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Donald Corenman, MD, DC
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September 16, 2012 at 9:49 pm

Post count: 8660

in reply to: Biostat Biologx Fibrin Sealant for Degenerative Discs #6956

One of the biggest problems with biologics and the disc is that the disc is avascular (has no blood supply). I have treated patients that have had previous stem cell injections into the disc with no good results. I think the reason for failure is that there has to be a good blood supply to the structure injected with stem cells and the avascular disc will not support new cells that are implanted.

That reasoning continues with this fibrin sealant. I have treated patients who have had platelet gel (PRP or platelet rich plasma) injected into the disc without good results. I understand that the contents of this injection are similar to PRP so I have a difficult time understanding how this is going to be different.

I would love to believe that we now have a new treatment for the disc that can be performed by injection but I have been in the spine field for 35 years. I have seen many “new and improved” treatments come and then go (cage rage, IDETT, PRP, nuceloplasty, chymopapain, dynamic stabilization). All the past new treatments were brought in with much press and fanfare and all left without any notice. The only real new breakthrough in the last 10 years has been BMP (bone morphogenic protein) and that was only for fusion of the spine.

We will have to see if this new injection has any promise. The good news is that it should not be injurious to the disc so there should be minimal downside (except for the injection itself) if it does not work.

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.

Donald Corenman, MD, DC
Moderator

September 16, 2012 at 9:28 pm

Post count: 8660

in reply to: L4-L5 Herniated Disk #6955

You need to separate your symptoms by percentage into lower back and buttocks/thigh/leg pain. The difference in percentage may indicate the need for different surgeries. If most of your pain is from the buttocks/thigh/leg region, you might be able to undergo a simple microdisectomy. If the symptoms are more heavily weighted to the lower back, a fusion might need to be included in any surgery.

I would think your treating physician would want a new MRI as your symptoms have changed.

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.

Donald Corenman, MD, DC
Moderator

September 16, 2012 at 9:21 pm

Post count: 8660

in reply to: ask doctor a question #6954

Have you posted before as your identifier is familiar?

You have had facet blocks at L5-S1 with “no results” and a discogram with a painful disc at L5-S1 and L3-4 with a “normal disc” at L4-5. You however do not describe your symptoms. Do you have back pain, buttocks pain or leg pain? Please see the section on the website regarding “How to describe symptoms” to convey a description of your pain.

What level (or levels) were your two prior laminectomies?

For the sake of time, let’s assume that you have strictly back pain only. Facet blocks have a diagnostic window for pain relief. Just like going to the dentist where he or she will inject your jaw and it “stays numb” for three hours, any relief for only the first three hours is important to note. Typically, most injectionists do not have you record a pain diary (see website for instructions) which I think is highly important. If you can remember back to the first three hours after your injection and do not remember any pain relief, then rhizotomies will not be helpful to relieve pain.

Again, if lower back pain is your only problem, you might be a candidate for a fusion of only the L5-S1 level based upon your discogram. You need to understand what a fusion will and will not do for you. Read the section on fusion in the website to get a better understanding. Read “Preparation for spine surgery” and “Recovery information by surgery” for a better understanding of what you can expect.

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.

Donald Corenman, MD, DC
Moderator

September 16, 2012 at 9:03 pm

Post count: 8660

in reply to: In need of help – Chronic Lower Back Pain, DGD and 20 Degree Backward #6952

There are a number of unanswered questions regarding your biomechanics. A “backwards lean” (extension posturing) could be from any number of conditions. What does your standing lateral X-ray show? What is your lordotic angle measure? What does your sacral angle measure? What is your pelvic tilt angle?

What do your flexion/extension X-rays demonstrate? What is your global range of motion of the lumbar spine?

Do you have a lateral scoliogram X-ray? What is your positive or negative sagittal balance? Do you have a thoracic hyperlordosis (Scheueremann’s disorder)?

Backwards leaning can also be antalgic (holding a posture to reduce pain).

As you can see, the biomechanics of your condition is still relatively unknown according to your current understanding. You need more workup to determine what is causing the pain and the lean.

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.

Donald Corenman, MD, DC
Moderator

September 16, 2012 at 8:42 pm

Post count: 8660

in reply to: confused, please help #6951

A good diagnostician is needed to ferret out the cause of your symptoms. EMGs are good for significant peripheral nerve compression but mild compression may not be demonstrated and thoracic outlet syndrome cannot be diagnosed by EMG. Occasionally a nerve compression can be missed by the machine or by the technique used to obtain the readings.

The two doctors that typically diagnose these disorders are PM&R docs and neurologists. A good spine doc would also suffice.

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.

Donald Corenman, MD, DC
Moderator

September 16, 2012 at 8:34 pm

Post count: 8660

in reply to: L4-L5 Herniated Disk #6950

First- please let me know the level of the herniation. Is it mid back (thoracic spine) or lower back (lumbar spine)?

Any time you have a known preexisting hernation with worsening symptoms, one of the first questions should be if the symptoms are the same but with greater intensity or are the symptoms different. The reason is due to either recurrent herniation or a hernation at a new level.

A recurrent hernation at a previously herniated level will typically intensify preexisting symptoms and a hernation at a new level will typically yield different symptoms.

In either case in my opinion, a new MRI should be considered.

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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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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