Donald Corenman MD DC | Spine Surgeon Colorado

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glo
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May 23, 2018 at 9:58 pm

Post count: 9

in reply to: RE:MIS TLIF on L4/5 with dura tear, scared of arachnoiditis? #28338

Hello Dr. Corenman,

Thanks for your reply to all my questions. I am in despair to find out my nerve roots damage is PERMANENT!
a few more questions:
– Would the neurogram show any nerve injury at the dural tear location closed to left L4?
– So you are saying my nerve roots at L4 and L5 were damaged within the spinal canal and fixing the lesion at lumbosacral plexus and DRG will not heal the damage on the nerve roots?
– DO I have spinal cord injury at the L4/L5 level?
– so MRI neurogram will not help me to locate where the nerve root injury?
– Are there other tests you would recommend to help with my situation?
– if acupuncture helps with symptoms only, what should I do to improve my muscle recovery and paresthesias?
– So I am hopeless to even try to find other surgeons to help me repair my injury?
– Would you be able to help me if I schedule a consultation with you?

Please help!

thanks for your time and any helps and advises would be greatly appreciated.

Best,
Gabriela

glo
Participant

May 22, 2018 at 9:02 am

Post count: 9

in reply to: RE:MIS TLIF on L4/5 with dura tear, scared of arachnoiditis? #28324

Hello Dr. Corenman,
Thanks for your quick reply.
I have a few questions and hope you can provide your recommendations:
-Would the nerves damage possibly caused by the dural tear at Left L4 during surgery?
-Would nerve monitoring during surgery prevented damaging the nerves? I know they used Stealth GPS & O-arm but unsure about nerve monitoring.
-You said the nerves damage would be permanent, are there any treatments for damaged nerves?
-Would an MR neurogram as suggested by the neurologist show the location of the damage? If so, would revision surgery resolve the damage and pain/numbness/weakness?
-Would acupuncture or other non-invasive modalities help?
-Would my pain develop into CRPS II as the surgeon is sending me to get evaluation for SCS?

I am looking to consult with other neurosurgeon/orth.spine surgeons for treatment plans. Any surgeons in California whom you would recommend? Any help and advices would be greatly appreciated.

Best regards
Gabriela
glo
Participant

May 21, 2018 at 3:31 pm

Post count: 9
in reply to: RE:MIS TLIF on L4/5 with dura tear, scared of arachnoiditis? #28319
Hello Dr. Corenman,
I would like to give an update to my nerve root injury. It’s over 6 months since my MIS TLIF on L4/5 and I had an EMG/NCS test last week. Here is the report from the neurologist at UCSF:
: The results of nerve conduction studies are abnormal for :
1) reduced amplitude of the left superficial peroneal sensory nerve potential (SNAP) compared to study from 9/2017. The results of EMG studies are abnormal for : 1) fibrillation potentials in the left tibialis anterior (TA) and tensor fascia lata (TFL),
2) an increased incidence of long duration motor unit action potentials (MUAPS) in the left TA, TFL, vastus lateralis (VL), tibialis posteroir(TP) and peroneus longus(PL),
3) an increase incidence of polyphasic MUAPs in the left TA, and
4) reduce recruitment of MUAPs in the left TA, TFL and TP.
These abnormal electrodiagnostic studies provide evidence for:
1)a sub-acute left L5 radiculopathy, and
2)a chronic left L4 radiculopathy.
the decrease in the left superficial peroneal SNAP amplitude compared to prior study would suggest the lesion includes the dorsal root ganglion or possible the lumbosacral plexus. Clinicial correlation is advised.
Compared to the study from 9/2017, the left L4 and L5 changes are NEW. The relative sparing of the peroneus longus and tibialis posterior is unusual. Would consider an MR neurogram of the lumbosacral roots and plexus to confirm anatomic location.

I would greatly appreciate your help in understanding the extent of the nerve root damage…
How bad are the damages?? Are DRG orlumbosacral plexus part of the spinal cord?
Are they reversible? correctable? if not, I was told radiculopathy can spread from extremities to the trunk!
Any advises and recommendation would be greatly appreciated.

