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Donald Corenman, MD, DC
Moderator

May 20, 2013 at 11:55 pm

Post count: 8660

#8720 In reply to: POTS |

Three years after injury with continuing disabling symptoms would mean you are a surgical candidate. A grade one isthmic spondylolisthesis with a disc herniation should be handled with a TLIF-a posterior surgery. This will stabilize the disorder and remove the disc herniation which will decompress the nerve roots.

I am generally not a fan of an anterior approach.

Generally, spinal fusion will temporarily aggravate orthostatic hypotension as the fluid shifts from surgery will cause some temporary swelling. You can have anesthesia “run you dry” during surgery which might help as some patients with heart failure need to be run.

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.

ahmedhelalm
Member

May 19, 2013 at 8:29 am

Post count: 3

#8707
Topic: Herniated discs , please advise in forum GENERAL |

My mother (47 years old) school teacher, with 3 kids

It initially started 1 year ago, with pain in her left leg, but then 6 months ago the symptoms that am describing now started happening and got very intense 2 weeks ago, pain is almost there 24/7, and it increases when she does activities like driving, or doing any physical effort, but driving a car is one of the things that increase the pain the most.

– She suffers from pain (that she describes as tearing, as if she feels a knife cutting through her) in the 2nd half region of her back, mostly concentrated in her Lower back (pain’s strongest point is the lumber area), also she feels the pain extends through the sides of her back not just the back bone/spinal cord area.

– That back pain extends to both right and left hips, she can feel the pain passing down to the center of both left and right hips.

– She feels also strong pain in her left leg starting from her back going through hips, leg, back part of the knee, down to the foot, till her feet and fingers down there.

– In her right leg she feels also pain but its quiet insignificant compared to what she feels in her left leg.

– She doesnt feel any pain when urinating, and she doesnt complain about any pain in her bladder
– She doesnt feel any pain in her knee, except that back part area of her left knee where she feels its the same pain extending from her hips down to her feet.
– She doesnt have any menstrual abnormalities/pain.

– Occasionaly when waking up from bed after sleep or after walking a lot, she feels that she isnt able to control both her legs, that they almost cant carry her body and she is about to fall

, feeling both legs almost numb.

– About once per week, it happens that her left leg makes an involuntarily move that she didnt mean to do, which disorients her and some times causes her to fall.

– Recently she started also feeling some pain in her left shoulder, and numbness in her left arm also started feeling some pain her whole left body region that turns into numbness after

minutes.

We checked several doctors and the problem is each one come up with a different diagnosis, and requiring a different surgerical operation to be done, what is confusing them as they say

is that the MRI shows disc protrusion at L3 – L4, but the symptoms and pain she is complaining about is more about L5-S1 issues.

One of the doctors suggested having a some sort of a pain killer injection (a mixture of DIPROFOS/Betamethasone and 2 other things that i do not remember) at L5-S1 disc, and in case
that the pain went away, they would know for sure that its the disc causing all that pain, after that my mother kept feeling strong pain from the injection itself for 12 hours after the injection operation, and after that all the usual pain came back as it used to be, if not worse.

MRI Report:

MRI Images:

We need your opinion about her illness, what exactly is she suffering from is it spinal stenosis , or foraminal stenosis, is it a protrusion or what ?

Also what kind of surgery she would need, we fear that after doing a surgery her pain remains as is, before the surgery.

Please advise

Note: if you save the above images to your pc, you will be able to view them in a bigger size and zoom at them, as the forum here resizes them

Donald Corenman, MD, DC
Moderator

May 18, 2013 at 2:38 am

Post count: 8660

#8698 In reply to: MRI Needs helps please |

Neck pain may be related to narrowing of the spinal canal as the degenerative changes that occur with degenerative disc or facet disease can cause neck pain as well as produce the bone spurs that compress the spinal canal. A neck pain workup is different than a suggested surgery for cord compression but these two potential surgeries may still be one and the same if these degenerative levels cause both cord compression and neck pain.

If you are active (the noted sports I previously mentioned along with some others), you have a higher risk for cord injury (see central cord syndrome) due to head impact

Neck pain can be worked up with a careful history and physical examination as well as evaluation of the images including flexion/extension X-ray images. Further studies such as discograms, facet blocks or SNRBs may need to be considered.

