe my iFuse procedure in the operating room. He’s an excellent example of a clinician and surgeon who constantly seeks to learn new techniques, and further expand his ability to care for his patients. I admire him.

I’ll post a post-operative update on the left SI joint fusion… Now if I can only figure out how to install some chrome and a V-Twin engine on my walker.

Continued success to you in the meantime.

S.W., NC
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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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