thomas Italy - L4-L5,L5-S1, D12-L1, C4-C5-C6-C7 ernias and spondilosis

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thomasvenice
Member

February 15, 2014 at 11:52 pm

Post count: 23

#10332

Hi dear Doctor, sorry for my english..
I look all your videos on youtube, and I try to ask help..

currently strong internal pains in the lumbar region , with burning and severe pain in any movement , pain in the feet and calves in all two legs ,pain in the left thigh and femoral side , both buttocks. severe pain in the scapular area middle back because d12L1 .
(in addition to the entire cervical )

Hello Doctor Thomas I’m resident near Venice Italy.
I 33 years and for almost 11 years, I have very great back pain to
2 protruded discs and operations without good results , post car accident, and more ernias cervical and d12-l1-

If I write is because I am desperate because I closed two companies and not work for at least 4 years.
I was operated on twice in the last year a total of 3 times with the laser and discectomy in Rome last November in applying a titanium coflex L4 L5 but negative outcomes .
I have two protrusions wide-ranging median paramedian left and right L4 L5 and L5 S1, a protrusion D12 L1, three protrusions C4 to C7 ( the neck for 2 years ) all of which affect the dural sac spondilodiscoartrosi with dehydration and particularly the L4 L5 disc .

Over the years I have spent the extra mile to get back to my work activities but I could not find a solution together doctors for my
problems .
The last alternative that many doctors offered me was to capture the L4 sacred stretch with fingers and remove most of the records, but not we are sure that the solution is.
There are claims that the pains are now chronically given the long time spent but I think there is a cure for me too ..
for neck the doctor say the same things: they don’t know..

The real problem is that nobody is in charge of my situation
always slipping interventions and making me really hurt because I’m desperate ..
because I can’t make another kind of job. ..
I’m only house that aspect ..

I hope I do not ask the impossible, but I’m really desperate because 11 years looks to be night to go to bed to wake up in the morning
hoping that nothing had happened ..

in which I invested all my savings , but it will declarefailure again..
thomas.

Donald Corenman, MD, DC
Moderator

February 17, 2014 at 3:20 am

Post count: 8660

#10336

Please differentiate your pain regarding lower back and buttocks/legs. Generally, buttocks/leg pain is nerve related and lower back pain is disc or facet related. Separate your pain in a global percentage ratio (60 back/40 legs, 80 legs/20 back, etc…). We will work only with your lower back and legs so not to confuse the issues here.

You report degenerative disc disease at L4-L5 and L5-S1 (“I have two protrusions wide-ranging median paramedic left and right L4 L5 and L5 S1”), Without a specific report (and I do not trust most radiologist reports to accurately determine the pathology), I cannot determine what is disc pain and what is nerve compression pain.

You have had three prior surgeries which includes a “laser surgery” and finally a Coflex implant. Unfortunately, none of these surgeries will relieve lower back pain and the Coflex device will actually increase lower back pain if the source of pain is a degenerative disc.

Let us assume that your pain is generated from the discs and not from some other structures. The only surgery that will relieve most of your pain is a fusion. You would need a workup (blinded discograms-see website) to determine if the discs were in fact the pain generators and if you did not have a pain processing problem.

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.

thomasvenice
Member

February 17, 2014 at 3:32 am

Post count: 23

#10338

Hi dear doctor.
I have pain on back for 50% and legs/foots for 50% (more in left).
I have send a email to your staff with the images of my magnetic resonances.
I hope you can look this images and understund my problems.
I do not trust of the italian doctors because they say to my many kind of surgery operation all different and all more dangerous..
Someone say to open my back other from belly..
Thanks so much.. huggs
Thomas

Donald Corenman, MD, DC
Moderator

February 17, 2014 at 11:42 am

Post count: 8660

#10350

With 50/50 pain in lower back and legs, you have a component of nerve compression along with your degenerative disc disease. I cannot comment upon how much relief you can expect from leg pain as there could be nerve damage from three prior surgeries.

Nerve damage, depending upon the findings on examination and imaging could be relieved at least somewhat with a decompression along with a fusion.

Emailing images can be difficult to interpret. I do prefer a CD disc to review the images.

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.

thomasvenice
Member

February 17, 2014 at 5:35 pm

Post count: 23

#10355

thanks again for your quick response.
means for merging the screws and rods or come back from the belly, remove the 2 drives and put the 2 disc prosthesis?
discs must be removed completely or you can put the screws back bars and leaving the discs?
approximate time to return to work? (I do not work for 4 years ..)
to be able to work by yourself, how does it work? in Italy you do not pay the cost of the intervention, in America how does it work?
thanks

Donald Corenman, MD, DC
Moderator

February 17, 2014 at 9:18 pm

Post count: 8660

#10356

You can approach this problem from the belly and then the back (called a 360 in the USA) but I do not prefer this approach, especially for a male (the chances of retrograde ejaculation and bowel problems).

If I am correct in assuming that your L4-S1 discs are the pain generators, you would need a TLIF (see website) of these levels. This surgery is performed all from the back of the spine where you already had your prior surgeries. This can also address any nerve compression that is present.

Return to work depends upon the job you have. Sedentary employment (a desk job) could lead you back to work in 2-4 weeks part time. Heavy labor would be at least three months.

In the USA, you have to have insurance to pay for this procedure or be over 65 years of age (medicare-a federal insurance program). Of course, the other option is self-payment.

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

Average rating:

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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thomas Italy – L4-L5,L5-S1, D12-L1, C4-C5-C6-C7 ernias and spondilosis