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Donald Corenman, MD, DC
Moderator

November 5, 2020 at 7:29 am

Post count: 8660

#33352 In reply to: Assistance Reading Post ACDF MRI |

Actually, your current situation might be somewhat beneficial for you. If you had a solid fusion with continuing nerve and spinal cord compression (and continuing symptoms), then you might have more of a problem solving your issues. However, it seems like you have a pseudoarthrosis (non-fusion) due to the lucency seen on X-ray and the presence of a broken screw. Both are an indication of pseudoarthrosis.

A careful look at the CT scan and review of flexion/extension X-rays will confirm this problem. A non-fusion means you are a candidate for an anterior revision of this level which can solve most of your problems. Removing the plate and graft, revision of the residual bone spur compression of the cord and root and re-fusion could be accomplished. I would advise using your own bone (iliac crest bone graft) if you do have this surgery as this is the best technique to get a pseudoarthrosis to heal from the front. The broken screw tip might have to stay in as sometimes removing it is more destructive than leaving it. As long as it is embedded in bone, it should be OK.

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.

wendyltb
Participant

November 4, 2020 at 4:47 pm

Post count: 7

#33349 In reply to: Lumbar facet pain? |

wendyltb wrote:

Hi. A follow up on this (as a reminder I am fused L5/S1, have facet-type pain and saw pain management for an injection). My insurance would not approve the cortisone facet injections, but instead would approve median nerve blocks, which I had today at L3/L4 and L4/L5 on both sides.
.
Unfortunately, I did not get any relief from the pain. I haven’t yet talked to my pain management doctor about it (they had me move around and asked about pain in the recovery), but I’m wondering what else this could be. My MRI shows no compression, and I’ve had failed SI and now facet joint blocks. My pain is:

-left of center
-Can radiate into glute
-deep
-Worse with extension, better bending
-flared by sitting for a long time
-initially better with walking, then worse

Any ideas?

Sorry I left out some information on the above update: I was given versed (2 mg) for the procedure. And feel like I remember everything, including my pain in recovery. My husband says I rated it a 2, but I don’t remember it ever feeling that good (6 with extension when I came in). At the 30 minute mark it was some better but still painful for sure. I wish they had not sedated me now. My pain is *much* worse this evening, about 10 hours post injection. Does that mean anything? It’s not like pain where the needle went in, but the actual pain that I have on a daily basis is extremely flared up in my back and glute.

wendyltb
Participant

November 4, 2020 at 12:40 pm

Post count: 7

#33348 In reply to: Lumbar facet pain? |

Hi. A follow up on this (as a reminder I am fused L5/S1, have facet-type pain and saw pain management for an injection). My insurance would not approve the cortisone facet injections, but instead would approve median nerve blocks, which I had today at L3/L4 and L4/L5 on both sides.
.
Unfortunately, I did not get any relief from the pain. I haven’t yet talked to my pain management doctor about it (they had me move around and asked about pain in the recovery), but I’m wondering what else this could be. My MRI shows no compression, and I’ve had failed SI and now facet joint blocks. My pain is:

-left of center
-Can radiate into glute
-deep
-Worse with extension, better bending
-flared by sitting for a long time
-initially better with walking, then worse

Any ideas?

taketwo
Participant

November 2, 2020 at 7:50 am

Post count: 4

#33337 In reply to: ACDF Surgery Candidate ? |

I really appreciate your feedback Doctor. I had some more questions:

– In your experience how are the outcomes for this procedure ? Online literature tells me that ACDF at two levels results in high probability of adjacent disc degeneration and a rework might be needed in 10 years. Is there a fair probability of me leading a normal life without future surgery ?

– What are possibly some things I should clarify with my neurosurgeon. Is choice of instrumentation something I should be concerned about ? He mentioned using a plastic spacer (with bone powder maybe?) and a titanium cage

– Post operation what are somethings I should do to prevent this from happening again or other levels ? My MRI report mentions discs at all levels in my neck are “mildly hypo intense”. Does this mean degeneration is happening at all levels ?

Thank you !

Sdc1213
Participant

November 1, 2020 at 9:51 pm

Post count: 8

#33333
Topic: Assistance Reading Post ACDF MRI in forum NECK PAIN |

Good Evening Doctor,

I had an MRI done of my Cervical spine and I’m having some issues understanding the area under C6-C7. I understand the stenosis part, but when it gets to the part about flattening the “Ventral Cord”. I’m not sure if this was a typo on the doctors part? Mind you, this is post ACDF surgery at that level. I thought the Ventral Cord was essentially the Spinal Cord? I guess do these findings cause a big concern?

Thank You in advance!

“Cervical vertebral alignment is maintained. Vertebral body heights are preserved. Remainder of intervertebral disc space heights are preserved. No acute fracture or subluxation. The bone marrow signal shows no significant abnormality. The craniocervical junction is normal for age. The cervical spinal cord is normal in size and signal intensity without syringohydromyelia. Partially visualized posterior fossa structures are within normal limits. Prevertebral and paraspinal soft tissues are unremarkable.

C2-3: Unremarkable.

C3-4: Small central disc bulge. No spinal canal stenosis or neuroforaminal stenosis.

C4-5: Small annular disc bulge indents the ventral thecal sac. Mild uncovertebral joint hypertrophy. No spinal canal stenosis or neuroforaminal stenosis.

C5-6: Small annular disc bulge with bilateral foraminal extension indents the ventral thecal sac. Mild uncovertebral joint hypertrophy contributes to moderate left and mild right neuroforaminal stenosis.

C6-7: Broad-based disc osteophyte complex flattens the ventral cord and results in moderate spinal canal stenosis. Uncovertebral joint hypertrophy contributes to severe left greater than right neuroforaminal stenosis.

C7-T1: Small central disc protrusion indents the ventral thecal sac. No spinal canal stenosis or neuroforaminal stenosis.

IMPRESSION:
Status post anterior interbody fusion at the C6-C7 level, no acute complication.

Multilevel cervical spondylosis most prominent at the C6-C7 level.

Moderate spinal canal stenosis, severe left greater than right neuroforaminal stenosis at the C6-C7 level.

Moderate left and mild right neuroforaminal stenosis at the C5-C6 level.

No severe spinal canal stenosis at any level, no cord compression or myelomalacia.”

Glow
Participant

November 1, 2020 at 9:23 am

Post count: 3

#33332 In reply to: MRI Cervical Spine is surgery the only answer |

When I say it became worse in July, ran the pain and tingling were worse in intensity and almost constant. Prior to July, I had mild pain and mild tingling that would only happen intermittently.

Also, since I have seen the physical therapist, the pain has become unbearable.
I get very little relief. I called pain management and they increased the gabapentin from 100 mg 3 times a day to 300 mg 3 times a day.

I would like to thank you very much for your feedback and I will be scheduling surgery when I see the neurosurgeon November 10. The neurosurgeon didn’t know what type of surgery could be done and sent me for a flexion extension x-ray. He said it would either be disc replacement or ACDF. The only thing on my flexion extension x-ray is retrolisthesis at C5 + C-. I’m hoping for disc replacement but I won’t find out until November 10. Any other opinion on this would be greatly appreciated.

Thank you again.
Gloria
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Viewing 6 results - 193 through 198 (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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