Donald Corenman MD DC | Spine Surgeon Colorado

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Viewing 4 posts - 1 through 4 (of 4 total)

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WKBW
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May 29, 2020 at 9:12 am

Post count: 6

in reply to: Final Update: Revision microdiscectomy – thoughts/suggestions? #32601

Once again, thank you vey much Dr. Corenman for your time. You’ve been extremely helpful!

WKBW
Participant

May 26, 2020 at 3:47 pm

Post count: 6

in reply to: Recurring sciatica post-op microdisectomy #32598

Dr. Corenman,
I met with my neurosurgeon today to review my new MRI results of a symptomatic large recurrent disc protrusion at L5-S1, exactly where my first one was. Per your suggestion this included a discussion regarding my previous lumbar CT scan report from Feb. which stated I had a “Left L5-S1 spondylolysis” along with a SBO defect at S1, which you referred to as a “floating facet”. (See previous post for exact details). He explained that it was, in actuality, an intact (non-fracture) elongated pars that likely developed along with my SBO.

He then said that due to his previous pre-op concerns regarding these two findings, he checked the stability of my spine during surgery and made note of it being “quite sturdy”. In regards to the thinner bone area, he further explained that he will enter through the same incision and only remove a little more bone to give him a slightly bigger window. Consequently, he and I feel confident that a revision microdiscectomy is the most appropriate choice for me at this time.

We briefly discussed the possibility of other pain generators, but the fact that my symptoms are so similar to before and were completely resolved following the first surgery, he feels sure this revision will have the same affect with a more long-lasting result. There’s never a full guarantee or a crystal ball, but do you agree with his thinking?

Also, I know that each surgeon has their own post-op instructions/guidelines, but do you offer your patients (going through revision microdiscectomy) any additional instructions that you feel would help prevent another reherniation? If so, I would appreciate any suggestions.

Finally, thank you so much for helping me with my recent situation. Your willingness to take the time to read my story and give quick responses to my questions, has been remarkable! I’m lucky to have found your forum, been educated by the vast “free” information you have available on your website, and most of all, to have had the benefit of your knowledge and experience. Thank you for selflessly giving back to all of us here.

WKBW
Participant

May 21, 2020 at 1:41 pm

Post count: 6

in reply to: Recurring sciatica post-op microdisectomy #32588

My understanding from the neuro is that the pars defect is actually an “elongated (stretched?) pars”. Prior to surgery he explained that this would actually make the laminectomy easier as it is thinner bone than normal. Does this make sense, and does it mean that he would have removed a portion of the dysplastic area during surgery? Could this add to it not being visible on the new MRI?

I will discuss my options for surgery with my neuro and take your advice regarding the CT. Thank you!

WKBW
Participant

May 21, 2020 at 12:04 pm

Post count: 6

in reply to: Recurring sciatica post-op microdisectomy #32585

Hello, again, Dr. Corenman

Per your request, here are portions of the notes from my recent MRI (5/20/20). I copied what I believe are the most important.

“The lumbar lordosis is well maintained without subluxation, spondylolysis or spondylolisthesis. There is no scoliosis. The lumbar vertebral bodies demonstrate minimal spondylitic change in the lower lumbar spine with small Schmorl’s node along the inferior endplate of L5. Lumbar bone marrow signal is benign. No compression or other fracture identified. Marrow signal and morphology of the upper sacrum appear normal.”

“The L5-S1 level demonstrates postoperative changes of a left-sided laminectomy. There is a large recurrent left-sided L5-S1 disc herniation at this level directly compressing the left ventral aspect of the thecal sac with direct compression of the left S1 nerve root sleeve. There is normal appearance of the right-sided articular facets and right-sided ligamentum flavum. The left-sided spondylolysis at L5 identified on the CT is not identified on this MR.”

“The lumbar nerve roots of the cauda equina are normal. No epidural hematoma or collection. Benign postoperative signal in the posterior paraspinous soft tissues. Retroperitoneal soft tissues are normal.”

“Impression:
1. Sequela of left L5 laminectomy with large recurrent left paramedian disc herniation directly compressing the left S1 nerve.
2. Minimal degenerative changes at L3-4 and L4-5, stable in comparison to prior studies.”

Since the MRI I have not had any discussion with my neurosurgeon. My appt. is on 5/26. Over the past few days I’ve been achieving some occasional relief of left low back/left leg symptoms by taking Motrin 400mg po q6h tid. Pain level 3-5 down to 1-2. However, I also need to take Colace tid with it (prone to constipation) and have a history of chronic superficial gastrtis so can’t live on these meds for long.

As you previously mentioned, do you think that getting standing 4 view
X-rays would still be beneficial? Any need for another CT?

Are there other conservative treatments you would recommend I try before a revision microdisectomy?

In your experience, if revision surgery is necessary, what is the success rate?

What do you consider my best options to be at this point? Thank you, again, for any advice or guidance you can give.
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Viewing 4 posts - 1 through 4 (of 4 total)

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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WKBW

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