Donald Corenman MD DC | Spine Surgeon Colorado

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Brian McC
Participant

August 14, 2023 at 4:55 am

Post count: 6

in reply to: Bertolotti Syndrome Diagnosis #35789

Thank you very much for your reassurance regarding the Bertolotti and your comments Doctor Corenman, and for your speedy response. It is very much appreciated. I am assured I have a solid fusion at L5/S1 despite it being very tender to touch. It also ‘lit up’ considerably on the last SPECT CT scan, along with both SIJ’s taken prior to the most recent si-bone fusion in my right SIJ in January.
I am aware of the possibilities of ASD and have feared this happening for a long time. Since the discogram provoked such a painful response (as did both ADR levels) I am told I can understand. I am alarmed about the prospect of fusing right up to T10 – what happens to T9 in the future.
The constant back pain is very hard to live with and the regular flare ups even harder. More surgery is frightening because I know what the recovery process is like. It’s a very big decision.
Thank you so much for your comments over recent weeks, all very much appreciated.
Regards and best wishes

Brian McC
Participant

August 13, 2023 at 12:01 pm

Post count: 6

in reply to: Bertolotti Syndrome Diagnosis #35785

My pain is a persistent, continuous dull low back pain that increases after any activity. Periodic/frequent ‘flare-ups’. Sporadic pain in my left leg, intermittent very sharp pain in my low back, pain going into my foot and toes.
Here is a history of my symptoms and treatments over the years since my first experiences with back pain and first of several surgical interventions:
A history of SIJ problems since late teens requiring Chiropractic each time my back ‘locked up’.
• Microdiscectomy 25/11/97 L4/L5
• Chiropractic Care 2002-September 2007
• Massage Therapy 2002-to date
Continued pain leading to:
• MRI Scan
• Facet Injections L4/5 four times
• Epidural injection 26/06/07
• Diagnostic Facet injections 5 right side 07/08/07
• Diagnostic Facet injections 5 left side 19/09/07
• MRI Scan 03/10/07
• De-nervation 5 one side 16/10/07
• De-nervation 5 other side 13/11/07
• Nerve Root Block Right side L4/5 S1 18/12/07
• Nerve Root Block Left L4/5 S1 15/01/08
Increased pain
• Positive Discogram/Discography. Feb 2008. Diagnosed with Spina Bifida Occult and Sacralised Transverse Process (AKA Bertolotti Syndrome).
• Hybrid Charité ADR L3/L4, L4/L5, ALIF L5/S1 surgery 22/04/08
• Pain Management Hospital Stay Oct 2008
• FJ Injections
• SI Joint Injections
• Bi-lateral five level denervation
• De-nervation 3 one side Nov 2008
• De-nervation 3 other side Dec 2008
• Positive Discogram/Discography. March 2009
• Surgery April 25th 2009 – revision fusion L5/S1 with instrumentation and complete bi-lateral SIJ fusion
• February/March 2010. Pain Management and diagnostic/pain relief procedures and bi-lateral three level denervation plus Sacroiliac Joints.
• Surgery May 25th 2010 – revision bi-lateral SIJ fusion with instrumentation
• Pain Management Hospital Stay 16th January – 12th February 2010
• Repeat discogram, SPECT Scan, Infusion, drugs changes, hydrotherapy
• Referral to Pain Consultant, 1st March 2011 for SCS or Morphine Intrathecal Pump
• Referral to Spinal and Orthopedic Surgeon 4th July 2011. Diagnostic facet injections and MRI scans.
• Discogram 7th November 2011. Proved positive and confirmed two loose screws and mal-union at L5/S1.
• Surgery 8th November 2011. Revision fusion at L5/S1, instrumentation removed and replaced with larger sets both sides. Excise of Bertolotti Syndrome anomaly.
• Discharged 20th November 2011.
• Six weeks daily care from district nurse to monitor and dress infected wound.
• Hydro-therapy June 2012, on-going weekly. Stopped
• Referred to Pelvic Surgeon for assessment.
• Surgery 28th January 2013. Removal of bi-lateral SIJ instrumentation
• Referral to Pain Management Doctor 1. 23rd April 2013
• Referral to Pain Management Doctor 2. 1st May 2013 – Assessment for Spinal Cord Stimulator/Pain Management
• Referral to Pain Management Doctor 3. 8th May 2013 Assessment for Spinal Cord Stimulator/Pain Management
• Referral to Physiotherapy and acupuncture
• Pain Management. September 2013
• Three week residential in Coventry, Real Health
• Orsett Hospital Pain Management October 2013
• Various appointments with physiotherapist, Medication Nurse and psychotherapist.
• Aqua therapy April 2014 ongoing (stopped now)
