Donald Corenman MD DC | Spine Surgeon Colorado

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BillL
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August 12, 2019 at 11:40 am

Post count: 18

in reply to: THORACIC AND ABDOMINAL Sx #30868

As always, thanks for the response. Just as a quick follow-up, presumably at this point this would need to be a pain management consultation? How would they know what level to potentially inject given four or five diseased levels? And would this be in your experience more of a trans foraminal/selective nerve root block or an epidural steroid injection? I know that the anatomy is significantly different in the thoracic area along with increased risks due to presence of the spinal cord as well as mid the Resik location of anterior spinal artery blood supply.

BillL
Participant

August 11, 2019 at 5:23 pm

Post count: 18

in reply to: THORACIC AND ABDOMINAL Sx #30857

Dr Corenman:
Since the last post the updated thoracic MRI returned probably not greatly different than previous study. “Mild dextrooconvex thoracolumber curve.” Also at T5/6 left paracentral disc bulge with mild anterolateral cord deformation, at T6/7 left paracentral protrusion with left cord deformation, at T8/9 small midline protrusion with mild anterior cord deformation,and T10/11 mild broad based left sided disc protrusion with effacement of anterolateral thecal sac without cord deformation.

Abdominal MRI done per GI doc verbal initial reading by radiologist seems negative with official report due 8/12. Up to date on colonoscopy 1.5 years ago and periodic EGD UTD. Possible faint thigh weakness at times going up stairs but could be imagination. To Further complicate had elevated total CK this past week 365 (upper cut 200 – Age 55), but had also been doing some home exercises and also take rosuvastatin.

Ortho/spine who ordered thoracic MRI said little other than that the cord was not markedly compressed, that he had never done non traumatic thoracic disc surgeries, that surgery not pursued without severe compression and that’s about it. No plan from here or even sure of exact cause. Didn’t seem very interested overall once MRI resulted. At times feel a momentary sharp pinch sensation LUQ abdomen randomly or with some positional change (plus the original Sx).

At this point not sure next course of options? GI is going to stay in his specialty area. I would also think that thoracic MRI being done standard supine could possibly underestimate degree of issue vs weight bearing either standing or sitting (although sitting remains the primary issue)? And finally, given Hx of multiple Lumbar discectomies/degen disease can a left lumbar issue including facet produce similar symptoms? Can subtle lumbar instability? Still no leg pain either side.

Any additional insight appreciated.
Thanks

BillL
Participant

July 31, 2019 at 6:53 pm

Post count: 18

in reply to: THORACIC AND ABDOMINAL Sx #30792

Thanks, and I understand your point. Thoracic MRI pending. Can follow up but a bit hard to tell if this could be source of symptoms assuming medical causes not proven and especially if Thoracic MRI is largely unchanged…

BillL
Participant

July 31, 2019 at 12:21 pm

Post count: 18

in reply to: THORACIC AND ABDOMINAL Sx #30785

Thanks for the response. There was an addendum post after the first to correct that previous MRI was 2015 and not 2005.

Since the post, abdominal U/S negative other than trace gallbladder sludge, and while pancreas was unremarkable the radiologist stated U/S not optimal for pancreatic Ca sensitivity (gland not obscured by gas per tech). Also oddly a minimal amylase elevation 110 (Normal to 100), and normal lipase at 26, rest of labs including CRP and Sed Rate normal.

Plan to update thoracic MRI right away. But if stable,no change, or maybe slight worsening how to interpret this scenario or proceed next?
Thanks

BillL
Participant

June 17, 2018 at 11:36 am

Post count: 18

in reply to: Persistent postoperative symptoms #28533

Okay, and as always, thanks for the additional insight. I certainly don’t want to keep harassing you with questions but in this setting would an L4 CT be mandatory? The second surgeon acted like he would be leery without that to estimate bone remaining after the laminotomy and medial factetectomy. Could a Metrix be done safely without the CT?

And two adjacent annulotomies close together with max 30% strength after scarring….any concerns about the annulus blowing out so to speak laterally?
Thanks

BillL
Participant

June 15, 2018 at 6:39 pm

Post count: 18

in reply to: Persistent postoperative symptoms #28517

Dr. Corenman:
I am trying to hold off MRI another couple weeks until week 8 post op to be more to the liking of the original surgeon and maybe better accuracy….

I did speak with at least one local surgeon who does some far lateral access discectomies but for a second procedure Accessing from that position per his usual minimally invasive dilator method he was a bit cautious (even if a residual or recurrent herniation is confirmed on MRI). He suggested that at least with the minimalist approach that he would have to remove more bone laterally including some off the superior facet joint area. He seemed a bit concerned about how much bone was removed by the laminotomy and partial medial facetectomy. Suggestion was if not enough bone left only recourse would be a TLIF?

He also mentioned the symptoms of late mainly around the posterior right belt line, at times laterally about halfway between the iliac crest/femoral head, and occasionally just below the ASIS as maybe having hip or hip girdle Sx, yet hip exam normal. Sitting and rising from sitting after a while seems to somewhat briefly radiate a discomfort in one of those areas. My PT also started trying to track that direction due to this being “non-dermatomal” or maybe atypical. No problems walking or climbing stairs, etc.

I read one article that suggested there might be some paramedian approaches with a slightly longer incision (vs minimal dilator) that could completely spare bone removal laterally? I have concerns to avoid TLIF if at all possible and concerns about effects of violating the superior facet joint and it’s capsule…..? Instability? Arthritis? Facet pain? And not sure about this hip girdle concept as it seems the other doctor perhaps wanted to consider that before tracking to a revision surgery….

Any thoughts appreciated…
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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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BillL

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