When is it time for surgery?

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Jellyhall
Participant

October 13, 2012 at 10:11 pm

Post count: 90

#7163

Dr Corenman,
Thank you so much for the generosity of your time and skills. It is so helpful to have an expert open to our questions and willing to give answers and your opinion.

I wanted to let you know that I have scheduled a 2 level ACDF for November 5th. On Wednesday next week, I am having an MRI scan done so that my surgeon has up to date information. I will let you know how I get on!

Donald Corenman, MD, DC
Moderator

October 14, 2012 at 4:03 am

Post count: 8660

#7165

I think it is important to let us know how you do. It is important for readers to know that these surgical procedures are not as intimidating or problematic as they have been thought to be 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.

hohman1118
Participant

October 16, 2012 at 12:04 pm

Post count: 8

#7170

That is really reassuring Dr. C. thank you!!!

Jellyhall
Participant

November 12, 2012 at 10:54 pm

Post count: 90

#7384

Well, I had my 2 level ACDF surgery on 5th November.
I am home again and doing well. I do have a hoarse voice and sore throat, especially when swallowing. I am struggling to swallow and sometimes choke on things, so am eating soft foods and taking very small mouthfuls. Strangely water is very difficult to swallow and causes me to make some very strange ‘croaking’ type of noises. When I got home from hospital, a speech therapist phoned and gave me some tips to help. She feels that my problems are due to swelling rather than nerve damage.

Any idea, Dr Corenman how long these swallowing issues will last? I did have a lot of swelling of my neck after the surgery that has gone down somewhat.

Mostly, I am doing very well. My surgeon said that things were very tight in there and it needed to get the pressure off the cord and nerve roots. I am on high doses of Gabapentin at the moment so can’t be sure how much help I will get, but things seem better. I have had some more of the stiffening spasms as I get up out of bed or a chair though, but not the back arching spasms in bed. Time will tell. At least if I am left with my symptoms, I didn’t wait any longer for them to get even worse.

Thanks so much for your help and advice Dr Corenman, as I told you, your opinion finally made me decide to go ahead with this surgery. You are very generous with your time.

Donald Corenman, MD, DC
Moderator

November 13, 2012 at 6:41 pm

Post count: 8660

#7397

Swallowing difficulties after an ACDF are not uncommon. Thin liquids like water are difficult to swallow in some patients initially. You will find that more viscous liquids like kefir or yoghurt are much more easily swallowed. Milk shakes and smoothies are welcomed by recent surgical patients. In more significant cases, oral steroids can be helpful to reduce swallowing difficulties.

Hoarseness is more concerning. Did you have a right or left sided approach to your ACDF? There is a small filamentous nerve called the recurrent laryngeal nerve that can be stretched especially during a right sided approach. This may take some months to recover function.

I m unclear as to why you are on high doses of Gabapentin after surgery. Were you on high doses prior to surgery?

Please keep the forum informed regarding your recovery.

Thanks

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.

Jellyhall
Participant

November 13, 2012 at 10:39 pm

Post count: 90

#7399

I had a right sided approach for my ACDF. My swallowing of food, (and especially smoothies and ice cream!) is definately getting easier but liquids can still be a challenge. I try to hold my breath, take a sip of water and swallow, and then breath out. This does seem to stop anything going down my trachea. I do still make these strange noises like a croaking frog though! I hope I am not left with that!

There is definately more swelling on the right side of my neck. My drain did fall out before it should, so I wonder if I have some blood there. I imagine it will all be absorbed by my body with time. I think that my voice is improving a little bit today, so hopefully it is all just temporary.

I am not sure why I am on the Gabapentin. I was taking Nortriptyline for nerve pain before my surgery. Then when I woke up, they stopped that and put me on Gabapentin instead.

I did tell the anaesthetist and surgeon just before my surgery, about some spastic stiffening spasms that I would regularly get. Sometimes they were so strong that they would cause my back and neck to arch up off the bed. I was very concerned that if this happened after surgery, it would harm the surgery, and that it would be very painful. I would get them every day. Perhaps this is why I was put on it.
Do you think that could be why?

Also, as I woke up from surgery I was tossing around in pain. When the anaesthetist asked me where my pain was, it was in my lumbar spine (I have problems there too and have had a lumbar fusion.) They adjusted the bed to raise my legs and that felt much better. I think I had been lying flat, which is always uncomfortable for me, for just too long during the surgery. Perhaps they thought the Gabapentin would help that.
What do you think?

After the surgery, for the first few days, I didn’t have any spasms at all, but the last couple of days, I have had the leg stiffening when I get up out of bed or up out of a chair. I haven’t had any of them while in bed though, so I am hopeful there will be some improvement.

I am feeling very good, and have been for a short walk outside holding on to my husband today.
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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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