Three times (min) weekly. 20 minutes walking with float in the water
• Orsett Hospital Pain Management November/December 2014
• January 7th 2015 Consultation Neuro Surgeon
• CT Scans 5th March 2015.
• July 14th 2015 Consultation Neurosurgeon, Pelvis Specialist, Pain Management Consultant
• Admitted to London Clinic July 27th 2015
• SPECT Scan 28th July 2015 – shows inflammation of bone around both SIJ cages possible reaction to metalwork.
• Local anesthetic and steroid bi-lateral SIJ injections 30th July – no pain relief beyond that gained from the local anesthetic.
• Admitted to London Clinic September 24th 2015
• Attempted bi-lateral denervation of SIJ’s, unsuccessful because of presence of scar tissue from previous surgeries as suspected.
• Repeated bi-lateral SIJ injections – no relief
• December 23rd 2015 The Roding Hospital Consultation Neurosurgeon
Discussed and agreed go ahead for trial of Spinal Cord Stimulator
• March 15th 2016 The Roding Hospital
• Trial 2 SCS, Medtronic and Nevro, one week each
• March 22nd 2016 The Roding Hospital Permanent Nevro HF10 fitted
• (December 2017 ORIF – fix broken right clavicle following fall on ice patch. Nuffield Hospital Brentwood)
• June 4th 2019 Spire Hospital Brentwood Consultation Neurosurgeon
Following six to seven months of muscle spasm flare ups and then a seven-week period of severe sharp acute pain to right side prior to: Bi-lateral Denervation Lumbar Facet injections L3/L4, L4/L5, L5/S1 plus injection in SIJ Bursa. Acute pain subsided within hours leaving ‘normal’ low back pain.
• April 8th 2022 Spire Hospital Brentwood
Consultation with Orthopedic surgeon – examination
• May 19th 2022 The Wellington Hospital London SPECT CT Scan Nuclear
• June 17th 2022 Blood tests
• June 20th 2022 DEXA Scan for checking bone density
• July 8th 2022 Follow up appointment
• September 7th 2022 SCS Adjustments made (NEVRO) new program provided.
• Same day. Zoom Call with Neurosurgeon 2.30-3.30. Discussed increased ‘new’ pain and diagnosis. BS evident on the printed image of my latest scan shown on Zoom. Suggested this or the fracture in the fusion mass in SIJ as the possible cause of the pain.
• November 3rd 2022. Agreed to go ahead with revision fusion right side sacroiliac joint for 9th January 2023 . This was to fix the fracture seen in the fusion mass and help reduce pain.
• January 9th 2023 admitted to hospital for SIJ revision fusion surgery si-bone right side.
• June 19th 2023 Follow up at Clinic
‘New pain’ to right SIJ had eased but all other existing pain still the same. (Discussed Bertolotti with consultant and is of the opinion that Bertolotti has regrown and is the likely cause of the pain. He would discuss with MDT meeting the following day)
Then met and discussed surgery outcome with surgeon who believes no further surgery will help with the pain and discounted the BS as the pain generator. Pain continues ….
• August 8th 2023 Discogram – positive. I had the discogram/diagnostic intervertebral disc injection L2/3, L3/4 and L4/5 and injection to my left SIJ on Tuesday. It has revealed: L2/3 a ‘globally torn, severe concordant pain at low pressure, L3/4 severe concordant pain at opening pressure, L4/5 severe concordant pain at opening pressure.
• L3/4 and L4/5 have Charite ADR but the exposed surfaces towards the back of each of the vertebra were tested resulting in the pain. I have been told that the Bertolotti at L5/S1 interbody is fused solid to my sacrum and is therefore not generating pain. I am confused by this because I was under the impression it was very likely the cause of all of my back problems originally and the reason why a resection was carried out some years ago and has since regrown. I can’t understand why it is now no longer a problem if it is back to the situation that it was before. Will it not place undue stresses on other joints even though L5/S1 is fused and my right SIJ now fused?
• The treatment being considered and discussed is to fuse all levels from L4/L5 up to T10.
My concern is in relation to the significance of the re-grown BS. I am told it is re-fused and rock solid but if it is now the same as it was before the resection, will it not cause the same sort of damage to the new fusions? My understanding was that BS creates asymmetry in the spine causing altered bio-mechanics leading to undue wear and tear on the various discs and joints.
Sorry for the amount of detail here but thought it best to let you know the complete history of my back problems and hope you don’t mind.