Dr. Corernman

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.

ahmedhelalm
Member

May 17, 2013 at 9:42 pm

Post count: 3

#8686
Topic: Sever lower back pain that extends to left feet, disc protrusion in forum READING X-RAY, MRI & CT SCAN |

My mother (47 years old) school teacher, with 3 kids

It initially started 1 year ago, with pain in her left leg, but then 6 months ago the symptoms that am describing now started happening and got very intense 2 weeks ago, pain is almost there 24/7, and it increases when she does activities like driving, or doing any physical effort, but driving a car is one of the things that increase the pain the most.

– She suffers from pain (that she describes as tearing, as if she feels a knife cutting through her) in the 2nd half region of her back, mostly concentrated in her Lower back (pain’s strongest point is the lumber area), also she feels the pain extends through the sides of her back not just the back bone/spinal cord area.

– That back pain extends to both right and left hips, she can feel the pain passing down to the center of both left and right hips.

– She feels also strong pain in her left leg starting from her back going through hips, leg, back part of the knee, down to the foot, till her feet and fingers down there.

– In her right leg she feels also pain but its quiet insignificant compared to what she feels in her left leg.

– She doesnt feel any pain when urinating, and she doesnt complain about any pain in her bladder
– She doesnt feel any pain in her knee, except that back part area of her left knee where she feels its the same pain extending from her hips down to her feet.
– She doesnt have any menstrual abnormalities/pain.

– Occasionaly when waking up from bed after sleep or after walking a lot, she feels that she isnt able to control both her legs, that they almost cant carry her body and she is about to fall

, feeling both legs almost numb.

– About once per week, it happens that her left leg makes an involuntarily move that she didnt mean to do, which disorients her and some times causes her to fall.

– Recently she started also feeling some pain in her left shoulder, and numbness in her left arm also started feeling some pain her whole left body region that turns into numbness after

minutes.

We checked several doctors and the problem is each one come up with a different diagnosis, and requiring a different surgerical operation to be done, what is confusing them as they say

is that the MRI shows disc protrusion at L3 – L4, but the symptoms and pain she is complaining about is more about L5-S1 issues.

One of the doctors suggested having a some sort of a pain killer injection (a mixture of DIPROFOS/Betamethasone and 2 other things that i do not remember) at L5-S1 disc, and in case
that the pain went away, they would know for sure that its the disc causing all that pain, after that my mother kept feeling strong pain from the injection itself for 12 hours after the injection operation, and after that all the usual pain came back as it used to be, if not worse.

MRI Report:

MRI Images:

We need your opinion about her illness, what exactly is she suffering from is it spinal stenosis , or foraminal stenosis, is it a protrusion or what ?

Also what kind of surgery she would need, we fear that after doing a surgery her pain remains as is, before the surgery.

Please advise

Note: if you save the above images to your pc, you will be able to view them in a bigger size and zoom at them, as the forum here resizes them

Rhino6
Member

May 17, 2013 at 1:47 am

Post count: 2

#8682 In reply to: Mri reading with motor weakness in arm |

Thank you for your reply. When should the decision be made for surgery?

For instance, I am still getting stronger granted, not as fast as I would like, but would you recommend therapy as long as it keeps getting stronger and do you feel eventually I will plateau? Is it true the longer you wait to repair, the longer it will take to recover?

The only exercise I’m doing is retraction extensions with 3 little turns and I’m trying to do them every hour.

Is supraspinatus atrophy related to the c6 nerve root? Is there a way I may send my MRI to you? I live in Michigan and I haven’t seen anybody yet although I have been referred to an orthopedic but just not sure how I should select the correct surgeon.

Thank you very much and I appreciate your time,

Ryan

Donald Corenman, MD, DC
Moderator

May 16, 2013 at 10:44 pm

Post count: 8660

#8680 In reply to: Mri reading with motor weakness in arm |

A disc herniation at C5-6 will compress the C6 nerve root. This will affect the shoulder rotators, biceps and wrist extensors, all muscles that are required for pitching. The C6 nerve has resiliency from some compression and can recover on occasions without intervention. However, if you are an athlete, the depth of recovery might not be satisfactory to you without surgical intervention.

Surgery vs. no surgery really depends upon the results of your physical examination and a critical look of the biomechanics of your pitching motion.

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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Viewing 6 results - 1,717 through 1,722 (of 2,199 total)

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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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