weakness in levels above TLIF

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MASpinept
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July 22, 2021 at 6:11 am

Post count: 17

#34203

This was the description of the fusion as of this months, about 3 weeks shy of the 1 year mark.

Intact L5-S1 fixation construct in place with bilateral pedicle screws, vertical rods, and interbody device. No significant periprosthetic lucency to indicate component loosening.
At the left L5-S1 facet joint, there is bony bridging that appears to be progressing towards osseous union. No joint gas to suggest excess motion. No posterolateral osseous union on the right.
At the L5-S1 disc space on the right, there is bony spicule formation that may span the entire height of the disc space. There also appears to be developing bony bridging at the site of the interbody device, although hardware related artifact precludes accurate assessment. No intervertebral disc gas to suggest excess motion.
Vertebral body heights are preserved.

Symptoms: back pain and leg pain, right worse than left.

Back Pain-central, the return of a sharp “catching” feeling has come back when exercising. The pain is more intense with position changes, it aches after standing upright for longer than 45 minutes. Squatting and leaning very forward when sitting takes pressure off. Turning over in bed creates pain in my spine. Many of these issues got better at about the 4-6 month mark post fusion.

Leg pain/weakness. Right side has always been worse. The L5 S1 i’m sure has chronic damage but many of the intense nerve pain/nerve sensations in that dermatome had improved until about 1-2 months ago when i really increased my exercise/activity. I do now have pain and weakness in other areas of my right leg and i have an emg to look further into that in 1 month. Prior to surgery i had some neurogenic claudication in both legs, again this improved after recovering from the tlif but has returned. Also, when i stand up straight and still my right leg, under my knee all the way to my toes on the right side, goes numb and tingly, it happens often when sitting up right as well.

Many of these symptoms blend together when i compound activities (i.e cycling, running, swimming, strength training). At this point i’m trying to continue my current level of activity but its getting harder and harder, it seems like my back is just declining again and i’m paying for my activities with pain more and more.

Thank you

MASpinept
Participant

July 27, 2021 at 11:48 am

Post count: 17

#34219

Would it be better to wait until the results of the EMG start the long distance consult with you? Also, if you have a chance would you share any thoughts on the CT i posted? I’m eager to hear your thoughts. The neurologist involved in my care says he is unsure of the fusion status based on that report and i’m having a very hard time getting any response from the neurosurgery team on their interpretation. I appreciate your time!

MASpinept
Participant

August 12, 2021 at 9:04 am

Post count: 17

#34277

Sorry to bug you but wondering if you have any thoughts on the CT report regarding fusion status from the last post?

Donald Corenman, MD, DC
Moderator

August 14, 2021 at 9:57 am

Post count: 8660

#34281

It appears that the fusion is “attempting” to heal but is not fully fused yet. It might be helpful to have flexion/extension X-rays performed to compare motion of L5-S1.

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.

MASpinept
Participant

August 16, 2021 at 2:58 pm

Post count: 17

#34291

In your experience is it likely that fusion growth continues beyond 12 months? My neurologist performed the EMG today, he said there is not continued acute compression but there is some chronic nerve damage to L5 S1. He feels that i have continued spinal instability and that my sx are related to irritation caused by this instability. He said his interpretation of the fusion is that there is “some bone growth there but not enough.”

There are conflicting opinions on my exercise/activity amount-neurologist says stop doing everything for the next couple of months to see if that will help the fusion growth (although he admits this may not make much of a difference), neurosurgery says no restrictions as there should be a stable joint.

I don’t have the follow up with neurosurgery until the end of October- roughly 14-15 months post TLIF-is it reasonable to expect a decision on if a revision surgery is needed?

Donald Corenman, MD, DC
Moderator

August 20, 2021 at 1:59 pm

Post count: 8660

#34299

Delayed fusion to a lumbar segment can occur but the chances get smaller, the longer you are away from the surgical date. 1 year is generally as long as it should take but there are rare times I’ve seen them fuse at 1 1/2 years.

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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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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