Brian McC
Participant

August 11, 2023 at 7:17 am

Post count: 6

in reply to: Bertolotti Syndrome Diagnosis #35780

I had the discogram/diagnostic intervertebral disc injection L2/3, L3/4 and L4/5 and injection to my left SIJ on Tuesday. It has revealed: L2/3 a ‘globally torn, severe concordant pain at low pressure, L3/4 severe concordant pain at opening pressure, L4/5 severe concordant pain at opening pressure.
L3/4 and L4/5 have Charite ADR but the exposed surfaces towards the back of each of the vertebra were tested resulting in the pain. I have been told that the Bertolotti at L5/S1 interbody is fused solid to my sacrum and is therefore not generating pain. I am confused by this because I was under the impression is was very likely the cause of all of my back problems originally and the reason why a resection was carried out some years ago, but has since regrown. I can’t understand why it is now no longer a problem if it is back to the situation it was before. Will it not place undue stresses on other joints even though L5/S1 is fused and my right SIJ now fused?
The treatment being considered and discussed is to fuse all levels from L4/L5 up to T10. In your opinion, do you think the BS should be resect again or is it best left as is?
I would welcome your opinion.
Kind regards

Brian McC
Participant

July 25, 2023 at 3:57 am

Post count: 6

in reply to: Bertolotti Syndrome Diagnosis #35770

Thank you for your comments Doctor Corenman. I will try to contact the surgeon and find out why a discogram and what he hopes to learn from it.
Kind regards

Brian McC
Participant

July 24, 2023 at 8:21 am

Post count: 6

in reply to: Bertolotti Syndrome Diagnosis #35768

Thank you very much for your reply Doctor Corenman. With my layman’s limited knowledge, my thoughts were that it was BS that caused the damage back in 2008 to L3-S1 and to both SI joints. These were fixed as described with various success and subsequent revisions since. If the BS has re-grown, as it appears it has, could this have been the cause of the fracture in my right SI joint, recently re-fused by SI-Bone procedure. (same side as the BS). Since writing to you last week I now have pain in the area of this latest fusion. I am wondering if it could be the joint under stress again from the BS? I do now remember my very first discogram did show clearly the BS (and incidentally, spina bifida occult). My limited understanding of BS indicates there is a range of different types, some described as a ‘false joint’. Can a discogram be used to recreate provocative pain in BS?
I am a little confused how or why a discogram would be used when I have three levels without any discs to test.
Thank you for your thoughts.
Kind regards
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Viewing 5 posts - 1 through 5 (of 5 total)

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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Brian McC

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