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YNA
Participant

January 1, 2019 at 9:30 am

Post count: 15

in reply to: L5/S1 Lateral Recess Stenosis #29955

Dr. Corenman,

I was wondering what your thoughts were in regards to these symptoms:

When I flex my knees, my feet (inside, no specific distribution, but not dorsum) feel more numb or more crampy. Is this just from the fact the tibial nerve already under stress cannot tolerate further compression with knee flexion? When I sit or lay down, I have to make sure I don’t flex my knees too much or both feet will develop paresthesias and numbness.

Also, 4/5 weeks after my original MIS, when I started to spasm, cramp, and have difficulty walking due to spasms and pain in my lower extremities (hamstrings, gastrocs, and quads!- L5), I was very hyperreflexic in my lower extremities when I was examined. Two months later, my reflexes are normal. What do you think occurred?

Happy New Year and thank you, again!

YNA
Participant

December 30, 2018 at 9:28 pm

Post count: 15

in reply to: L5/S1 Lateral Recess Stenosis #29950

Dr. Corenman, thank you again for this forum for all of us and answering our questions!

When I look up “lateral recess decompression” I see that the endoscopic and percutaneous (through the tubes) minimally invasive surgeries all claim they can decompress the lateral recess. Why then did it not work for me? My surgery was through the 16mm tube and included a microdiscectomy, laminoforaminotomy, and medial facetectomy. Is it just limited by the small tube exposure (even though they say they can move it around and do a bilateral decompression)? Or was it because my end plate is protruding out more than normal?

If I didn’t have a prior surgery, would I have had other minimally option these have been good options?

Thank you again! I’m sorry, I have so many questions.

YNA
Participant

December 29, 2018 at 2:06 pm

Post count: 15

in reply to: L5/S1 Lateral Recess Stenosis #29936

What is your opinion of this paper that discusses the improved long-term outcome of patients who get suction drains, fat grafts, and local steroids with their spinal surgeries. I have already demonstrated that I like to scar.

“Epidural Fibrosis after Lumbar Disc Surgery: Prevention and Outcome Evaluation” authored by Mohamed M. Mohi Eldin and Naglaa M. Abdel Razek

YNA
Participant

December 27, 2018 at 7:40 am

Post count: 15

in reply to: L5/S1 Lateral Recess Stenosis #29929

Dr. Corenman, is there a particular MRI image number I could look at that demonstrates the fact my S1 nerve roots are compressed?

Also, we talked I in our consultation about the decompression technique. I looked at the basic steps from “Orthobullets:”

1. Remove spinous processes of operative levels with rongeur (save as bone graft for possible fusion)

2 . Remove lamina and identify origin of ligamentum flavum

-Begin with decompression into canal into inferior half of lamina of cephalad vertebrae first with small curette

-Burr lamina and to thin and then complete resection with Kerrison rongeurs

3. Resect ligamentum flavum

-Gently retract ligamentum flavum with woodsen elevator
-Resect remaining lamina and ligamentum with Kerrison rongeur of cephalad vertebrae
-Resect ligamentum from superior lamina of inferior lamina
-Use Kerrison to resect caudad lamina from inferior vertebra

Lateral Recess and Foraminal Decompression

1. Perform Medial facetectomy
-Decompress medial aspect of facet on each side (2-3 mm of medial facet)

2. Decompress lateral recess

-Locating pedicle key to safe decompression
-Kerrison to undercut medial edge of superior facet of caudad vertebra until medial edge of pedicle visualized
-Identify osteophytes that could impinge exiting nerve root around pedicle
-Undercut remaining superior facet using kerrison rongeur (no more than 50% superior facet should be resected)

3. Confirm exiting and descending nerve roots are well decompressed
-descending nerve root should be visualized

4. Check to make sure no disc herniation.

Dural sac/nerve root may be retracted to see if there is bulging disc is present.

It sounds like the steps are pretty simple. If the spine surgeon uses a microscope and follows the directions, isn’t it a pretty (simple) routine procedure?

Thanks again, I hope to get the CT soon.

YNA

YNA
Participant

December 26, 2018 at 10:57 am

Post count: 15

in reply to: L5/S1 Lateral Recess Stenosis #29927

Thank you, Dr. Corenman!

I’m sending my x-rays out to you today.

Is it possible for your injectionist to call me with the cocktail he uses for his nerve blocks? I need to relay the information to my pain management doctor to see if we can accomplish the same thing here.

In regards to getting a L5/S1 CT, is there anything special I need to have ordered? Spiral CT, High resolution CT?

Thank you again. I am literally only able to be on my feet 5 to 10 minutes then I have to lay or sit down. It’s an awful existence.

YNA
Participant

December 25, 2018 at 9:17 pm

Post count: 15

in reply to: L5/S1 Lateral Recess Stenosis #29921

Dr. Corenman, thank you for your quick answer! I guess I am trying to understand why I had just left-sided symptoms below the knee (in the S1 distribution) before the surgery and now I have bilateral symptoms in the full S1 distribution after surgery. Inflammation, scar, osteophytes from surgery? Is there a way to reduce scar or osteophytes? Should Amniofix be used routinely with decompressions to reduce scarring? Thank you, again. Merry Christmas to you and bless you and your family!
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Viewing 6 posts - 7 through 12 (of 14 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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YNA

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