thoracic fusion

Tagged: thoracic kyphosis proximal junctional kyphosis

Viewing 4 posts - 1 through 4 (of 4 total)

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cindy2836
Participant

March 24, 2021 at 5:33 pm

Post count: 22

#33808

Dr. Corenman, I’m going to copy paste here my recent operative post. I thought you might like to see how it was performed here in Ohio.

PREOPERATIVE DIAGNOSES:
1. Thoracic pseudoarthrosis.
2. Hardware failure.
3. Back pain.
4. Kyphosis.

POSTOPERATIVE DIAGNOSES:
1. Thoracic pseudoarthrosis.
2. Hardware failure.
3. Back pain.
4. Kyphosis.

PROCEDURES PERFORMED:
1. Placement of bilateral pedicle screws with DePuy Expedium screws
from T4 to T8.
2. Posterolateral fusion from T4 to T11 with autograft and allograft.

INDICATIONS: The patient is a 67-year-old female who presents after a
T10 to S1 instrumentation and fusion at an outside institution. She
presented with increasing thoracic back pain. She was found to have
some loosening of her T10 screws indicating a T10-T11 pseudoarthrosis.
She did have some subtle kyphosis at that level. Given the
pseudoarthrosis, extension of her fusion with posterolateral fusion from
T4 to T11 is indicated.

DESCRIPTION OF PROCEDURE: The patient was intubated and placed under
general endotracheal anesthesia. She was positioned in the prone
position. All pressure points were appropriately padded. Fluoroscopy
was used to localize the incision. Skin was marked, then prepped and
draped in sterile fashion. Antibiotics were given prior to incision.
Midline incision was made with a #10 scalpel. Monopolar cautery was
used to expose the T4 to T9 lamina in subperiosteal fashion out to the
transverse processes. Dissection was carried up and over the T10 and T9
screws out to the transverse processes. The ends of the rods were
exposed and end-to-end connectors were attached. Attention was directed
to the T8 pedicles. High-speed drill was used to create a starting
point and gearshift was used to access the pedicle. Ball-tip feeler
ensures no cortical breaches. An undersized tap was used followed again
by the ball-tip feeler and placement of bilateral pedicle screws at T8.
DePuy Expedium screws were used. Pedicle screws were also placed
bilaterally from T7 to T4. AP and lateral fluoroscopy ensured adequate
placement of all instrumentation. Screws were all stimulated and found
to stimulate above threshold. Rods were then measured and cut and
placed in the end-to-end connector and the screw heads. Set screws were
placed at all levels. Torque, counter-torque was used to final tighten
all set screws and the end-to-end connector. At this point, the wound
was copiously irrigated with 3 L of sterile saline with vancomycin.
High-speed drill was used to decorticate the exposed transverse
processes as well as lamina from T4 to T9 and a large kit of BMP along
with 60 cc of cortical cancellous chips, and the autograft from the
decortication was placed in the posterolateral gutters and along the
lamina from T4 to oT9 to achieve posterolateral fusion with autograft
and allograft from T4 to T9. Two hubless channel drains were placed
prior to closure. Powder vancomycin was applied to the incision prior
to closure. Fascia closed with 0 Vicryl in interrupted fashion. Dermis
was closed with 2-0 Vicryl in interrupted fashion. Skin was closed with
staples. A Prevena incisional wound VAC was applied to the incision.
The patient tolerated the procedure well with no acute complications.
Estimated blood loss was 300 cc. Following the procedure, patient was
brought to postop anesthesia care unit in stable condition. All needle
and sponge counts were correct. I was present for the entire procedure.

Donald Corenman, MD, DC
Moderator

March 24, 2021 at 6:44 pm

Post count: 8660

#33809

A typical report for an extension of the thoracic fusion to T4. How did you do post-operatively?

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.

cindy2836
Participant

March 25, 2021 at 2:28 pm

Post count: 22

#33814

I am doing excellent! The radiating rib pain is gone. My only real soreness was my front side and I think the positioning table caused some deep bruising on my chest and back of my arm tops. I’m very glad I had the surgery!!

Donald Corenman, MD, DC
Moderator

March 25, 2021 at 3:45 pm

Post count: 8660

#33815

Excellent

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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