thanks,
Gabriela
glo
Participant

February 19, 2018 at 9:22 am

Post count: 9

in reply to: RE:MIS TLIF on L4/5 with dura tear, scared of arachnoiditis? #27646

Good morning Dr. Corenman,
Here is my CT-SCAN taken 2/14/18:
FINDINGS:
Interval surgery with interbody fusion elements at L4-5 level and bilateral L4 and L5 pedicle screws. No pedicle cortex is seen inferior to the left L4 pedicle screw. Pedicle screws do not extend into the lateral recesses or the foramina. There appears
to be focal bony continuity across the L4-5 disc space. Slight anterolisthesis of L4 on L5. No acute vertebral body compression fractures. Pseudoarticulation of right L5 transverse process with S1 as before.
T12-L1 (focal posterior left of center disc protrusion with annular calcification noted without high-grade bony spinal canal or foraminal narrowing).
L1-L2 (disc bulge and facet joint degenerative changes. No high-grade bony spinal canal or foraminal narrowing).
L2-L3 (disc bulge and facet joint degenerative changes. No high-grade bony spinal canal or foraminal narrowing).
L3-L4 (disc bulge, facet joint degenerative changes and ligamentum flavum hypertrophy with mild spinal stenosis. Right posterior lateral disc protrusion might abut the extraforaminal portion of right L3 nerve sleeve as before).
L4-L5 (postsurgical level. Left foraminotomy. No high-grade bony spinal canal or high-grade bony foraminal narrowing.
L5-S1 (facet joint degenerative changes and spondylosis without high-grade bony spinal stenosis. Bony elements encroach upon the right foramen possibly affecting the exiting L5 nerve sleeve.
Mild to moderate bony narrowing of left foramen also noted. Bilateral SI joint spurring)
Paraspinal Soft Tissues: Mural vascular calcifications.

IMPRESSIONS:

IMPRESSION:
Interval surgery with interbody fusion elements at L4-5 level and bilateral L4 and L5 pedicle screws. No pedicle cortex is seen inferior to the left L4 pedicle screw.
There appears to bony continuity across L4-5 disc space.
No high-grade bony spinal canal compromise
Bony encroachment upon right L5-S1 neural foramen could affect the exiting right L5 nerve sleeve. Correlate clinically.

Questions:
1) Does CT scan show any nerve compression due to placing the screw in the pedicle after TLIF?
2) Do you see any bone growth indication in the report?
3) any issues with the finding of the report?
3) my surgeon kept saying nerves takes 6-12 months to recover from surgery. I need to wait for at least 6 months to suspect nerve damage or ARC. He is saying all my progressive symptoms are nerve irritation caused by handling during surgery. IS THAT TRUE?
4) Your comment “I can’t tell you that you don’t have arachnoiditis but you are worried about the wrong disorder. You have a direct nerve injury.” Would the direct nerve injury caused arachnoiditis down the road? Their Symptoms are so similar.
5) what are the best treatments for direct nerve injury/damage? PT, Pain Med, exercise, etc??

Your advices and help are greatly appreciated.

best regards
glo

glo
Participant

February 18, 2018 at 11:37 pm

Post count: 9

in reply to: RE:MIS TLIF on L4/5 with dura tear, scared of arachnoiditis? #27643

Dr. Corenman
Thanks for your reply and your advice.
You made my day that I don’t have ARC！
Beside numbness, random stabbing/burning, electric shocks pain from knee to toes,I am super sensitive to gentle touch,I can’t wear socks or shoes and bedsheets touching feel like pin prickling from knee to toes. Also start having aching pain from my left buttock(sit bone) to my left outer calf. Are they also symptoms of nerve damage?
The surgeon ordered a ct scan to check on bone growth, I’m waiting for the radiology report. Would it show any nerve damages? Also per your comment “Placing the screw in the pedicle after the TLIF could have created some nerve compression. A CT scan would be the study to obtain if that is suspected.” Would the report show that?

Thanks so much for your time and advice
You’d given me more help than my surgeon and his team!
Best regards
Glo

glo
Participant

February 18, 2018 at 9:35 am

Post count: 9

in reply to: RE:MIS TLIF on L4/5 with dura tear, scared of arachnoiditis? #27620

Hello Dr. Corenman,
thanks for your quick reply.

the operative note was given to PCP by the surgeon. Would there be more detailed operative notes with the hospital medical records? I will call them Monday to ask for it. The fellow told my husband the dural tear was small but did not give any details.
I read through the link you sent regarding chronic radiculopathy. I actually have L4 nerve injury too as my left knee will buckle during walk and cannot balance on the left leg. I tested myself with the exercises you listed online and I failed them on both L4 and L5 nerve tests.

I’d contacted my PCP for an MRI and she referred me back to the UCSF surgeon. She has given me a referal to see a neurologist last August(before surgery). I will see if I could make an appointment with the neurologist for an EMG test and ask for a MRI.

Questions:
– would I need a MRI with contrast due to hardware in spine?
– would EMG test help to confirm the nerves damages and where they are?
– based on my symptoms, would my nerve damages during surgery recover over time?
– regarding your comment on “left L4 screw we placed after the TLIF to avoid hindering the TLIF view”, would his approach caused damages to my nerve roots during surgery?
– how would I find out who actually performed all the procedures during surgery?
(the op note said he did the decompression and hardware placement, might be the fellow did the dural tear repair, kwires placement, drilling, ???
– What other steps are done during TLIF & decompression that can be performed by fellow?

I greatly appreciate your help and advices. You had given me hope that I might NOT have adhesive arachnoiditis which is my BIGGEST fear!

have a wonderful Sunday!

best regards,
gabriela
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Viewing 6 posts - 1 through 6 (of 8 total)

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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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glo

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