Cervical CT Scan Results

Tagged: Continuing symptoms after ACDF

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323marine
Participant

July 6, 2015 at 7:10 pm

Post count: 5

#19980

Hello Dr. Corenman,

I was wondering if you would be kind enough to assist me in reading the CT scan results of my neck. Here are the results as follows:

C2-3: There is no significant uncovertebral hypertrophy. The intervertebral disk height is preserved. There is asymmetric left facet arthrosis with a ventromedial left facet osteophyte. The central spinal canal is patent. There is subtle narrowing of the left foramen. The right foramen is patent.

C3-4: There is a small right uncovertebral osteophyte. There is no significant facet arthrosis. The central spinal canal and both foramina are patent.

C4-5: There is no significant uncovertebral hypertrophy. There is mild right facet arthrosis. A subtle posterior broad-based bulge is present. There is a mild central protrusion. This appears to abut the ventral aspect of the cord. Both foramina are patent.

C5-6: There has been a prior ACDF at this level. The left C5 vertebral screw extends to the medial margin of the left foramen transversarium. There is no evidence of hardware fracture or hardware loosening. There is complete ankylosis of the intervertebral disk. There is a small to moderate right uncovertebral osteophyte.
There is a right central osteophytic spur. This may abut the right ventral to ventrolateral cervical spinal cord. The central canal appears patent. There is no significant facet arthrosis. The right foramen is subtly narrowed.

C6-7: There is no significant uncovertebral hypertrophy. The central spinal canal and both foramina are patent. There is mild left facet arthrosis.

C7-T1: Normal.

There is no significant cervical lymphadenopathy. There is no dominant neck mass. There is no lytic or blastic lesion of the cervical spine. There is a focus of dystrophic ossiflcation in the subcutaneous tissue of the mid neck at the level of C5. The paravertebral muscles are normal.

The 3-D volume-rendered reformations were invaluable in assessing the position of the fusion hardware and the alignment of the cervical vertebrae.

IMPRESSION:

1. Prior ACDF at C5-6. An osteophytic marginal spur appears to abut the right ventral aspect of the cord.

2. Degenerative changes of the intervertebral disks, the uncovertebral joints and the facet joints of the cervical spine are mild in severity. A mild central protrusion at C4-5 appears to abut the ventral aspect of the cord. There is no significant foraminal encroachment.

Any information/advice you can provide would be greatly appreciated.

Donald Corenman, MD, DC
Moderator

July 7, 2015 at 7:46 am

Post count: 8660

#19984

You illustrate the image reading but give no indication of your symptoms. Imaging does not rest in a vacuum. Correlation with symptoms is very important.

You have had a previously successful C5-6 ACDF (fusion). The screw from the plate might be abutting the C6 nerve on the left. See “symptoms of cervical nerve injuries” to understand what symptoms a C6 nerve can cause.

You have mild degenerative disc disease at C4-5 and degenerative facet disease at C2-3, C4-5 and C6-7. See the section on cervical degenerative facet disease to understand what symptoms these structures can generate.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

323marine
Participant

July 8, 2015 at 8:26 am

Post count: 5

#19995

Thank you Dr. Corenman for your prompt response and I apologize for leaving out the details regarding my symptoms. Nonetheless, here are the symptoms I’ve been experiencing:

Neck stiffness and burning shoulder pain that radiates down to my arms into my wrist, thumb and index finger (primarily on the left side). In addition, I have this pins and needles sensation that starts in my neck that migrates to my legs.

Based on the aforementioned information, is this a cause for concern?

Please advise.

Donald Corenman, MD, DC
Moderator

July 9, 2015 at 12:41 pm

Post count: 8660

#20002

Left sided arm pain can result from the potential of the screw impinging on the nerve root. You could try a cervical selective nerve root block (SNRB) of the C6 nerve on the left. If this is diagnostic (see pain diary), you might consider removal of the plate and screws to see if this gives you relief.

“Pins and needles sensation that starts in my neck that migrates to my legs” would not originate from your neck based upon the information you have supplied.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

Donald Corenman, MD, DC
Moderator

July 9, 2015 at 12:41 pm

Post count: 8660

#20003

Left sided arm pain can result from the potential of the screw impinging on the nerve root. You could try a cervical selective nerve root block (SNRB) of the C6 nerve on the left. If this is diagnostic (see pain diary), you might consider removal of the plate and screws to see if this gives you relief.

“Pins and needles sensation that starts in my neck that migrates to my legs” would not originate from your neck based upon the information you have supplied.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

323marine
Participant

July 17, 2015 at 6:45 am

Post count: 5

#20028

What is the medical procedure called to remove the plate and screws? Moreover, by removing the hardware, would it cause any instability issues? Thank you again, Dr. Corenman.
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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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