Donald Corenman MD DC | Spine Surgeon Colorado

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failedACDF
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May 27, 2015 at 3:13 pm

Post count: 30

in reply to: Failed ACDF with 3 different opinions from 3 top surgeons. #19543

Thanks for your very insightful response.

The posterior is not fused yet, but the anterior is incorporated superiorly and inferiorly with a transverse defect present in the graft at C5-6 and there is bridging bone across these vetebral bodies. At C6-7 the graft is incorporated superiorly and inferiorly with a transverse defect in the midportion. There is a small area of bridging of the graft across these vetebral bodies. Based on prior comparison studies, the anterior seems to be fusing slowly.

I too am baffled as to how I still have severe compression after two surgeries. My guess is that the first surgery (anterior) never got the osteophytes and that the second surgery (posterior) resulted in only indirect compression. If I do fully fuse, could that eliminate the problems I am having, even though I have severe compression?

Is C3-4 typically operated on if there is severe compression there?

How does an osteotomy procedure work?

If I do SNRB’s at C5-7–would it be a mistake to do them at the same time? Thanks.

failedACDF
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May 26, 2015 at 9:26 am

Post count: 30

in reply to: Failed ACDF with 3 different opinions from 3 top surgeons. #19531

Hi Dr. Corenman,

I just wanted to gove you an update on my situation. As you may recall, I had ACDF C5-7 surgery last May, followed by a C5-7 posterior laminoforaminotomy with right-sided instrumentation last December.

My recent myelogram shows severe bilateral foraminal compression at C5-7 and my chief complaint is really bad right-sided shoulderblade/scapular pain. The surgeon wants to redo the anterior surgery and also do posterior fusion–a circumferential approach at C5-7.

The surgeon wanted me to do a SNRB at C3-4, due to the myelogram showing severe right sided C3-4 foraminal compression. The SNRB was done with an anesthetic and a steriod. After the SNRB my shoulderblade, arm, and neck pain were 50% better for 3 days, and now are back to the bad level they were at before. Based on the SNRB working for 3 days, the surgeon wants to do a circumferential surgery at C3-C7 (my C4-5 are fine).

I am nervous about such extensive surgery. Based on what I have read the C3-4 does not cause scapular pain, but yet the SNRB there made the pain and numbness 50% better for 3 days. At this point having had two spine surgeries in the last year, I don’t want to go through another without a high degree of certainty that it will work. I also want to make sure that any area that is causing the pain is fixed. What would you recommend? Thanks.

failedACDF
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April 26, 2015 at 6:02 pm

Post count: 30

in reply to: Failed ACDF with 3 different opinions from 3 top surgeons. #19238

Thanks. I think that the graft is fully intact, but without full fusion in the center. The C4-5 shows as mild disc bulging and minimal osteophyte formation on the left uncovertebral joint with no canal or foraminal stenosis and normal facet joints.

I never had a myelogram before, but the myelogram with CT clearly shows much worse than an MRI or regular CT of around the same time frame. The Myelogram with CT was read by a couple of radiologists as well as the surgeon and they all said that it showed severe bilateral foraminal stenosis at C6-7, and severe right at C5-6.

Since C3-4 showed moderate to severe compression, the surgeon wanted to do a selective nerve root block at that level to rule out that playing a part in my problems–he doubted that such level was playing a role, and thought it had to be C5-7. This surgeon is not the surgeon that did my two surgeries. I am extremely baffled as to how I could still have severe compression after two surgeries by a top surgeon. Have you ever seen this before?

Thanks

failedACDF
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April 20, 2015 at 11:59 am

Post count: 30

in reply to: Failed ACDF with 3 different opinions from 3 top surgeons. #19070

Hi Dr. Corenman,

I just wanted to update you on my situation. As you may recall, I had ACDF C5-C7 done last May, followed by a posterior laminoforamintoomy with instrumentation on the right done this past December. After my most recent surgery, my symptoms were all better for a month, only to come back. What came back first was bad shoulderblade pain and numbness on the right, followed by right arm numbness. I had both an MRI and a CT which showed clear improvement post second surgery. I also tried various pain medicine shots (subcutaneous perineural shots offered some relief).

Currently the arm numbness has improved some in that it is not numb all of the time. The shoulderblade pain and numbness are still pretty bad. I had a Myelogram last week and the pertinent part is as follows:

Interbody fusions with cortical bone graft at C5-C6 and C6-C7 with small areas of bridging across the vetebral bodies. Right lateral fusion with instrumentation from C5 to C6 without hardware complication. The fusion does not appear to be united. Right laminotomy is at C5-C7.

C3-C4 Uncovertebral osteophyte formation compressing thecal sac and right C4 nerve root. Moderate right foraminal stenosis.

C5-6 United interbody fusion. The interbody graft is incorporated superiorly and inferiorly with a transverse defect present. There is bridging bone across the vetebral bodies anteriorly. Right posterior lateral fusion not united. Mild posterior ridging. Prominent osteophyte formation at the uncovertebral joints bilaterally. Mild canal stenosis. Compression of the right auxillary sleeve. Severe right and moderate left foraminal stenosis.

C6-7 United interbody fusion. Right posterior lateral fusion is not united. The interbody graft is incorporated superiorly and inferiorly with a transverse defect in the midportion. Small areas of bridging of the graft across the vetebral bodies. Facet joints are not fused. Mild canal stenosis. Compression of the right axillary sleeve. Severe bilateral foraminal stenosis.

The CT Myelogram shows worse results than the regular CT and MRI showed after my second surgery as well as before both of my surgeries. So I’m baffled as to how I could still have severe narrowing after two surgeries. I also don’t know if my posterior instrumentation would make a possible revision ACDF possible without removing the posterior instrumentation. I also wonder if any of my arm/shoulderblade pain and numbness could be coming from the C3-C4 as well. I certainly am not looking forward to a potential third surgery in a year, but also don’t know if I risk damage by waiting.

As always, I’d very much welcome your views. Thanks.

failedACDF
Participant

March 1, 2015 at 1:32 am

Post count: 30

in reply to: Failed ACDF with 3 different opinions from 3 top surgeons. #12323

Thanks. I will keep you posted.

failedACDF
Participant

February 27, 2015 at 7:01 am

Post count: 30

in reply to: Failed ACDF with 3 different opinions from 3 top surgeons. #12314

I am actually posting something that has nothing to do with the spine. I know that you went to Wayne State for medical school and there was a very interesting article in the NY Times today describing how downtown Detroit is in many instances relying on the Wayne State Police Department. I was not able to include the link within the forum.
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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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failedACDF

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