spondylolisthesis

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Deepcove22
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December 13, 2012 at 6:09 am

Post count: 14

#7591

Hello Dr. Corenman,

I had my CT scan and the results match the flexion/extension xray..ie lots of movement. What else should I ask about in regards to my CT?
Also, I had a week long episode of perineal numbness and urinary incontinence that was relieved by traction from my physiotherapist. I thought this was an urgent symptom, however, I will not get in to see the surgeon until January. Am I at risk of serious sequela? Is it likely to happen again? I have also developed weakness in my left foot and am limping. I cannot brake while driving with my right foot and must use my left foot. The back and leg pain is severe, unrelenting. A few times I have felt icy cold sensation creeping into my thighs.

I am trying to get strong for surgery by doing core work….small movements really, just engaging the muscles. And short walks.
Any advice or comments please, would be very appreciated. Thank you so much.

Donald Corenman, MD, DC
Moderator

December 14, 2012 at 7:39 pm

Post count: 8660

#7599

It appears that you will need a surgical consult sooner than later. Perineal numbness and incontinence can go along with cauda equina syndrome. Motor weakness of the foot muscles should also get the attention of an astute physician. It is my understanding that if you present in Canada to an emergency room with the symptoms you have discussed, this will move you “up to the front of the line” for an appropriate surgical consult.

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.

Deepcove22
Member

December 14, 2012 at 9:26 pm

Post count: 14

#7603

Thank you for your reply. I spoke with my neurologist yesterday who recommended I go to our ER dept if the symptomsmof cauda equina return. He told me more about the CT scan results. Apparently, while the slippage is clearly evident, the Ct did not show any spinal stenosis or compression of the spinal cord.

I have a question about position during the scan. Since lying completely flat on my back right now is quite painful, I asked the technician if I could put a large bolster under my legs. This raised them to about 80 degrees and the pain dropped.

Would this be a different scan if I had been flat?
Compounding the diagnosis for the incontinence/perineal numbness/foot weakness is that I have had MS for 10 years. Stable, no symptoms at present and have never had bladder issues.
And, from my own expertise, MS bladder incontinence does not resolve with traction…as mine did!
Thank you again for your thought and your time. I am quite overwhelmed with the thought of having this pain for a other few months and worry about residual deficits.

Donald Corenman, MD, DC
Moderator

December 15, 2012 at 1:02 am

Post count: 8660

#7604

It is good news that you do not have cauda equina syndrome. If you have MS with some sub-clinical involvement of the bladder neurological mechanism and then increased pain from your spondylo- this can cause bladder malfunction that can mimic cauda equina syndrome.

I think the weakness in your ankle (foot drop) should be enough to get the attention of the ER doctor, especially if it is newer onset weakness.

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.

Deepcove22
Member

January 17, 2013 at 5:21 am

Post count: 14

#7752

Hello again, Dr. Corenman,

I had a consult with a neurosurgeon today. Apparently, although the flexion-extension x-ray showed 12mm movement, the CT scan indicated the fusion is intact and there was 6mm movement. I had my legs elevated for the CT scan (comfort position)and am not sure if this “flattened” out my spine, changing the images.

Next, I am having a contrast MRI. The surgeon thinks there is nerve involvement and does not think this has anything to do with my MS (neither do I). The pain, numbness and weakness are affected by movement and bedrest settles things down somewhat. The L5-S1 area is very warm (to my physiotherapist also)and I wear an ice belt for some pain relief.

My question to you is what could be the cause of the pain if my disk is fine and the fusion appears to be stable on CT? I am still on large amounts of narcotics for pain, it keeps me awake and I am slowly becoming despondent!
Thank you again for your time. I very much appreciate your forum and hope the questions/answers can assist others who read them.

Donald Corenman, MD, DC
Moderator

January 17, 2013 at 10:58 am

Post count: 8660

#7758

I am confused. If you had a solid fusion of L5-S1, there would be no movement on flexion/extension films. Also, if there was no motion of the fusion site and the other levels were relatively normal, motion should not cause increased pain in your back or your leg.

It is possible that you have chronic radiculopathy (see website) but I would be suspicious of a pseudoarthrosis of the L5-S1 level with motion and intermittent compression of the nerve root.

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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