Non-fusion of cervical spine

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Jellyhall
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February 24, 2020 at 7:02 am

Post count: 91

#32122

Dr Corenman,
I am hoping that you will help me to understand my neck problems.
Last August, a neurosurgeon shocked us by stating that he thought I was going to need another surgery on my neck because he didn’t think it was fused. He sent me for flexion / extension x-rays and a CT scan. He also requested a new 3T MRI scan to see my cervical and thoracic cord.

I had an ACDF of C3/4 and C4/5 done 7 and a half years ago. At the time the two levels below this were also not good, but the neurosurgeon said he would only fuse the two upper levels where my cord was being compressed because if he did all four levels there was a much higher chance that not all of them would fuse. The surgeon used two Titanium CeSpace implants. He didn’t used a plate or screws and didn’t use bone graft and I didn’t wear a collar. He explained to me that he had used this method for the last 10 years and it did work. He said that he would rough up the vertebrae to make it bleed and that my own bone would then grow through the hole in the spacers to fuse my vertebrae together. He said that the spacers had ‘teeth’ in them that would hold them in place while I fused.

Most of my symptoms remained after surgery, but the surgeon had warned me that it might not help them and that he was doing the surgery to get the compression off the cord to stop the damage that was happening. He did say that I might need another surgery from the back later. When he last reviewed my neck about 3 years ago, he said that he didn’t need to do another surgery on my neck because there was still just enough room for the spinal fluid to flow around the cord. He did mention surgery on my thoracic and lumbar spine and emphasised that they would be very invasive. His follow up letter didn’t mention anything about surgery and it didn’t sound like there was much wrong with them. I wondered why he had talked about surgery during our appointment. After this, my GP felt that we should get another opinion. which we did.

So I was very surprised to have another neurosurgeon tell me that he thought my cervical spine wasn’t fused. I am in the UK where we have to wait for a long time to see specialists. I had to wait until the beginning of February this year to get the results of the scan and x-rays to find out if I was fused or not. I was very disappointed to be told at that appointment that the registrar wasn’t sure if I was fused or not but it looked ok to her. She wanted to view the scans with the Consultant, but he was on leave, and she would write to me when she had done that.

Today I received her letter. She mentioned that C2/3 had slight movement on the extension x-ray. I knew about that and there is a degernative grade 1 spondylolisthese there, but I don’t think that is a problem at the moment. She mentioned that the MRi of the whole spine showed degenerative changes throughout, but I knew that. There is just one sentence specifically related to my neck. I quote ‘Complete fusion has not yet taken place in the cervical spine’. Now this could sound like there is still time for my neck to fuse, but I feel doubtful that it will happen now, 7 and a half years after the surgery. My neck is becoming progressively more painful and the level of pain in both arms and especially the hands is also getting worse, and both neck and hand pain are significantly worse that before the ACDF. Back in August, the Consultant neurosurgeon pointed out the stenotic foramen to me. I hoped that if I needed a revision cervical fusion surgery, that he would be able to deal with that at the same time.

In the letter today, no mention has been made of another surgery, just that they will continue to follow up in the outpatient clinic. I now have an appointment in August this year. I don’t think that this registrar neurosurgeon knows how long ago my surgery was. At the start of our appointment a few weeks ago, she was under the impression that my ACDF had been done at that hospital 6 months previously, and clearly hadn’t read any of my notes. Ideally, I would hope that when she viewed my scans with the Consultant, they would have read the notes and seen how long ago the surgery was done, but I know that he is a very busy man, very much in demand and overwhelmed with the number of patients he overseas. She does say that they do not advise any particular restriction to my mobility.

So, my questions are,
* is my neck likely to fuse itself now after over 7 years?
* Is it ok to just leave it unfused? I do think that NHS patients are often left for much longer before surgery than in the US because of the waiting lists.

I am feeling very grateful to you for the opportunity to come to your forum and ask my questions.

Donald Corenman, MD, DC
Moderator

February 24, 2020 at 6:35 pm

Post count: 8660

#32129

Your neck will not fuse after 7 years. Non-fusion can on occasion be OK as long as there is no neck pain from the motion around the implants. If there is motion noted and associated neck pain, further surgery can be indicated.

You also probably have broken down somewhat at the levels below if they “did not look good” 7 years ago. You note “the level of pain in both arms and especially the hands is also getting worse” which could indicate nerve compression at C5-6 and C6-7 as both of those nerves radiate into the hands.

It seems the wait for spine care in the UK is much longer as I think this care is put on the back burner.

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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