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MASpinept
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September 29, 2020 at 6:37 am

Post count: 17

in reply to: S/p TLIF 8 weeks ago-new sx #33063

The new symptoms are what concern me as well. I did have a phone conversation with the surgeon and shared with him how i am feeling;he thought the MRI at the higher lumbar levels looked great. He thinks these symptoms are related to the tlif and nerves being irritated. I guess this could be possible but im not completely convinced. He did share that i had terrible scar tissue around L5 and he really had to dig in to dissect it. I do respect his opinion. he is the chief nsurg at a top orthopedic hospital, but unfortunately i have had some poor outcomes from people being wrong in the past, so i may be a bit jaded.

As far as the back pain-its inconsistently better in the past couple of days. The surgical pain is better but i find that changing positions (especially from laying down-sitting-standing) is very painful in the lower back area. Also, i become very stiff when laying down and trying to change positions in bed is very painful and challenging-this is how things were pre surgery, as well. And depending on which side of by body i am laying on, my leg symptoms change-if that makes any sense

I do find with more activity i am getting more nerve pain both in L5-S1 (which i expect) but also in this new distribution. For example, last night after sitting/standing at my son’s hockey game my leg felt more tired and heavy to pick up from the floor when walking, my knee felt very weak and on the drive home i had nerve pain all the way down to the inside of my ankle. Below are the most recent reports for standing xrays and MRI. Thanks for your help!

***Final Report***
EXAM#: 2511655
PROCEDURE: MR 0109 MRI SPINE-LUMBAR Aug 21 2020 3:10PM
CLINICAL INDICATION: post op pain
CLINICAL INDICATION: post op pain
TECHNIQUE: MR imaging of the lumbar spine was performed without contrast
in multiple planes with multiple sequences according to department
protocol.
COMPARISON: MRI from July 28, 2020
FINDINGS:
There are postsurgical changes related to anterior and posterior fusion
at L5-S1, with right-sided laminectomy and facetectomy changes.
Alignment and Curvature: Normal.
Conus and Cauda Equina: The conus terminates at the L1-L2 level and
demonstrates no signal abnormality. Cauda equina appears unremarkable.
Vertebral Body Heights: Normal.
Marrow Signal: There is persistent mild marrow edema at the L5-S1
endplates, likely reflecting Modic 1 changes..
Discs: Interbody spacer at L5-S1. Remaining discs are well preserved..
There is no significant canal or foraminal narrowing inferiorly through
L4-L5.
L5-S1: There is postsurgical fluid along the surgical tract into the disc
space, which superiorly displaces the right L5 nerve root within the
foramen, for example series 3 image 11. There is persistent T1
hypointense material in the epidural space extending along the right S1
descending nerve root, likely reflecting scar tissue. The is no
significant bony narrowing of the foramina. The canal is patent.
There are postsurgical changes in the paraspinal soft tissues. There is
small amount of postsurgical fluid in the surgical bed.
The imaged upper sacrum and upper iliac bones appear unremarkable.
Miscellaneous Findings: None.
IMPRESSION:
Lumbar postoperative changes at L5-S1 as described, with postoperative
fluid within the surgical bed and along the tract on the right side.

***Final Report***
EXAM#: 2507247
PROCEDURE: RAD 0137 XR LUMBAR SPINE 2-3 VIEWS Aug 7 2020 11:55AM
CLINICAL INDICATION: CHECK HARDWARE
EXAM: XR LUMBAR SPINE 2-3 VIEWS
COMPARISON: 02/17/2020. Correlation with MRI 7/28/2020 –
INDICATION: CHECK HARDWARE
FINDINGS: Upright AP and lateral views of the lumbar spine show
transitional anatomy at the thoracolumbar junction, with a lumbar-type
left transverse process and rudimentary right rib at what is considered
L1. There is a mild rightward curvature at L4-5. There is minor stepwise
grade 1 retrolisthesis from L1 to L4, and slight anterolisthesis of L4 on
L5. There are bilateral pedicle screws, posterior paraspinal rods, and an
interbody cage at L5-S1, and right-sided laminectomy defects.
IMPRESSION:
Laminectomy and interbody fusion L5-S1 with fixation hardware in place.
NUMBER OF IMAGES: 2
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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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