[Donald Corenman, MD, DC]

#12053

Pars fractures with a slip (isthmic spondylolisthesis) will not heal in any circumstances so a bone stimulator will not be effective.

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.

[john123]

#12119

I believe I mentioned in an older post to you that I also have a partial labral tear in my left shoulder. I assume I will have to do a great deal of rehab after TLIF surgery because I have been wearing back brace for a long time, i.e. planks, push ups, etc.

If I came to the Steadman clinic would it be possible to have shoulder surgery and back surgery during the same visit ? I would like to get them both over with if possible.

Also, how long before you let you patients fly back home after fusion surgery? Is it Ok to travel after fusion surgery in a car/flight?

Thank you always for your guidance.

John

[john123]

#12120

Also, I know it is a long shot, but do you think that a series of facet injections would help any ? Most of my pain is under control with brace on; I just can’t walk very far at all with the brace off as it becomes very painful and I have to sit down.

I spoke to a pain management Dr. that said I had a small chance of getting back to normal with a series of facet injections at L4,L5 and L5,S1 even with the grade one spondylolisthesis.

Please let me know you thoughts.

[Donald Corenman, MD, DC]

#12123

There is no penalty that would occur if you undergo facet injections. It is highly unlikely these injections will work as the facets are “disconnected” from the vertebra due to the pars fractures. Nonetheless, if you want to try them, there is very little down side (other than the cost and the highly unlikely possibility of infection).

I would not want you to have both surgeries at the same time. The anesthesia time and amount of different rehab procedures necessary post-operatively would be too much to accomplish.

After fusion surgery of the lumbar spine, you are generally in the hospital for 2-3 days and I would want you to stay in the Vail Valley for another 3-4 days before you fly home.

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.

[john123]

#12151

Thank you.

I met with my Neurosurgeon again this past week to discuss TLIF instead of 360.

He does feel very adamant that 360 is better to stabilize the spinal column because, as mentioned previously, cage is bigger and he can get better access to disc space. He did however mention, as did you, that pars fracture should be removed and he will use pars bone for posterolateral fusion. He seems to have everything covered; I can’t thank you enough for your guidance.

He believes retracting one nerve root with TLIF and not being able to access disc space well enough will not give me “as good” of a result, but would probably be good enough. I do respect this surgeon. He has the best reputation in my area and has consistently had very good results for over 30 years. I personally have two friends that he did posterior fusions for that are doing very well 10 years later. He has agreed to do either TLIF or 360 when I am ready.

Having said that, 360 fusion will put 8 screws in my L5,S1 and two rods (4 screws through stand alone alif cage and 4 more more posterior with two rods). I know of many surgeons that are using the same technique but it would seem like the two incisions and hardware alone could become a pain generator after all the other pain generators have been removed.

questions

1.) Could screws from stand alone alif device create pain from the front once the bone grows around them ?

2.) Does 8 screws and two rods sound excessive to you for 360 or does it not matter once fusion takes place ?

3.) I have another surgeon that wants to do 360 without built in screws. He will not remove pars fracture and wants to put perc screws in to back me up without gutter fusion ? Any idea why anyone would do this ? Is it suppose to be less invasive ?

4.) I have a grade one spondy with no change after onset of symptoms 4 years ago. How important is O arm for TLIF ?

I believe you have good results because you are precise with your screw placement. I do not believe other surgeons have the same technology. Would you agree ?

In short, my thought pattern is the same as yours. Why would I want to have two incisions with 4 additional screws, and assume the risk of cutting through abdomen in order to put a larger cage in through the front.

I assume that 360 could be favored by a surgeon because there is no nerve root retraction.

Thank you

[Donald Corenman, MD, DC]

#12154

If he is adamant that his 360 is better than a TLIF, you should not argue too hard as he is uncomfortable doing a TLIF for this disorder.

Once the front cage is solidly fused, the front screws will not cause you any grief (as long as the cage remains in the intended spot).

The amount of hardware should not matter once a solid fusion takes place.

The other surgeon uses a technique that utilizes “minimally invasive” procedures. I can assure you that this is not the place for that technique. You need to address the pars fractures and the extra bone derived from this will go a long ways to help with fusion.

In my opinion, O arm is essential for screw placement. Before O Arm, I was very good at placing pedicle screws (98% placement accuracy). Now my accuracy is 100%.

There are about 500 O Arms in the USA now so they are not so rare.

I do not understand the reluctance of neurosurgeons to retract nerve roots. This is performed every day when they do microdiscectomies and lateral recess decompressions (which I assume they do every day). I have been performing TLIFs for about 10 years now and there are no increased problems vs. other fusions I have performed in the past.

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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