Disc Replacement

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ajpf52
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October 2, 2012 at 12:54 am

Post count: 3

#7067

Hello Dr. Corenman

I have gone to 2 surgeons who both recommended surgery soon and both said fusion surgery was recommended. As a mechanical engineer I have some strong reservations with the Fusion surgery and the loss of flexibility of the spine. It would seem to me disc replacement would be a good alternative, but when I ask about it they don’t recommend it for no other reason than they dont do it. What is the criteria for disc replacement as I have read many comments from people that get them and are very impressed with the results. I realize one type of treatment doesnt fit all situations but I feel like it is fusion or nothing. What is your opinion? I have included below my MRI results.

IMPRESSION:

1. Discogenic abnormalities as described below, most significant at C5-C6 where there is discogenic cord compression. See additional comments about other levels.

PROCEDURE:

Multisequence, multiplanar MR imaging was performed on a 1.5 Tesla System.

IV Contrast: Not administered as per protocol/request.

COMMENT:

Comparison exams: None available.

Discs: There is disc desiccation at all cervical levels. There is also narrowing at C3-C4, C4 dear C5 and C5-C6. This is compatible with degenerative disc disease. There is also degenerative joint disease at the C1-C2 articulation.

Vertebral Bodies: There are no destructive lesions or compression fractures.

Alignment: There is reversal of the normal cervical lordosis. Additionally,there is a retrolisthesis of C5 on C6 by approximately 3 rom.

C2-C3: There is a symmetric ventral disc/ridge complex that impresses but does not efface the ventral subarachnoid space, touch the ventral surface of the cervical cord nor displace or compress the cord. The foramen are patent.

C3-C4: There is a diffuse, but asymmetric right-sided ventral disc/ridge defect that effaces the ventral subarachnoid space, and mechanically contacts and indents the ventral surface of the cervical cord, but does not posteriorly displace the cord. The CSF posterior to the cord is effaced. There is bilateral foraminal narrowing.

C4-C5: There is a symmetric ventral disk/ridge complex that effaces the ventral subarachnoid space, and mechanically contacts and indents the ventral surface of the cervical cord, but does not posteriorly displace the cord. The CSF posterior to the cord is he faced at this level. There is bilateral foraminal stenosis.

C5-C6: There is a diffuse but asymmetric ventral disc ridge complex that is more prominent in the left parasagittal region. It contacts and deforms the ventral surface of the cervical cord, posteriorly displaces it and compresses it. There is no residual CSF remaining posterior to the cord at this level. There is no evidence of myelomalacia at the site of compression. There is bilateral foraminal stenosis.

C6-C7: There is a symmetric ventral disc/ridge complex that impresses but does not efface the ventral subarachnoid space, touch the ventral surface of the cervical cord nor displace or compress the cord. The foramen are patent.

C7-Tl: There is no disc herniation, canal or foraminal stenosis ..

There are no intrinsic cord abnormalities.

Donald Corenman, MD, DC
Moderator

October 2, 2012 at 7:54 am

Post count: 8660

#7072

Fusion surgery (ACDF) for the cervical spine is not as deleterious as you might think. A one level fusion is consistent with play in the NFL (think Peyton Manning) and should not significantly change the outcome of surrounding levels.

Nonetheless, artificial disc replacements (ADRs) are good implants in the right circumstances. In my opinion, those circumstances are herniated discs causing cord or root compression with a relatively normal (mildly degenerative) disc space. ADRs do not work if the disc space is significantly degenerative or there is bony stenosis (narrowing of the canal due to bone spur) which by your report is most likely your case.

The reason that ADR is not a good selection for significant bony spinal stenosis is that ADR allows motion. Bony canal stenosis can require significant vertebral endplate removal to make sure the canal is open. The technique for implanting an ADR requires preservation of the endplates of the vertebral bodies. If there is residual bony compression of the canal and now you increase motion of the segment, there is a chance for compression of the spinal cord. This is what you are trying to avoid with a surgery at this level.

I understand that you want to preserve motion, especially with the degenerative changes in your neck, but you still have to pick the correct surgery to match the desired outcome (reduction of the risk of spinal cord injury).

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.

ajpf52
Participant

October 2, 2012 at 8:16 am

Post count: 3

#7073

Thank you for your quick reply. My concern is that a 3 level fusion is recommended. It just seems like locking up 4 inches of your spine is a last resort. Have you ever performed multiple ADR and was the outcome good?
I guess I am disappointed with the options presented to me. One surgeon stated that I would lose 30% of my mobility with fusion surgery.

Would you be willing to look at the MRI if I send a CD to you for your opinion. If you feel you can help me, I am willing to come to your facility for the procedure.

Donald Corenman, MD, DC
Moderator

October 2, 2012 at 7:38 pm

Post count: 8660

#7079

A three level ACDF will stiffen your neck and increase the load on levels above and below. However, it might be helpful for you to measure the motion from flexion to extension on the lateral motion X-rays. IF you have a highly degenerative neck to begin with and the motion of these three segments is less than ten degrees total, a three level fusion will not cause a significantly notable difference to you.

Surgeons can perform hybrid surgeries. That is a combination of ADR and fusion. You might be a candidate for that procedure but again, this depends upon the quality and degenerative nature of your discs.

I can review your MRI and X-rays if you like. Please call the 888 number and talk to Margaret.

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.

ajpf52
Participant

November 7, 2014 at 4:10 am

Post count: 3

#11682

Hello Dr. Corenman

I hope all is well with you. I had spine surgery with you a few years ago where you had fused C5-7. I am sure you cant recall every surgery but I was having serious with neck upper back and shoulder pain. I have been treated for these problems with injections but they are becoming less effective. The pain radiates from my neck through my shoulders down my arms to the tendons of my thumbs. I was told it is most likely an impingement in the nerve. I am scheduled for an MRI and wanted to know your opinion as I was very satisfied with the previous treatment I received from you and your staff.
Andrew

Donald Corenman, MD, DC
Moderator

November 7, 2014 at 7:49 pm

Post count: 8660

#11685

As a previous patient who lives at a distance from the clinic, I would be happy to review your MRIs and X-rays. Please call Diana, Sarah or Becky at 970 476-1100 and let them know your interest.

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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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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