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Seattle Scott
Member

November 19, 2012 at 5:47 am

Post count: 5

#7450 In reply to: Direct Pars Repair |

Yes, I reviewed the information on your site, which led me to post on your forum.

I did have a lido infiltration of my pars, which yielded some relief. However, during the procedure you could see that the injection went in 1 side of the pars and then came right out the other side into the surrounding structures. So, according to the dr., he could not be sure the success could be attributed to the pars.

Here is the summary from the MRI about the discs. I guess healthy is relative.

FINDINGS: No evidence of vertebral compression or destructive lesion. No evidence of subluxation. Bilateral L5 pars defects are again noted. Visible caudal spinal cord is normal caliber and signal. Conus terminates in normal location at T12-L1.
T10-T11: Normal disc hydration and stature. No disc bulge, protrusion, or extrusion. No central canal or neural foraminal stenosis.
T11-T12: Normal disc hydration and stature. T12 superior end plate Schmorl’s node, unchanged. No disc bulge, protrusion, or extrusion. No central canal or neural foraminal stenosis.
T12-L1: Normal disc hydration and stature. No disc bulge, protrusion, or extrusion. No central canal or neural foraminal stenosis.
L1-L2: Moderate disc desiccation and moderately diminished disc stature. L1 inferior and L2 superior end plate Schmorl’s nodes, unchanged. Shallow disc bulge causes no central canal or neural foraminal stenosis. No focal protrusion or extrusion.
L2-L3: Mild disc desiccation with normal stature. L2 inferior endplate Schmorl’s node, unchanged. No disc bulge, protrusion or extrusion. No central canal or neural foraminal stenosis. No interval change.
L3-L4: Mild disc desiccation and mildly diminished disc stature. Shallow diffuse disc bulge is unchanged. No central canal or neural foraminal stenosis.
L4-L5: Moderate disc desiccation and moderately diminished disc stature. Focal central protrusion with high intensity zone (annular fissure) indents the ventral thecal sac but causes no central canal stenosis. Mild bilateral facet joint arthrosis causes no neural foraminal stenosis. No interval change appreciated.
L5-S1: Normal disc hydration and stature. No disc bulge, protrusion, or extrusion. No central canal stenosis. Stable mild bilateral facet joint arthrosis but no neural foraminal stenosis.
IMPRESSION:
1. Bilateral L5 pars defects and mild bilateral facet joint arthrosis, unchanged.
2. L4-L5 focal central protrusion with high intensity zone (annular fissure) and mild bilateral facet joint arthrosis without central canal or neural foraminal stenosis, unchanged.
3. L3-L4 shallow diffuse disc bulge without central canal or neural foraminal stenosis, unchanged.
5. L1-L2 shallow disc bulge without central canal or neural foraminal stenosis, unchanged.

I’m not sure if this would make me suitable for a potential pars repair v. a fusion. My concern with fusion, is that while I do have leg pain, it’s not so bad. For me, its more the lack of stability and that I can no longer exercise, ski, bike, run, etc. I would only consider surgery, if there was a good shot of returning to those activities. While I do have pain and some sleep disturbance, it’s not so awful that I cannot tolerate it.

Thanks again for the discussion. I appreciate you cannot give medical advice via the Internet.

Purduejaime
Member

November 19, 2012 at 2:51 am

Post count: 6

#7449 In reply to: Help! Effectiveness of prior surgery without disc removal? |

Oh my goodness!!! I want to thank you Dr. Corenman!!! You’ve thoroughly answered the questions I have (given the constraints) and told me things no doctor has told me before! I cannot tell you how much I appreciate your advice and the time you took!

In regards to your further questions, the recent films I’ve had (flex and extension X-rays and mri w/ and w/out) show mild Spondylolisthesis at L5/s1 and nothing wrong at the next level up. In regards to your disc question, YES a change has happened! Over the years I’ve had imaging, my disc has gone from bulging (at time of fusion) to nearly completely black and compressed! I had NO IDEA that the disc was supposed to stay the way it was, ie frozen in time!!

So, even though the X-rays don’t show movement, could there still be movement?

Thank you again for these answers. I’m optimistic that I could have helpful treatment for the first time in a decade!

Bev56
Member

November 17, 2012 at 8:24 pm

Post count: 2

#7418
Topic: MRI results with hemangiomas in forum GENERAL |

Good Morning Dr. Corenman. I am a surgical nurse with chronic back pain. I recently had an MRI of the L spine which shows some disturbing impressions:
“Circumferential disc osteophyte complexes with superimposed left foraminal disc protrusion at L2-3 level causing left neural foraminal narrowing. Circumferential disc osteophyte complex, facet degenerative changes, and ligamentum flavum thickening causing bilateral neural foraminal narrowing at L5-S1 low signal intensity lesions are visualized in the L4 and L5 vertebral bodies, which could be related to atypical hemangiomas, however multiple myeloma or metastatic disease cannot be completely excluded. Follow up with Bence Jones proteins and further evaluation with MRI of the lumbar spine with and without IV contrast would be helpful.”

Blood test results showed normal CBC, negative ESR, elevated cholesterol, (don’t we all) and further blood tests have been ordered.

My question is will CRP, LDH, and serum electrophoresis rule out multiple myeloma? And what other tests or treatments would you recommend?

