Donald Corenman MD DC | Spine Surgeon Colorado

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epqe17
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September 17, 2012 at 3:59 pm

Post count: 4

in reply to: In need of help – Chronic Lower Back Pain, DGD and 20 Degree Backward #6974

As I am not in the immediate area are there any further diagnostic tests or other recommendations you may have for me to ask for with my network of local doctors?

epqe17
Member

September 17, 2012 at 2:03 am

Post count: 4

in reply to: In need of help – Chronic Lower Back Pain, DGD and 20 Degree Backward #6967

Dr. Corenman,

What you have said makes a great deal of sense, however, my body is reacting completely the opposite way. As I lean forward to attempt to walk more vertically there is no pain, however, I am forced (it feels as if my paraspinal muscles are firing to force me backward) backward to this 20 degree off normal position (there is no lean left or right – just straight backward). After my body has been forced to this position I feel pain as I walk. I can lean forward to alleviate the pain, but my body forces me back to the painful position.

I have one additional image (Image 1) that can be seen in my previous link that I just added (I hope you can look at it).

This shows a “mass” in the anterior space of what remains of the disc (within the broken end plate area) and my working theory is that the L5-S1 disc remnants have created a more solid diametrical mass and I can no longer overcome this “obstruction” to stand up straight. As I stated earlier I can bend over and touch my toes without pain so the working antalgic theory doesn’t make sense (there is no pain bending forward).

Have you ever seen anything like this before?

Thanks for your time as you have offered more to me in this brief summary than all 7 previous orthopedic surgeons combined.

epqe17
Member

September 16, 2012 at 11:08 pm

Post count: 4

in reply to: In need of help – Chronic Lower Back Pain, DGD and 20 Degree Backward #6958

My images can be found at https://docs.google.com/present
To answer your specific questions:

1. My standing lateral X-ray indicates decreased disk height at L5-S1 and significant osteophye growth. T11-T12 and T12-L1 have Schmorl’s nodes and reduced disk height.

2. The specific angles have not been calculated, but you should know that the pain actually occurs after the extension posturing occurs (not before). My body isn’t reaching the extension posturing due to pain, but it is created after extension. As I try to straighten, my body is forced back to extension and more pain.

3. Flexion/extension xrays are included in the link.

4. I do not have a scoliogram X-Ray, but I do not have any signficiant scoliosis.

What I do want to provide you is the actual MRI report and CT Scan report text:

MRI:

FINDINGS:
There is no abnormal signal evident to suggest fracture. The pars interarticular are intact.

T12/L1:Small anterior disc bulge is evident with disc space narrowing and disc desiccation. There is no central canal stenosis or neuroforaminal narrowing.

L1/2: There is no disc bulge or protrusion. There is no central canal stenosis or neuroforaminal narrowing. The facet joints are preserved.

L2/3: There is no disc bulge or protrusion. There is no central canal stenosis or neuroforaminal narrowing. The facet joints are preserved.

L3/4:Disc desiccation is evident with high signal in the 6 o’clock position of the annulus reflecting an annular tear. Small superimposed disc protrusion with minimal inferior extrusion is evident that deforms the ventral thecal sac without central canal stenosis. There is no neuroforaminal narrowing. Minimal left facet arthropathy is evident.

L4/5: Disc desiccation is evident with diffuse disc bulge symmetric to the left extending into the left neuroforamen. The disc bulge causes flattening of the thecal sac without central canal stenosis. Mild bilateral facet arthropathy is evident. All this causes bilateral neuroforaminal narrowing, mild on the left and minimal on the right.

LS/S1:Diffuse disc bulge is evident asymmetric to the left extending into the left neuroforamen. Small superimposed central disc protrusion is evident. Bilateral facet arthropathy is identified. Prominent disc space narrowing with endplate Modic change is noted. Endplate osteophytes are appreciated. The disc bulge, endplate osteophytes and facet arthropathy cause bilateral neuroforaminal narrowing, moderate to severe on the left and moderate on the right. The disc bulge and endplate osteophytes contact the exiting/exited nerve roots.

The paraspinal soft tissues are grossly unremarkable.

IMPRESSION:

1. T12/L1: Small anterior disc bulge

2. T12/L1, L1/2, L2/3 and L3/4: No central canal stenosis. No neuroforamlnal narrowing.

3. L3/4; Disc protrusion. Minimal Inferior disc extrusion. Annular tear.

4. L4/5; Disc bulge asymmetric to left Into left neuroforamen. No central canal stenosis. Bilateral neuroforaminal narrowing, mild on the left and minimal on the right.

5. L5/S1: Diffuse disc bulge asymmetric to left into left neuroforamen. Central disc protrusion. Bilateral neuroforaminal narrowing, moderate to severe on the left and moderate on the right. Contact exiting/exited bilateral L5 nerve roots.

CT SCAN:

-There is minimal retrolistliesis of L5 on Sl.
-The vertebral bodies are normal in height.
-Schmorl’s nodes are seen at Tll and Tl2 levels.
-There is reduction in disc space at T11-TI2, Tl2-L1 and L5-S1 levels.
-There is contiguous endplate irregularity with vacuum phenomenon in the disk at L5-S1 level.
-T11-T12, T12-L1, L1-L2,and L2-L3 levels: Mild bilateral facet hypertrophy is seen. There is also mild bilateral neural foraminal narrowing at T11-T12 level.
-L3-L4 level: There is a disc bulge with a bilateral facet hypertrophy and mild canal stenosis.
-L4-L5 level: There is a disc bulge with a bilateral facet hypertrophy causing mild canal stenosis and mild narrowing of bilateral central foramen.
-Pre and paravertebral soft tissue is normal.
-Spina bifida is seen at S1 level.
-There is evidence of sclerotic lesion likely a bony island.
IMPRESSION:
-Multilevel degenerative changes seen in the lower thoracic and lumbar spine, as described above.
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Viewing 3 posts - 1 through 3 (of 3 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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epqe17

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