Reply To: Re: Back Surgery Candidate/Heart History

Member

May 20, 2014 at 1:42 am

Post count: 3

#10875

Thanks for clarifying that Dr. Corenman. Now with that, may I present you the findings of an CAT scan and MRI to get your comments?

In November 2012– an XRAY of the lumbar spine showed 5mm grade 1 spondolythesis at l5 on s1. There are small osteophytes noted at t12-l1 and l1-l2.

In December 2012, an MRI of the Lumbar showed the following:

L3-L4, L2-L3, L1-L2- no significant disc protrusion or formanial stenosis.

L4-L5- There is moderate facet arthritis seen. Mild to moderate bilateral neural foraminal narrowing is seen due to disc bulge, facet disease and ligamentum flavum thickening.

L5-S1- Moderate to severe facet arthritis seen. Broad based disc bulge effaces the ventral aspect of the thecal sac. Disc dissecation is seen. Mild bilateral neural foraminal narrowing is seen to due to disc bulge, facet disease and ligamentum flavum thickening.

Impression: Spondolytic changes of the lumbar spine at l4-L5 where is disc bulge formation and acting in concert with facet disease and ligamentum flavum thickening to lead to mild-moderate neural foraminal narrowing at L4-L5.
2. There is subtle anterolisthesis of L5-S1 due to facet arthropathy.
3. No acute lumbar compression fracture deformity, or abnormal fluid collection or mass collection with the lumbar spine canal is appreciated.

In May 2013, I had at CT scan of the lumbar:

L1-L2, L2-L3, and L3-L4- mild hypertrophic facets and ligamentum flavum. Possible minor disc bulge. No significant spinal stenosis.

L4-L5- Disc bulge and mild hypertrophic facets and ligamentum flavum. These produce bilateral moderate foraminal stenosis. Central canal is borderline in size.

L5-S1- Promninent disko-osteophytic bulge and extensive bilateral vacuum facet arthopathy. These produce mild central and severe bilateral formainal stenosis, worse on the right.

Impression: Lumbosacral degenerative disc disease and worse in the lower lumbar spine.

2. Disc bulge and hypertrophic arthropathy at l4-l5 and l5-s1.
Resultant moderate bilateral formaninal stenosis at l4-l5, and mild central and severe bilateral foraminal stenosis at l5-s1.

In October of 2013, I had an MRI. I thought I would be having surgery in a few weeks, and this was done for an update:

l1-l2, l2-l3, l3-l4- Minor disc bulge. Hypertrophic facets and ligamentum flavum. No significant spinal stenosis.

l4-l5- Disc bulge with a mild left foraminal disc protrusion. Borderline right and mild left foraminal stenosis.

l5-s1- Substantial hypertophic facets. MInor disc bulge. These produce bilateral moderate foraminal stenosis, worse on the right.

Impressions:

1. Lumbosacral degenerative disc disease.
2. Disc bulge with a mild left foraminal disc protrusion at l4-l5. Mild left foraminal stenosis.
3. Hypertrophic arthropathy and a minimal disc bulge at l5-s1. Bilateral moderate foraminal stenosis.

I had an EMG done in January 2013 which showed acute denervation in left mid lumbar roots and acute left lumbar radiculopathy mainly l4-l5.

I have had 2 spinal injections which did not give me any relief. But just a few months ago, I had a nerve root block at s1. This has calmed down the nerve significantly. Whereas pain was a 7-8. It has lowered it to 4-5. Have to be thankful for such improvements. But I still experience plenty of pain and weakness.

Now in analyzing the spinal changes, what I see are the mention of a disc bulge higher up and mild stenosis at l4-l5, which is not seen in the MRI in December 2012.

Given these findings, what procedure would be best to correct these issues? I am very concerned that one back surgery would or could lead to another down the road. It has been suggested by 2 surgeons that I have fusion. One suggested ALIF and one suggested PLIF. What I have heard regarding fusion is that although it stabilizes that area, it causes the other levels to break down in years to come requiring another surgery.

If I would have fusion, I’m not sure if I’m correct in my feeling that ALIF is better because it does not disturb the back muscles which has been suggested to help in preventing destabilazation of the spine at other levels in the future. I have heard it’s an easier recovery than PLIF. Although, the advantage to PLIF is that the nerve roots are easier to see and correct. But I have been assured the same is possible with ALIF. One downside to ALIF, is that it works better only on one level not more. That later results show stenosis at l4-l5, is ALIF an option? I look forward to hearing your thoughts.

What has been so remarkable to me Doctor Corenman, is that I never had any back issues prior to this. I was involved in 3 car crash in April 2012, resulting in us being rear ended. Besides for stiffness and a back sprain, I made nothing much of it until 3 months later, while dealing more achiness and stiffness than I ever experienced, it became difficult and painful to walk. Not long after I had to get a cane. And within a few months I was unable to walk more than a block without a wheelchair. I do get around and usually after an active day, I am in excruciating pain at night. I take some pain medication and sometimes wake up feeling better in the morning, and sometimes the pain lingers.

If this needs to be fixed surgically, what can give me the best possible outcome to be thriving and active as I am only 45?

Thank you so much for your time and direction.

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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