12 Week post-op meeting for C5-6 ACDF

Tagged: posterior shoulder and thoracic pain after an ACDF cervical fusion

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cybermarc
Participant

November 30, 2019 at 9:45 am

Post count: 7

#31597

Hi Doctor Corenman, my name is Marcus and I’m a 36 year old male. 9 Weeks ago I had an ACDF performed on my C5-6 disc (with plate + cadaver bone.) And I’m looking for advice on how to go forward since my pain seems to still be much worse than before surgery (perhaps that’s normal at 9 weeks, I’m not sure.)

As background, I have had progressive pain and weakness from hands to biceps/triceps in both arms for 2+ years. I also had tingling and numbness when waking up. It is not nearly as bad as some people report, and mainly shows up when I exert myself physically (I live a very active lifestyle, homesteading on an off-grid cabin and farming sometime during the season.) I chose to get the surgery to try to get back some of my strength level to continue in these activities. Unfortunately, so far it’s had the opposite effect.

MRI revealed I had stenosis of spinal cord at C5-6 and also foraminal narrowing at same level. Attempted ~5 months of PT to little effect before opting for surgery.

Post surgery I had what I believe is the normal pain moving around to different places on different days. I regret to report I was not very strict with my restrictions (was not prescribed neck brace, first 6 weeks 10 pounds lifting, 2nd 6 weeks 25 pounds as tolerated.) Because of my lifestyle I had continual temptations to carry/push heavier things, which I did fairly regularly, although I definitely took it much easier than usual. This brings up worry about whether I may have aggravated my body’s attempt to fuse, and maybe that is why I still have pain?

For past two weeks my pain has been seemed to settle into a dull stabbing pain between my shoulder blades, but more on the right side, and also that travels up the back of my neck and around it’s right side when it gets worse. This shoulder blade pain comes very often, like when I am walking around or any impact really on my body, or even just turning. This was not really a pain I had before, at least not with any regularity.

My surgeon’s personality seems to be excessively relaxed, and his main input has been to congratulate himself on his surgery/experience so far. He says he does not do Xrays except in the most dire of pain circumstances (which I know I don’t have), but I feel like his lax attitude might be letting something slide. I’ve also read you saying that Xrays might not even show a failed fusion, but that CT scans are the way to go.

Another factor to add into the mix is that ten years ago I fell 85 feet out of a tree, compression fracturing T7 and T9 and facet fracturing T7. I healed up in a torso brace over 3 months with no PT and only suffered occasional back spasms over the ensuring years. Then, over the past three years I had a lot of life changes that first resulted in me being on the computer more (when the pain started in my hand, wrist, and forearm) and then progressed up to my medial epicondyle and bicep/tricep as I started a farming job and was regularly lifting heavy loads and also bending over for hours on end. I assume my tree fall had some cumulative effect over the years in combination with the normal wear and tear of aging and work on my body.

Thanks for your time in reading this. I’m specifically wondering how to direct my surgeon on my upcoming 12 week visit. Should I ask for xrays/CT, or some other approach? Of note also is that no imaging was ever done on my thoracic spine, which surprised me considering the level of trauma I’ve experienced there; might it be somehow linked to my cervical issues? I’m also wondering if my worry about failed fusion is unfounded because it’s so early after my surgery and pain right now is normal. To that end, I’ve been starting to do gradual warm ups with my body and light weightlifting to experiment with strengthening, but then if non-union is a danger then that could be the totally wrong thing to do.

Best,
Marcus

cybermarc
Participant

November 30, 2019 at 4:12 pm

Post count: 7

#31600

I suppose I should also note that the surgery is on my right side, and so is the shoulderblade pain I’m having.

Donald Corenman, MD, DC
Moderator

December 5, 2019 at 6:16 am

Post count: 8660

#31633

I’ve summarized your history here; “9 Weeks ago I had an ACDF performed on my C5-6 disc…MRI revealed I had stenosis of spinal cord at C5-6 and also foraminal narrowing

“My pain seems to still be much worse than before surgery”. “As background, I have had progressive pain and weakness from hands to biceps/triceps in both arms for 2+ year”

After surgery, you report; “I was not very strict with my restrictions (was not prescribed neck brace, first 6 weeks 10 pounds lifting, 2nd 6 weeks 25 pounds as tolerated.) Because of my lifestyle I had continual temptations to carry/push heavier things”,

The first thing to consider is new X-rays with flexion/extension components. My thought is similar to yours, a possible pseudoarthrosis. I assume that it is neck and posterior shoulder (trapezius) pain you are concerned with and that your arm pain and weakness has abated.

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.

cybermarc
Participant

December 5, 2019 at 8:11 am

Post count: 7

#31638

Thanks for your reply. I will ask for X-rays at my next appointment. What will the surgeon/radiologist be looking for? Movement? Might they justify that there “should” be movement because the fusion isn’t complete?

I don’t think it’s safe to say the arm pain/weakness is gone. Prior to surgery, it mostly manifested when I was exerting myself, which I’ve been doing less since surgery, but the threshold for the arm pain is now much less too it seems. The weakness is still there too, just less noticeable because I don’t carry heavy loads very much and have been “babying” myself more.

Regarding being 9-10 weeks out, I’ve heard conflicting reports from people that I should still expect to have a lot of pain, and no fusion anytime soon, and then from other people I hear it “should” be fused by 8-12 weeks. Any thoughts on this? Might I just be freaking out over the normal course of healing? It just seems odd that the pain has become so localized to one specific area.

Donald Corenman, MD, DC
Moderator

December 5, 2019 at 12:32 pm

Post count: 8660

#31645

You should not have more pain in your neck after surgery so various problems need to be ruled out. Did the graft migrate?, Did the graft collapse? Did the plate screws go where they should? Is there loosening. Most of the answers should be provided with simple X-rays including flexion/extension views.

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.

cybermarc
Participant

December 20, 2019 at 9:33 am

Post count: 7

#31750

Ext/Flex Xrays showed fusion progressing and no problems with the graft.

I am now again experiencing the full pain and tingling/numbness of my worst symptoms from before surgery, extending from neck down both arms and into hands. My doctor has suggested the possibility of carpal tunnel and double crush syndrome. This would make sense, as my symptoms started 3 years ago in the wrist from computer use, before progressing up forearm, bicep, and then to neck last.

I have an EMG scheduled for both wrists in a couple weeks, but I am wondering if that may, again, be trying to isolate the problem at one location and then miss the bigger picture. Just watched a video on double crush that pointed out it can come from a combination of a number of locations, including ulnar nerve entrapment sites, thoracic outlet, etc. My surgeon has already told me he doesn’t believe thoracic outlet syndrome is a real thing…which scares me that diagnostic testing might be just paying attention to the most popular sites like the median nerve at carpal tunnel.

He also suggested the possibility that it’s my C6-C7. My previous MRIs showed some disc degeneration there, but nothing like the C5-6 that I had removed/fused. We will look into diagnostic steroid or nerve block to investigate if that level is causing the pain/weakness. Would you recommend nerve block over the steroids for that?
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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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