3 level cervical fusion C5-T1

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Gianna13
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July 5, 2013 at 2:00 am

Post count: 6

#8999

I have a few questions concerning my up coming surgery. I am presently scheduled to have a left C5-T1 anterior cervical partial corpectomy, diskectomies ,foraminotomies,and arthrodesis with structural fibular allograft and local veterbral autograft, and titanium plate and screws. The fusion is to correct the the atrophy and weakness I have in my left forearm and hand.I have very weak grip strength and unable to straighten out my left pinky . The muscle under my thumb has completely wasted away.Initially I had pins and needles running down my arm but that has gone away.My grip strength has come and gone over the last couple of years,however the atrophy is new. I don’t have any neck or back pain whats so ever.

Im a 44yr old male firefighter who works out with kettle bells, practices martial arts ( grappling,wrestling and boxing).I also do crossfit type work outs, scuba dive and snowboard.I have had 2 past shoulder surgerys to my left labrum over the last 2 yrs.I was diagnosed with a brachial plexopathy prior to my second shoulder surgery.

On cervical studies I have multifactional stenosis canal and foramen at levels all the way from C3 toT3 with the canal itself maximally narrowed at C5-C6 and behind the body of C6 with opll where the cord is flattened.My thoracic MRI shows multiple levels of bulging herniated disks.Partly,the one that is very slightly touching the cord T5-T6 on the left,but it is not sever or even moderate compression.I have loss of lordosis and cervical kyphosis,the apex around C6, and kypotic angulation at C5-C6 and C6-C7.There is cord compression at C7-T1 where there is very significant left foraminal herniation and moderate to severestenosis of the canal.
There is also some foraminal narrowing down into the thoracic area at T1-T2 and T2-T3,along with the changes of the herniated disk.

My doctor says I should have full recovery in 6 months if all goes well. I will be in a Miami J collar 24/7 for 8 weeks,a soft collar 24/7 for 4 weeks and use a pulse electomagnetic stimulator 4 hr a day for 16 weeks. After that begin core strengthening
physical therapy program and evolve into a wellness program with pilates.By 6 months no limitations if everything goes as expected I should be able to resume physical activites including weightlifiting and martial arts if I insists,although its not recommended.
My question to you after reviewing my case do you agree with his course of treatment? Also do you think I will have any limitations after surgery?

Donald Corenman, MD, DC
Moderator

July 5, 2013 at 9:14 am

Post count: 8660

#9001

Much depends upon your physical examination. You could have added carpel tunnel syndrome (CTS) with your workout routine and occupation. If there was any question of CTS, I am sure the surgeon would have ordered an EMG/NCV test.

Let’s assume that all your symptoms stem from nerve and cord compression. I will also assume that the C4-5 level is not compressing the cord or any nerve roots, is not severely degenerative and is not in significant kyphosis.

T1-2 is the exit of the T1 nerve root which innervates (goes to) the hand intrinsic muscles (fine motor skills but not to be confused with myelopathy which also causes loss of fine motor skills). I will also have to assume that this level is not causing any symptoms.

If the above caveat is accepted, then it appears by your description that surgery is warranted at the levels planned. There are many ways to perform this surgery from the front (see ACDF section on the website) and this surgeon’s technique is perfectly acceptable.

Now “full recovery” is somewhat of a gray area. You have about about a 90% chance of a solid fusion. The surgeon can decompress and stabilize the nerves and cord but these nerves and cord have to recover on their own. That is mother nature and most likely but not guaranteed (see section under “nerve injury and recovery”-“nerve damage and healing”).

You would have some mild limitations after “full recovery” only in that you will have three discs fused (C5-6, 6-7, 7-10 which will put some increased pressure on the C4-5 disc. If you were my patient, I would have you forego kettle ball exercises and any ballistic exercises that were unnecessary (P90X). Your occupation creates enough ballistic motion. I think Pilates is great.

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 5, 2013 at 8:28 pm

Post count: 8660

#9006

Allowable exercises would allow strength, conditioning (the ability to lessen muscle fatigue) and range of motion. These exercises should not allow significant stress or motion that can overcome the inherent stability of the C4-5 disc and cause a tear of the annulus.

Unfortunately, life is about risks and your acceptable level of the risk. If you just stayed in the gym and away from kettle balls, the stresses on your neck would be minimal. If you decided to ski, horseback ride or mountain bike ride, you risk goes up if you have an unintended fall.

If you decide to continue martial arts and just perform katas, risk is reduced. If you spar, risk goes up.

There is no diet that can change the course of your 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.

Gianna13
Member

July 5, 2013 at 9:24 pm

Post count: 6

#9007

I do no gi grappling I guess I could stay away from live grappling.I have a couple of more question do you find it odd that I have zero pain with my condition?Is it a good thing or bad?Does it mean the nerves are past the point of return to normalcy ?

Donald Corenman, MD, DC
Moderator

July 7, 2013 at 1:27 am

Post count: 8660

#9014

I have some concerns regarding your diagnosis with no pain associated with your condition. Normally, nerve compression will cause pain to radiate down the arm. If this is strictly cord compression, this could be a painless condition but with other symptoms.

Do you have paresthesias (pins and needles) or numbness? Are any of the symptoms made worse with neck extension (bending the head backwards)? Do you have long tract signs (hyperreflexia, Hoffan’s sign, clonus). Do you have loss of fine motor control of your hands or imbalance with walking?

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.

Gianna13
Member

July 7, 2013 at 2:44 am

Post count: 6

#9015

At the tip of my left index finger i have pins and needles with a numbness.I use to have pins and needles running down my left arm but they have subsided at this time.Prior to my 2nd shoulder surgery (capsillar release) when I was diagnosed with a brachial plexopathy I had constant pain with pins and needles radiating down my left arm and no grip strength.The symptoms are not made worse by neck extension. I do have trouble with fine motor control of my left hand. I also noticed that my muscles in my left arm and hand tend to spasm every so often when I try to use them.I have no imbalance with walking or any long tract signs.
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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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