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Jellyhall
Participant

October 1, 2019 at 12:32 pm

Post count: 91

in reply to: Non-fusion of cervical spine #31224

I have now had a CT scan to see if my lower level of ACDF is fused or not. I am awaiting flexion/extension x-rays on my neck and a new MRI scan in 3 Tesla scanner of my neck and thoracic spine. I hope that I will hear if I am fused or not before my February appointment. It is a long time to wait with that uncertainty.

My last flexion/extension cervical x-ray stated that there is a grade 1 spondylolisthesis that moves slightly on the flexion x-ray compared with the extension one. Would you think that this also needs to be dealt with if another surgery is done?

I am also looking into postmenaupausal women having a higher chance of pseudoarthrosis due to lack of estrogen. I am now 64. If I do need another surgery to deal with this, do you think that it would be worth me taking HRT to attempt to improve my chances of fusing? I am also wondering if having a plate would help.

The surgeon who did my ACDF wasn’t reluctant to remove a titanium cage. Our discussion was before my surgery when I had asked about not having any bonegraft, plate and screws or collar. He was giving me evidence that a stand alone titanium cage would fuse.

I am under another surgeon in London for ongoing spine issues. These are also in my lumbar and thoracic spine. I had thought that my cervical spine was fine and wasn’t going to need another surgery because I had been told that there was spinal fluid flowing around the cord, so no more surgery was needed. This latest surgeon has told me that I do have foraminal stenosis.

I am very interested to hear your opinion about taking HRT and if you think C2/3 would need attention.
Thank you for your help Dr Corenman.

Jellyhall
Participant

September 23, 2019 at 10:19 am

Post count: 91

in reply to: Non-fusion of cervical spine #31142

Thank you Dr Corenman for your reply.

The 2 levels of C5/6 and C6/7 are also very degenerated with the disc practically completely gone and there is foraminal stenosis, which is why I am assuming that I have pain in both hands and arms.

I asked the neurosurgeon who did my ACDF 7 years ago, about not using any bone graft, plate and screws or collar. He explained that he and other neurosurgeons at the same hospital had been using the ‘stand alone titanium CeSpace implants’ for over a decade and they were successful. He described one of his colleagues who needed to remove one just 2 weeks after the ACDF surgery due to incorrect placement, and it was in so tightly that it was necessary to drill it out.
This now worries me as although the upper level of the implant appears to not be attached, the lower level does look like it is fused to the vertebra.
He also explained that he was doing an anterior surgery because he may need to do another surgery on the two levels below in the future, and it was difficult to do a repeat fusion surgery using anterior access after a posterior surgery had been done. I do have more pain now than before my first neck surgery, both in the neck and in my arms and hands.

Jellyhall
Participant

August 21, 2019 at 4:57 pm

Post count: 91

in reply to: Radiofrequency Ablation after Facet Joint injections #30944

After the facet joint injections, I did experience immediate relief but then my pain returned, but about two weeks later the pain improved again.This pain relief lasted for about 6 or 7 weeks.
It is very unfortunate that each time I have had an appointment at the hospital I am under now, I have seen a different doctor. The first three appointments I saw three different Fellows but then at my fourth appointment I saw the consultant that I am under. Each doctor has had a slightly different slant on my problems, so I am left a bit confused.

Right at the beginning, I was referred to have an up-to-date full spine MRI scan, flexion/extension x-rays of my neck and lumbar spine, full spine saggital x-ray and Bone SPECT CT Scan of my neck and lumbar spine.
The SPECT CT Scan showed a lot of ‘glowing’ areas on my spine, but particularly strong were the L3/4 and L5/S1 facet joints on the left side, which I think is why they wanted to start with facet joint injections to see if they would help.

I asked the consultant at my last appointment if the facet joint injections could help my leg pain and he said they could, so I am hoping that having the RFA will give me longer lasting relief. The Radiologist who did the injections told me that they were to try to relieve my pain but also to help the neurosurgeon plan for surgery! Surgery on my lumbar spine hasn’t really been mentioned, although at my latest appointment the consultant told me that L3/4, the level above my fusion at L4/5 isn’t good, that the level below my fusion is even worse and that L2/3 isn’t much better. I did know this. A different neurosurgeon told me that he would have to fuse the two levels above my lumbar fusion and extend the existing L4/5 fusion into it. He didn’t mention the L5/S1 level, and on some MRI images it looks OK. On other views it is extremely stenotic.

At my latest appointment I was told that I might need another surgery on my neck. He is ordering flexion / extension x-rays and new MRI scan of my cervical and thoracic spine. He wants to check that my neck is fused! That was rather alarming, because I thought that my neck was the least worrying level of my spine. I had an ACDF of C3/4/5 done nearly 7 years ago.

Thank you, Dr Corenman for being available to answer our questions. It is very helpful.

Jellyhall
Participant

April 26, 2019 at 12:02 pm

Post count: 91

in reply to: Ankle collapsing inwards when walking #30400

I think that the reason they want to begin with facet joint injections is because they did a SPECT CT scan, and although I have many levels with increased uptake of the radioactive substance, the left facet joint at L3/4 and L5/S1 are glowing particularly intensely.
They have suggested that we try a caudal epidural injection next, which they say will be able to flood up to cover three levels of L5/S1, L4/5 and L3/4. Do you think this is a sensible idea that would help me?

Jellyhall
Participant

April 20, 2019 at 12:02 pm

Post count: 91

in reply to: Ankle collapsing inwards when walking #30383

Thank you Dr Corenman, for your reply.

On reading my message to you I have noticed some errors.
I meant to say that I have … hypertrophied facet joints …

and that … this foot/ankle is collapsing inwards and my foot is turning out slightly.

I will be having a left facet joint injection at L5/S1 in 8 days. Do you think that it may help this pain and weakness?

Jellyhall
Participant

April 4, 2019 at 6:34 am

Post count: 91

in reply to: Left sided Facet Joint Injection L3/4 #30303

Thank you for your reply Dr Corenman.

Sadly, the pain relief in my lower back and leg and hip didn’t last long; only three days.
I am still wondering if I could notice the pain relief again because I am only 10 days post injection and have read that the steroid can take up to two weeks to give benefit. Do you think it is possible that the pain relief will return during this time?

I am wondering if the injection will be considered as a positive result as I have experienced pain relief, even though it was short lived.

I have another left sided facet joint injection of L5/S1 appointment in four weeks.

The doctor is also suggesting that I try a Caudal Epidural injection with enough steroid and enough local anaesthetic to flow upwards as far as L3/4. He said that it wouldn’t be possible to cover up to L2/3, where I also have problems, with this injection.
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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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Jellyhall

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