Donald Corenman MD DC | Spine Surgeon Colorado

Participant

February 27, 2024 at 5:11 pm

Post count: 79

#36168

Hi Doctor. I had the procedure today. Feeling pretty good for day 1. I don’t have any questions today but you asked to keep you posted, so here is the post-op report! Thank you so much for always being so generous with your analysis and guidance.

OPERATIVE REPORT

PREOPERATIVE DIAGNOSES:
1. LEFT L5-S1 HERNIATED NUCLEUS PULPOSUS.
2. BILATERAL L5-S1 LATERAL RECESS STENOSIS.
3. BILATERAL L5-S1 LUMBAR RADICULOPATHY.

POSTOPERATIVE DIAGNOSES:
1. LEFT L5-S1 HERNIATED NUCLEUS PULPOSUS.
2. BILATERAL L5-S1 LATERAL RECESS STENOSIS.
3. BILATERAL L5-S1 LUMBAR RADICULOPATHY.

OPERATIONS:
1. LEFT L5-S1 LAMINOTOMY AND DISKECTOMY.
2. RIGHT L5-S1 HEMILAMINECTOMY WITH PARTIAL MEDIAL FACETECTOMY.
3. USE OF INTRAOPERATIVE MICROSCOPE AND MICROSURGICAL
TECHNIQUES.
4. INTERPRETATION OF INTRAOPERATIVE FLUOROSCOPY.

ANESTHESIA: General

TYPE OF ANESTHESIA: GENERAL ENDOTRACHEAL ANESTHESIA.

ESTIMATED BLOOD LOSS: MINIMAL.

HARDWARE: NONE.

DRAINS: NONE.

CONDITION: stable

FINDINGS: LEFT L5-S1 HERNIATED NUCLEUS PULPOSUS (PROTRUSION WITH IMPENDING EXTRUSION), BILATERAL LATERAL RECESS STENOSIS.

PROCEDURE IN DETAIL:

The patient was transported from the preoperative holding area to the operating suite where general anesthesia was administered by Department of Anesthesia. Sequential compression devices were placed on the bilateral calves for DVT prophylaxis. Perioperative intravenous antibiotics were administered.

POSITIONING: The patient was positioned prone on the Jackson table utilizing the Wilson frame with care to position the cervical spine in appropriate position and the axilla free of compression. All bony prominences were well padded as well as the ulnar nerves of the elbows.

PREPPING AND DRAPING: The patient was prepped and draped in the usual sterile fashion and manner utilizing ChloraPrep solution and Ioban draping.

INCISION AND EXPOSURE: Following surgical time-out, radiographic localization in both AP and lateral planes utilizing fluoroscopy (interpreted intraoperatively by the surgeon), a 22-mm incision was made longitudinally in the midline over the L5-S1 interspace just to the left of midline. A left paracentral fascial incision was performed to the left of the L5 spinous process with electrocautery. Sequential tube dilation was the Medtronic METRx system until a 4 cm x 18 mm tube was docked on the left side on the L5 hemilamina. A marker was placed underneath the lamina and a cross-table fluoroscopic radiograph was taken confirming the appropriate level. This was interpreted intraoperatively by the surgeon. At this time, the operating microscope was brought in to the sterile field and microsurgical techniques were utilized for the remainder of the case.

LAMINOTOMY: A laminotomy was performed utilizing the motorized high-speed bur and completed with Kerrison rongeurs. The ligamentum flavum was resected at the L5-S1 interspace on the left side. At this time, the S1 nerve root was identified along with the thecal sac.

LEFT L5-S1 DISKECTOMY: The S1 nerve root and thecal sac were gently mobilized and protected with a nerve root retractor. A disc protrusion was identified underneath the medial aspect of the traversing S1 nerve root and the thecal sac. At the apex of the protrusion it appeared that and extrusion was imminent. A small transverse annulotomy was performed with a #15 blade scalpel. Gentle pressure was applied to either side of the annulotomy with the #8 suction and small straight ball-tipped probe and the disc herniation readily extruded through the annulotomy. The disc base was explored with a small ball-tipped probe as well as the micro pituitary rongeur and additional fragments were removed. A maximal amount of healthy disk material was maintained. The disk space itself was irrigated with antibiotic irrigation and any free and loose fragments were also removed. At the termination of the decompression, a long ball-tipped probe was utilized to palpate the ventral aspect of the thecal sac, the exiting L5 nerve root and traversing S1 nerve root. The traversing nerve root was noted to be gliding freely. Hemostasis was confirmed.

RIGHT L5-S1 HEMILAMINECTOMY WITH PARTIAL MEDIAL FACETECTOMY: The retractor tube was removed and then attention was turned to the right side. A second separate fascial incision was made to the right of midline and sequential tube dilation was performed until a 4 cm x 18 mm tube was placed clearly visualizing the right-sided hemilamina. A crosstable fluoroscopic radiograph was taken confirming the appropriate level with a Woodson elevator underneath the lamina. The operative microscope was brought into the sterile field again. Soft tissue was denuded from the right L5 lamina. A motorized high-speed bur was utilized to perform hemilaminectomy and partial medial facetectomy. This was completed with 3 mm 4 mm Kerrison rongeurs. The cephalad aspect of S1 was also decompressed and removed utilizing Kerrison rongeurs. At the termination of decompression the traversing right S1 nerve root and thecal sac were noted to be free of further compression. Hemostasis was confirmed. Then, 1 mL of 80 mg Depo-Medrol was instilled into the spinal canal as an epidural injection.

CLOSURE: The METRx tube was removed. The fascia was closed with #0 Stratafix suture bilaterally on both sides of the spinous process. The subcutaneous tissue was closed with 2-0 Vicryl suture. The skin was closed with 4-0 Monocryl Stratafix suture. Marcaine 0.25% was injected. Dermabond and Steri Strips were applied. A sterile bio-occlusive dressing was applied.

At the termination of the procedure, we were informed that all needle, sponge, and instrument counts were correct. The patient was turned supine and extubated by the Department of Anesthesia. The patient was noted to be moving bilateral lower extremities grossly. The patient was transported to the Postanesthesia Care unit in satisfactory condition, having tolerated the procedure well without incident or complications.

WOUND CLASSIFICATION: CLEAN.

SPECIMENS: NONE.

COMPLICATIONS: NONE.

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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