Reply To: Re: Stand alone ALIF on a male

Member

February 9, 2015 at 2:20 pm

Post count: 30

#12167

Yes, you are right once again. The surgeon that wants to do the PLIF is a neuroseurgeon. Is TLIF more on an ortherpedic specialty ?

After doing so much research your argument for TLIF is the most plausible for me. It would appear that some of the other “minimally invasive” surgeries like ALIF would lead to a revision surgery down the road to remove parts fracture. Also you mentioned previusly that ALIF was more for grad 3-4 spondy. MY spondy has not change at all in 4 years. As a matter of fact the grade one slip has always been there, but I guess no moblie.

Questions:

1.) Why do you insist that the Pars defect be removed when there are so many surgeons that say leave it alone if you do not have leg pain. I understand that bone spurs need to removed, but if it is not causing leg pain then why do you believe it is mandatory to take pars out ? for bone graft purposes ?

2.) Also another concern is the size of the cage being put in to the disc space, you have said previously that the TLIF is a large enough cage to support the spinal column but many “neurosurgeons” emphatically disagree with this. They say the smaller TLIF cage will not give enough support up front, which will lead to weakness and instabilty. (doesn’t cover enough area)

3.) When you put in cage for TLIF how much of the disc space do you remove and do your add BNP or other graft to the surrounding cage to help bone grow together ?

4.) You said above “TLIF is the best procedure for an isthmic spondylolisthesis as the surgery addresses the spurs that originate off of the fractured pars, fuses the disc and transverse processes (ala of the sacrum) and addresses both nerve roots (decompression) with retraction of only one root on one side.”
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What do you mean it decompresses both nerve roots ? You mean when you remove the pars defect it will decompress whatever nerve roots they are pressing on ?

5.) The surgeon who does the PLIF is probably a neurosurgeon as this speciality tends to like the PLIF. If he or she is good and comfortable with this procedure, this is probably the best acceptable alternative.

Do you feel this way because the other neuro wanted to do 360 first even though he does TLIF as well. I believe he can perform surgery. He did posterolateral fusion 5 years ago (never removed disc? for a friend with spondylolithesis from pars fracture and he is doing great. He also did surgery 10 years ago on another friend with DDD spondy, again never put in cage, just screws and rods (posterolateral fusion) and he is also golfing, traveling with little to no pain.

It doesnt sound like any one was using cages 5-10 years ago ?

So I am assuming he can do a TLIF for me with a similar result.

You seem to be have the the best intuition when it comes to this. I really want to stay away from PLIF.

Will PLIF clead out entire disc space and provides as much bone graft as TLIF. Does PLIF also cram some bonegraft in the disc space next to the cages ?

Sorry, I know I a rambling, but I am getting close to scheduling this. I have some decent surgeons around, no one like yourself. but I think that can give a good result. I really only have on shot at this. I would to like ski and skate again. Do you think this is possible ?

Do you know of anyone at the Cleveland clinic or Pittsburg/Buffalo area that specilaized in TLIF ?

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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