Age 56, 155lbs 5’5, no other real health issues. MVA in 1985 with pelvis fx among other injuries, G4P4, all healthy children, breast CA in mother, living, age 80 living in a nursing home, father age 85 living,very active no CA. 4 siblings alive and well, no sig health issues.

Thank you for this forum. BevRN, Michigan

bensonjacoba
Member

November 17, 2012 at 3:20 pm

Post count: 1

#7417
Topic: Foot Drop due to L5-S1 Herniation in forum BACK PAIN |

Hello Dr. Corenman,

First off, thank you for taking the time to respond to all our queries.

History:
Since 2004, on & off, i have had back pains which was treated with Physiotherapy and traction.
In 2006, my left leg fell numb all of a sudden after 2 days of excruciating pain. The doctor’s refused to conduct a surgery. I was on complete bed rest (23 hrs traction & 1 hour physiotherapy) for 29 days. My left leg became better and i was back to work after a month.

Recent History:
On Aug 8, 2012 I had radiating pain on the left leg going downwards. The next day, my left foot (ankle downwards) fell numb and loss of ability to push towards the body. I opted for traditional ayurvedic treatment. The pain went away, but the numbness and Foot drop remained. Its been 3 months, i have no pain (touchwood) but my foot is 50% numb, i am unable to rise the foot towards my body (i can lower it) and my toes dont have the strenght to push up.I have absolutely no pain or radiating pain on any part of my body, only minor strain at the back due to excessive lifting of my 3 year old son.

MRI dated November 14, 2012
– Normal Curvature & Alignment of Lumbo sacral spine
– At L5-S1, there is reduced disc height and signal intensity on T2 suggestive of the desiccation accompanied by type II end plate degenaration. Its disc shows large and broad central subligamntous extension which is touching the theca and moderately pressing bilateral preforaminal S1 nerve roots.
– Normal marrow signal od examined vertebrae
– Vertebral bodies and appendages are normal
– Facet joints appear normal
– Normal appearence of Spinal cord,cauda equina and filum terminale
– Spinal ligaments and para spinal soft tissue is normal

Neurosurgeon’s Observation & Treatment Plan

The doctors advised that due to the numbness on the feet for the past
3 months without any healing a lumbar micro discectomy (on Nov 26) will be performed to chip out the herniated portion of the disc only, which will reduce the pressure on the nerve. Surgery is advised for avoiding permanent damage to the nerve which may further cause loss of bladder and bowel control. She also mentioned that they cannot guarantee the removal of the numbness & foot drop.

After reading the above,
a) Would you advise a MDisectomy
b) If i choose not to go ahead with the surgery, will i lose the ability to withold my bladder/bowel movement
c) Any other suggestions ?

Thanks doc for your time.

God bless.

Cheers,
Ben

hope_20022000
Member

November 15, 2012 at 12:10 pm

Post count: 1

#7405
Topic: Please help! I'm in a great deal of pain. in forum BACK PAIN |

I am experiencing very bad back pain so I had an MRI and see a spine specialist soon. I have had back pain since I was about 14 years old so for about 15 years now. It seems to be worse now. Things that have been tried are physical therapy, a steroid injection (this made the pain worse), tens unit, anti inflammatories, and a back brace. My pcp gave me vicodin 5-500 and said take 1 twice a day until I see the specialist. These don’t seem to take the edge off at all. I have also been on ultram which doesn’t do anything at all for it. I have a dip in about the middle of my back and this is where the pain seems to start but moves down to the top of my butt. The pain in the dip feels like someone stabbing a knife through my back and into my stomach then twisting it. I also have some numbness that comes and goes in the bottom of each foot. I am going to post my MRI results in hopes that someone can give me some idea of what it means and what might happen next in the treatment of this. Any information would be much appreciated as I’m in the dark on all of this and kind of freaked out since I’m only 29 and having all these issues. Thank you in advance.

MRI FINDINGS:
Alignment is anatomic. The paraspinous soft tissues are normal. Incidentally noted is chronic, mild ectasia of the distal thecal sac. The distal spinal cord and nerve roots of the cauda equina are normal in appearance. No bone marrow pathology is seen.

No significant abnormality is demonstrated at the T10-T11 through L3-L4 levels. There is no lumbar disc protrusion, spinal stenosis, or foraminal narrowing.

L4-L5: There is a posterior annular tear and a small, broad-based, left foraminal disc protrusion. There is mild left lateral recess narrowing. There is no nerve root displacement. There is no significant facet arthropathy. There is no spinal stenosis or foraminal narrowing.

L5-S1: There is disc degeneration and mild disc bulging. There is mild bilateral facet arthropathy. There is no spinal stenosis or significant foraminal narrowing.

The visualized upper sacrum is unremarkable.

Again thank you in advance to anyone who has any input for me.

boog1
Member

November 14, 2012 at 10:36 pm

Post count: 1

#7403
Topic: need a doctor for fusion in forum GENERAL |

I am looking for a doctor within a few hours of grand junction that will do a L5/S1 fusion. I was in a car accident and need one that will do a lein until my lawsuit is settled. I am in excrusiating pain and would like to do this asap. I was diagnosed with grade 2 spondy with spinal instability I have a 17mm slippage with movement on flexation and extension. I was hit by a 10 Wheeler dump truck, never had a back pain ever, now I cant walk. Ive done all the conservative treatments. If anyone knows a doctor willing to help please let me know. God bless
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Viewing 6 results - 1,843 through 1,848 (of 2,200 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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