POSTERIOR HARDWARE PAIN

Tagged: POSTERIOR CERVICAL HARDWARE REMOVAL

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

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PhillyT
Participant

October 12, 2017 at 9:36 am

Post count: 9

#26575

Hi Dr Corenman,
We spoke a couple years ago about my C67 non union and 7/1 pain pattern.
Dr R said C6/7 was not fusing and that I needed to fuse it and C7/T1 posteriorly in order to get 6/7 to fuse and fix the herniation at 7/1.
May 2016 I did the C6toT1 posterior fusion.
Woke up with brutal left arm burning. Long story short, it improved about 50% but R told me there are two rods on the left side where I’m complaining of local neck pain. The muscle tissue pops off and on the offending hardware. It’s like a chunk of flesh that is floating over the hardware. When I push on this flesh it causes arm burning. Weird right? R doesn’t understand why this happens and would love to hear an answer, perhaps from another surgeon…

R did MRI’s an CT scans and can’t see any problem with the hardware or the nerve roots. I want the hardware OUT but he said it won’t help and is unethical to perform a useless surgery because everything is where it’s supposed to be and that I’m fused. But the pain is endless and now I’m getting pain from 5/6 (on top of fusion)

I think it’s unethical to leave offensive hardware in while someone is suffering.

Have you ever seen two rods on one side installed in a posterior fusion? R seems to be the only on doing it. A few other surgeons think that was a bad idea.

Are there any studies and data on removing posterior hardware? Have you done it often?

Dr P C in Barcelona looked at my CT scan and MRI and thinks removing certain parts of the hardware will give me the best chance at pain relief there, and to install an M6-C at C5/6 to stop the adjacent disc disease. (I’m having horrible arm pain from C6 and did a nerve root block which alleviated the arm pain for 4 hours, so I know 5/6 is a problem) It sounds like a good idea but at the same time could be a huge gamble to mess with the posterior hardware.

Thanks for your time my fellow CSUN grad!

Donald Corenman, MD, DC
Moderator

October 13, 2017 at 3:16 am

Post count: 8660

#26583

I have never used two rods on one side, even in a scoliosis fusion. I did not know there was enough room to place two rods on one side in the neck. R is a good surgeon and he must have had some reason for this procedure but I am unclear why this was done.

If you are fused, and have continued local pain (neck pain and shoulder pain), I think removing the rods would be a reasonable procedure. It is not hard to remove this hardware. If your pain is arm pain from nerve root chronicity and there is no evidence of the metal touching any nerve root, it is less likely that removal will be helpful. A successful SNRB at C6 does implicate this level in at least some of your current arm pain.

Make sure you are a candidate for an artificial disc at C5-6 and not a fusion. See https://neckandback.com/treatments/artificial-disc-replacement-adr-for-cervical-spine/.

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.

PhillyT
Participant

October 13, 2017 at 10:04 am

Post count: 9

#26589

Thanks for the reply Dr!
Yeah, Dr R said he always does 2 rods on one side. 1000 times so far. AND he’s removed the extra rod a few times due to patients like me complaining. The removal has yielded roughly a 50% success rate. Seems like he’s the ONLY surgeon using two rods on one side. All top surgeons like yourself are baffled by this technique. He also told me, prior to surgery, NONE of his patients have pain from his posterior approach. Oh well, I guess he lied, because he just told me I’m #4 now.

No one can seem to understand why the tissue popping causes C7 and C6 arm pain. Perhaps all the swelling from the loose tissue is affecting the nerve roots as they exit the spine? I cannot live with the pain of the tissue popping off and on the hardware then causing local pain and arm pain. So something is going on outside of the spine to the nerve roots that is causing arm pain when the tissue pops off and on the offending hardware. Perhaps an MRN would show what the nerve roots look like after they exit the spine. Have you had any luck with MRN’s?

Dr P C said there’s no reason from my MRI or CT scan that I’m not eligible for an ADR. Have you heard anything about the M6? It’s widely used every else but here. I heard it did well in clinical trials here and should be available in the US in a few years. Wonder why it’s so late to the game?

I’m just hopelessly confused and in brutal pain. Thanks for your opinions!

Have a great weekend
Tom

Donald Corenman, MD, DC
Moderator

October 26, 2017 at 10:08 am

Post count: 8660

#26693

The M6 is an acceptable ADR. I am more of a fan of the Bryan disc as it has shock absorption.

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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