Tri-tanium TLIF cage vs Boomerang

Tagged: TLIF cages

Viewing 6 posts - 1 through 6 (of 8 total)

1 2 Next

Author

Posts
Renee123
Participant

March 8, 2016 at 10:14 pm

Post count: 130

#21504

I spoke to yet another surgeon today that says he is moving away from boomerang style cage for TLIF because there are no holes in it which help integrate fusion on the sides of the cage.

He said he now uses a new tritanium cage (light titanium) that is not shaped as a boomerang, but has holes on the sides to help with fusion. Surgeon did say that he just started using this cage and does use BMP in front of spine, which he believes will be shielded from the spinal canal with this new cage?

This surgeon also said he very rarely see bones spurs under pars once the pars fracture is removed ?

1.) Have you heard of this new tri-tanium cage and is it safe to use with BMP in the front ?

2.) What dose of BMP do you use in front and on the sides ?

2.) Are there always bone spurs underneath pars fracture ?

Thank you

Donald Corenman, MD, DC
Moderator

March 9, 2016 at 9:16 pm

Post count: 8660

#21508

This cage is a more porous metal cage that does have more and larger holes in the side of the cage. Any cage is really just a spacer to hold the two vertebral endplates apart when the fusion occurs. I personally don’t like metal cages as these are not radiolucent (you can see through them with an X-ray). This makes it harder to see with a standard X-ray if the fusion is taking place. Nonetheless, there is nothing wrong with these types of cages.

If the BMP is in the cage, it is my opinion that the cage does not shield the nerve from BMP.

The dose of BMP ranges from 1.5 mg to 2 mg depending upon the size of the disc space. I use the rest on the sides of the vertebral body where the facets are located (normally 2.5 mg).

If there is an isthmic spondylolisthesis present (pars fractures with slip), there is almost always pedicle spurs that are near or compressing 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.

Renee123
Participant

March 10, 2016 at 11:38 am

Post count: 130

#21515

Thank you and sorry to drill down to such detail. I find this interesting. I guess there would seem to be some advantage with fusion if bone can grow out of the sides as well at top and bottom ?

The surgeon does not put BMP in the cage, rather he puts BMP in front of the disc space the same way you do and then packs bone in front of the cage.

Question: Will this tri-tanium cage (even though it is not boomerang shape) still shield the BMP from traveling to the spinal cord ? It would seem like the boomerang shape would do a better job of shielding the BMP.

Will the holes in cage provide benefit to fusion process on the sides ?

Have you every seen one on of these cages I am referring to? I believe it is made by stryker and just came on to the market.

Please let me know your thoughts. the surgeon will use either cage.

Renee123
Participant

March 10, 2016 at 1:31 pm

Post count: 130

#21517

P.S. – new cage is made out of light titanium and from what I understand is more of a rectangular shape…

Donald Corenman, MD, DC
Moderator

March 11, 2016 at 5:55 am

Post count: 8660

#21521

If the BMP is placed in the front of the disc space and the cage has no BMP in it, there is a better chance that the cage can shield the nerve from the BMP. You are correct in that a rectangular cage is typically placed obliquely into the disc space so that it doesn’t work as well as the boomerang to shield the BMP from the canal. The “side holes” in the cage might create more surface area to help fusion but I would not bet on that as I have a 98-99% fusion rate with the current boomerang cage.

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.

Renee123
Participant

March 11, 2016 at 4:18 pm

Post count: 130

#21526

Tritanium PL posterior lumbar cage – this is the name of it, was just released march 4. Apparently, the cage is manufactured with a 3D printer. Larger lateral windows on the side to monitor fusion process.

My question is, how can you tell if bone is fusing through windows on the side of the cage ?

I will probably just ask for the boomerang cage, seeems to make more sense with your method in shielding the BMP.
Author

Posts

Viewing 6 posts - 1 through 6 (of 8 total)

1 2 Next

You must be logged in to reply to this topic.

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel