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sperryguy
Participant

March 14, 2017 at 9:16 am

Post count: 68

in reply to: Incomplete Spinal Fusion #24529

Hi Dr Corenman

This is the latest MRI report

MRI LUMBAR SPINE:

TECHNIQUE: Sagittal: T1, STIR, T2. Axial: T1, T2 (disc cuts L1-S1). Coronal: T2. Additional coronal STIR imaging of the sacrum was obtained.

CLINICAL HISTORY: Back pain, prior fusion surgery, assess interval change.

FINDINGS: Comparison prior lumbar MRI 09/27/16. The lumbar spinal canal is normal in size and configuration. No acute fracture is seen. No intradural abnormalities, bony destructive lesions or paraspinal masses are noted. The distal thoracic spinal cord and conus are normal. No bony or neural anomalies are identified. A small right renal cyst is partially visualized. Coronal imaging of the sacrum and sacroiliac joints is unremarkable.

L1-2, L2-3: Negative.
L3-4: Minimal posterior bulging of the disc annulus and mild facet arthropathy is noted. A small left foraminal disc herniation is causing very mild compression of the exiting left L3 root. No significant thecal sac deformity is seen..
L4-5: The patient has undergone laminectomy, posterior instrumented fusion and interbody fusion. Posterior metallic rods/screws and an anterior disc graft are noted. No herniated disc, spinal stenosis or postop collection is seen.
L5-S1: A small central and slightly more left-sided broad-based disc herniation is noted, causing mild midline thecal sac compression. Mild foraminal deformity of the exiting left L5 root is also noted.

Impression:
1. NO SIGNIFICANT CHANGE SINCE THE PRIOR LUMBAR MRI DATED 09/27/16.
2. SMALL LEFT FORAMINAL DISC HERNIATION, L3-4, CAUSING VERY MILD DEFORMITY OF THE EXITING LEFT L3 ROOT.
3. PREVIOUS LAMINECTOMY, POSTERIOR INSTRUMENTED FUSION AND INTERBODY FUSION, L4-5, AS SIMILARLY NOTED ON EARLIER IMAGING. POSTERIOR METALLIC RODS/SCREWS AND AN ANTERIOR DISC GRAFT ARE AGAIN DEMONSTRATED. THERE IS EXCELLENT DECOMPRESSION OF THE SPINAL CANAL, WITHOUT NEURAL COMPRESSION OR COLLECTION.
4. SMALL CENTRAL AND SLIGHTLY MORE LEFT-SIDED DISC HERNIATION, L5-S1, CAUSING MILD MIDLINE THECAL SAC DEFORMITY. MILD FORAMINAL DEFORMITY OF THE EXITING LEFT L5 ROOT IS AGAIN NOTED.

This is the XRAY of my hip:

History: Bilateral groin pain for 4 weeks, left more than right, no trauma

Technique: XR HIP AP AND FROG BILATERAL

Comparison: 6/24/2014

Findings:

The right and left hip joint are congruent. The joint spaces are preserved. The cortical margins are normal.

There is mild prominence of the anterior femoral head neck junction bilaterally. There is fibrocystic change at the anterior right femoral neck. The acetabular morphology is normal bilaterally.

There are no osteophytes or erosions. There are no aggressive appearing lytic or blastic lesions. The pubic rami, ilioischial and iliopectineal lines appear normal. The bilateral sacral foraminal lines and sacroiliac joints appear normal.

Impression:

There is no evidence of fracture or dislocation or arthritic change in the hips.

————————————————————————————————————

I believe that this will be the last MRI prior to revision surgery. The groin pain continues, Motrin 400MG appears to help along with 1/2 tablet of percoset(lowest dose).

sperryguy
Participant

March 9, 2017 at 10:50 am

Post count: 68

in reply to: Incomplete Spinal Fusion #24487

Hi Dr. Corenman

The surgeon indicated that the L5 disc has severely herniated and unstable. I just went for yet another detailed MRI. Once I receive the results, I will share with you and the forum.

Thanks

Steve

sperryguy
Participant

March 8, 2017 at 9:32 am

Post count: 68

in reply to: Incomplete Spinal Fusion #24464

Hi Dr Corenman

Thank you again for your help. He does want to do a fusion. He explained that without the additional fusion, I would be very unstable. He feels that the nerves are compressed and should have been addressed at the first surgery. I have one question, Over the last few months, I am really suffering with bilateral groin pain, worse on the left side. The pain level during an attack is 8-9. The pain throws me down, cannot function. Would you know if this can be a result of my issues?

Thank you Again… Steve

sperryguy
Participant

February 22, 2017 at 1:26 pm

Post count: 68

in reply to: Incomplete Spinal Fusion #24420

Hi Dr Corenman

Just a quick update, I tentatively scheduled my surgery for May 2017. What can I expect with this revision surgery? The surgeon would like to redo the rods and screws, use bone from my hip vs cadaver bone. He is reluctant to remove the Globus Expander cage for fear of injuring the dura. He mentioned that he doesn’t use such a spacer due to this issue. Then he plans on decompressing L5/S1, and removing the L5 Disc since it has degenerated since the last surgery. Typically will my recovery be more intense? Can you suggest ideas to heal better? I simply cannot believe that my first surgery was a failure and i need even more correction.

Thank You again

Steven

sperryguy
Participant

February 14, 2017 at 9:11 am

Post count: 68

in reply to: Incomplete Spinal Fusion #24331

Hi Dr Corenman

Its been awhile since I have contributed to the forum. A brief update. Im 27 months post TLIF L4/5 surgery. My primary surgeon finally said that there is no indication of any fusion. The nuclear scan showed activity, leading him to that conclusion. New, and disturbing symptoms, are aching, bilateral front leg pain, piercing groin pain. So severe that it causes me to fall to ground until it passes. My pain doctor indicated issues with the L3 as well as the L5. To say the least I am exhausted and leaning towards the recommended surgery of redoing the L4/5, decompression at the L5 levels. The juries out on the L3, since that is a new development. Any ideas or recommendations? As always thank you for your amazing advice

Steven

sperryguy
Participant

September 12, 2016 at 10:20 am

Post count: 68

in reply to: Incomplete Spinal Fusion #22963

Hi Dr C

The surgical consult indicated that in my situation, a bone scan was not necessary(as you so accurately explained). Prior CAT SCANS and X-ray Flexion Extensions provided him with all he required to make a diagnosis. Even prior to my detailed exam, he had a good idea what is happening. Again, you nailed it, a pseudoarthrosis. His assessment is as follows:
1) Questionable Complete Fusion of the Facets Joints
2) No Fusion within the cage. As a side note , he pointed out that the type of cage that was used was too small(typically used for minimally invasive ) and had a feature that spread once installed. He pointed out that he never uses such a cage since it limits the amount of fusion material placed within the cage. He typically uses a large cage. He also prefers harvesting bone from my hip vs cadaver bone.
3) The type of TLIF that was performed was minimally invasive where the facet joint was not removed. He felt this contributed to the current issues. As per the doctor, he always removes the joint so he visualize the area.
4) He mentioned that the Mylegram indicated that I have adjacent level disease at the L5. He mentioned that the facet block injections epidurals worked so well since I have issues at that level.
5) He requires a new MRI and Flexion Extension (since the old one didn’t show me leaning enough?)

I was completely blown away by the type of operation that was performed. No idea it was minimally invasive and that the facet joint wasn’t removed. As a layman, it appears I got a “Trim” vs a “Full Haircut”. He felt that the surgery should have included some of the above and if I understood correctly, removing the lamina(?) providing a better view of the nerves that are being squeezed.

His exam, and analysis took close to 2 hours and he was very through. He offered me two options, both of which are surgical. Option 1 was to clean up the L4 region. Attempting to remove the cage and replace with a larger cage and add fusion material. He would then fuse the L5 region. Option 2 would be as the above mentioned, but expose the area and relieve the pressure on the nerves. He said it is longer surgery and there is more risk. Though he has extensive experience in revision surgeries. He said typically there is a 60-70% success rate but it can certainly be higher.

Over the last two years (22 months) has been a daunting and frustrating experience. While I felt I did extensive research on this surgery(layman), it appears I was in the dark on what was actually done.

Dr C, is what i was told reasonable? This surgeon would be the third consult over the last 22 months. He was the first face to face doctor to give me a clear and concise diagnosis(aside from your self). What other questions should I ask? Mentally I am not prepared though logically revision surgery is appears to be the reasonable solution. Is option 2 the better solution or go through the less invasive option? Im so sorry for all the question. My symptoms are getting worse.

Again..thank you! Steve
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Viewing 6 posts - 25 through 30 (of 65 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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sperryguy

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