Neck has not fused and 3 of 4 screws lose

Tagged: ACDF, Failed neck fusion, loose screws

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

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Moonraker
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July 9, 2017 at 3:44 pm

Post count: 2

#25470

I had an acdf February 2015 c5-c6 using 4 screws, a plate, and a spacer. Horrific nerve pain stopped but have had chronic pain nearly ever since. The original surgeon left the practice one month after my surgery. Every time I went in I had someone different and they all said I was fusing. About 2-3 months after the surgery the muscular pain became unbearable. I had another MRI done and the new doctor at the same clinic never went over it with me. He said nothing was wrong. No one would help me. I found out later my bone spurs where never shaved down either. It wasn’t until spring 2016 my new physical therapist brought to my attention the MRI report indicated a screw may or may not be loose. No one would see me as a new patient since I had neck surgery already and I have been unable to find any relief or help besides learning to stretch out my whole body as now my hips are always rotated and my leg muscles hurt – I hurt everywhere. Finally a surgeon at a new facility caught it on regular X-rays a screw was indeed loose and I have never fused. After MRI and CT scan he indicated 3 screws are loose. We tried facet joint injections and it gave me relief for almost 2 weeks. He is recommending going in from the back adding 4 more screws, 2 rods, and a part of my hip to stabilize my neck and let it fuse. I am scared and very upset all these other surgeons I have spoke with have brushed me off as if I am crazy yet this surgeon saw on normal X-rays in the office there are problems. I am very pleased he took the time with me and actually found the problem – he said there is so much movement in my neck. I would like to know if this sounds like a good option for me? Also, is there anyway I can hold the original facility responsible in some way for blowing me off and telling me I was fusing when I was not and never telling me I may have had a screw loose and the fact they never even bothered to check – this was 5 months after the surgery. This has been so difficult on me physically mentally and emotionally and I am very upset with how they handled my case. I felt as if I was being shamed when I went in looking for help and pain relief. Instead I had to make trips to the emergency room to get any form of relief. Lastly, pillates seem to be something which will benefit my overall tightness of my body which is now so out of whack – would it be safe to do pillates while I am figuring out the surgical route to take? Thank you so much for your time. I want to have some quality of life and not have to take pills which don’t help much but are only thing I can seem to do so I can function at work.

Donald Corenman, MD, DC
Moderator

July 9, 2017 at 8:58 pm

Post count: 8660

#25473

I find it hard to understand that no one had see you since you have had a failure of surgery. Half of my practice is revision work and I am not the only one. It bothers me that you could not find someone else until you found this surgeon. Unfortunately, it is bad care to ignore your lack of fusion. You did not have progressive neurological loss thank goodness.

You have a pseudoarthrosis (lack of fusion) of the level (or levels) that were addressed. This is not too uncommon and can be repaired by another surgery. Some surgeons will go through the back of the neck and some will repair this by going back in the front. I look carefully at the MRI, X-rays and CT scan to determine if one approach is better than the other. There are rare occasions that both could be necessary.

The good news is that the repair should help you relieve some or all of your current pain.

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.

Moonraker
Participant

July 10, 2017 at 11:17 am

Post count: 2

#25487

Thank you so much for your response! This has been a nightmare. The surgeon who did my surgery left Spine Team one month after my surgery so I was bounced around to different people each time I went back for an x-ray follow up. After being brushed off by them. I had sought help from another place and they had me do a series of tests including a myelogram and when I met with that neurosurgeon to go over the tests he said the bone spurs which were never shaved down was the cause of my pain and sent me to pain management to get injections. At that time it had been roughly 9 months after surgery and said I was still healing and I would probably need another surgery in the future but I needed to wait. He said we need to buy me time basically. After the series of 2 injections (which kind of helped with swelling) I asked to do physical therapy again and have been pretty much ever since with a manual therapist to help with pain. I have sent my MRI and CT scans to other doctors which have been recommended to me and they straight up told me no I don’t need surgery and wouldn’t even see me. I have been trying to get someone to order me new sets of scans for over a year now and even my pain doctor told me it wouldn’t matter even if I had a loose screw and that I will never be pain free again but refused to give me even muscle relaxers. It has been a very humbling and frustrating experience to say the least. I went in to Texas Back Institute and was told they would just do X-rays and send me off for MRI and so forth and then I would meet with a neurosurgeon to go over the results. After getting the initial X-rays done they came back in and asked me to do a few more where I turned and looked up and then down. A neurosurgeon did then come in and speak to me on my initial visit and told and me he can tell I have not fused and can see halos around some of the screws (and even showed me the images which I was so grateful for!). This has been the first time in nearly 2 years of searching for answers anyone has actually listened to me and took the time to look at my images. After the new MRI and CT scan he told me I had 3 loose screws. He had measured how far my neck was moving and showed me those as well which I was blown away by the amount of information he was able to provide after all my experiences. He said the movement is far too much and gave me the numbers of how far it should be moving compared to now. He suggested facet injections to see if I got any relief and this would build a case for us to make sure surgery would help and so forth. They did help a lot but only for about 1.5 weeks. After I had the injections I saw Dr. Ju again and still felt better and he suggested we wait to see how long it lasts and follow up a month later to do more X-rays and see if the movement has changed as in getting worse and see how I’m feeling still from injections. Now I am back to higher pain level and meet with him next week were I plan to discuss going through with the surgery. I am 37 year old female and don’t want to live this way and hope I can get better quality of life. But I am scared. Sorry for so much information it’s just I have not had much luck with anyone giving me advice or guidance and I am just thrilled you have responded with such wonderful information. I appreciate you taking the time to read all of this. It means so much to me I can’t even begin to express my gratitude toward you and this forum. If I understand correctly I can send copies of my X-rays and MRI Ct scans as well? I would love to have another experienced set of eyes look over them if possible. Thank you so much Dr. Corenman! You have already helped me more than you know!!!!

Donald Corenman, MD, DC
Moderator

July 10, 2017 at 12:27 pm

Post count: 8660

#25489

Unfortunately, “pain doctors” are not surgeons. Some have a good understanding of surgical indications and others don’t understand these indications. The facet blocks did give you relief which indicates the facets are at least some of the pain generation problem but ultimately, it is the lack of fusion that is most likely the pain generator.

You don’t note differences between neck pain and arm pain. One doctor’s comment “the bone spurs which were never shaved down was the cause of my pain and sent me to pain management to get injections” indicates you have continued bone spurs (uncovertebral joint hypertrophy) which could be compressing the nerve roots. If you still have arm pain, due to nerve compression, this would require an anterior approach to take out the non-united graft (whatever was used) and redo the fusion here with iliac crest bone graft.

If no significant shoulder/arm pain and most of the pain is in the neck, a posterior fusion should work.

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.
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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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