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john123
Member

January 8, 2015 at 3:59 pm

Post count: 30

in reply to: Stand alone ALIF on a male #11956

Quick question, when reading through a consent form for fusion surgery , I saw that aside from death, paralysis, etc, being the risks of surgery that blindness could occur from spinal surgery or spinal fusion as well?

I would assume this is a low % however, is this true? Have you ever seen a patient become blind after surgery ? What is the probability that this could happen ?

Thank you again !

john123
Member

December 2, 2014 at 3:13 pm

Post count: 30

in reply to: Stand alone ALIF on a male #11816

Dr. Corenman,

Thank you so much again for the invaluable information and your meticulous advice !!

john123
Member

November 3, 2014 at 3:12 am

Post count: 30

in reply to: Stand alone ALIF on a male #11640

so to be clear

1.) stand alone ALIF with interior fixation really should not be done with out pedicle screws for spondylosisthesis with disc hernation at same level due to pars defect ?

2.) If the ALIF 360 surgery is performed I would be better off with the TLIf as I would only have to retract one nerve root and will have the added stability of a posterolateral fusion ?

3.) I have heard and read many times that once nerve root(s) are retracted that the retraction can create a life time of painful nerve irritation. Is this common ?

4.) how do you size and fit the TLIF cage ? Isn’t it trial and error like the ALIF procedure?

The way my back feels is that there is nothing holding it up in the back, i.e. pars bone; it feel like it is caving in without the brace, therefore I do not see how a stand alone ALIF would hold me up without posterior fixation.

john123
Member

October 31, 2014 at 4:16 am

Post count: 30

in reply to: Stand alone ALIF on a male #11634

“The third problem with an ALIF for an isthmic spondylolisthesis is that there already is a defect in the posterior elements. The ALIF does provide some stability with the screw in cage, but without the stability of the posterior elements (due to the pars fractures-see website), this construct is not as stable as with a posterior approach”

Thank you always ! Your comment above is where my apprehension lies with just having a stand alone ALIF.

1.) When you say the construct is not as stable as with the stability of the posterior elements, what does this mean exactly ? Is it fair to say the the TLIF with the posterolateral fusion provides that much more stability with isthmic spondylolisthesis ?

2.) Also, if I am not having any leg pain, do you still believe it is absolutely necessary to remove pars defect!

You are correct, my intention is to have one surgery, not having to go back for more.

john123
Member

October 30, 2014 at 12:59 pm

Post count: 30

in reply to: Stand alone ALIF on a male #11627

Hi Dr. Corenman:

I wanted to follow up with you once again regarding the stand alone ALIF. Although you make excellent points regarding TLIF over ALIF, I don’t believe that many surgeons can perform the TLIF as well as others and therefore they choose ALIF because it is an easier and shorter surgery for them. As a matter of fact, most Dr’s that I have consulted with locally have now moved to ALIF for grade one isthmic spondylolisthesis and claim to have very good results vs TLIF.

1.) They “claim” the surgery is about one hour with one night in the hospital, minimal blood loss and no need for back up pedicle screws.

2.) They “claim” that if the fusion doesn’t take place that they will bring me back in for minimally invasive pedicle screws, but that rarely happens.

3.) I am also hearing that all the negative press of BNP with the stand alone ALIF was not true and it is safe to use now.

4.) They claim at the L5,S1 nerve plexis does not endanger retrograde ejaculation and with a good access surgeon they hardly ever see hernia or digestive issues.

Most have downplayed TLIF because or nerve irritation and claim there is no need to cut muscle and bone to access the disc space when it can be done minimally invasive through the front.

What are your thoughts ? This almost sounds too good to be true !

Thank you

john123
Member

August 4, 2014 at 3:58 pm

Post count: 30

in reply to: Stand alone ALIF on a male #11252

Thank you again. I follow your logic but I guess not everyone has the same logic. Again, many surgeons seem very enthused with the ALIF recovery time and the fact that there is no nerve retraction. However, it sounds like the cons of ALIF could far out weigh the pros especially for a male patient…

“The pars fractures that caused the isthmic spondylolisthesis separates the facets from the entire vertebra. Preserving the facets will not make a difference in stability, but there are detriments to not removing them.”

“These facets are great bone graft sources and should be used for graft. Not using them again makes absolutely no sense. This graft can make the difference between a solid fusion and no fusion at all. In addition, there is typically a large spur that grows off the bottom of the pedicle of L5 where the fracture originates. This spur compresses the L5 root and can cause compression if the disc is distracted by a intradiscal cage.”

Questions:

1.) In a PLIF the pars defect is removed, leaving the facets in tact. The pars defect is used for bone fusion in the two cages and also posterolaterally?

2.) In a TLIF the entire pars defect is removed along with spinal process and the one facet joint off to the side where my disc herniation is ? OR is the pars defect removed along with both facet joints and tranverse proceses ? This would sound like the entire portion of lower back at L5,S1 is being removed and replaced by interbody and posterolateral fusion ? Are there any bones left behind?

3.) When you place TLIF cage in, do you leave some of the wall of the disc to hold the cage in ?

4.) Do you also fill the disc space with BNP to supplement the cage ?

5.) How long is the recovery in terms of pain meds and returning to normal activity with TLIF ?

6.) Will patients require the use of oral steriods or IV steriods after surgery to reduce inflammation ?

Thank you again for sharing your knowledge and expertise!!!
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Viewing 6 posts - 13 through 18 (of 27 total)

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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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john123

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