3 Fusion Surgeries Past 10 years. Worse now 2nd opinion didn't help.

Tagged: cervical, CT, failed, fusion, help, NECK, PAIN, review, scan

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wbwalsh
Participant

August 30, 2017 at 10:05 am

Post count: 3

#26245

Hi everyone. My name is Brian I am 50 years old and had my third fusion surgery in February 17 which included installing a cage at C2-C3. In 2007 I had my first fusion at C5-C6 and in 2010 that hardware was removed and a single plate installed from C4-C7. Wasn’t able to “bounce back” after Feb17 surgery. My pain management doc ordered MRI and strongly suggested a second opinion from a neurosurgeon as all my surgeries were done by the same orthopedic surgeon who is advising every “looks good”. My second opinion included nerve tests and a CT scan. I will post those results in separate post immediately following this post. The second opinion doc spent less than 5 minutes on our first appointment when ordering test then had his secretary call me this morning saying doc thinks only issue could be Feb17 surgery not fusing and wants to wait 6 months for another CT scan to see if any issues.

I have constant pain in the base of my skull, pain/pressure in neck, right shoulder, numbness/pain right arm/outer fingers. Pain move to left side, down back and legs as my activity increases.

Anyway I hope to get some insight from this forum on other people’s experience with continued pain/issues after fusion.

wbwalsh
Participant

August 30, 2017 at 10:21 am

Post count: 3

#26246

Below is a copy/paste of my latest CT Scan. I have removed my identifying information and the physician’s information.

Patient Copy

Generated on: 25-Aug-2017 13:05

Page: 1

Creation Date : 08/17/2017
Performed At : Mayo Building Jacksonville
Indications : Cervicalgia;neck pain

17-Aug-2017 13:31 *** Final ***
Exam: CT Cervical Spine WO/CST

Copy

Impression: Complex anterior cervical fusion is present from C3 through C7,
with stand-alone cervical cage fusion at C3-4 without loosening of hardware
but without evidence of bony bridging across the disc space, and ACDF/anterior
plating from C4 through C7 with solid fusion across the disc spaces at C4-C5
and C5-C6, questionable very minimal anterior bridging at C6-C7, but there is
no evidence of solid bony fusion across the disc space at C6-C7 otherwise.
Please see the discussion below.
Findings: Complex postsurgical changes are present of the cervical spine. At
C3-C4, there is a stand -alone anterior cervical cage fusion at C3-C4 without
evidence of loosening or displacement of this hardware. I do not see evidence
to suggest bony bridging across the disc space at this level. At C4-C5, C5-C6,
and C6-C7, there are further ACDF’s with intervertebral disc spacers, with
anterior plating from C4 through C7. There is solid fusion across the disc
spaces at C4-C5 and C5-C6. There is question of minimal amount of a bony
bridging across the anterior margin of C6-C7 disc space, but I do not see
evidence of a solid bony fusion across the disc space at this level. I do not
This printout was generated through Patient Online Services and was the most current version as of the date and time generated.

Copy

Comparisons: Outside MRI of the cervical spine dated June 7, 2017 and outside
cervical spine series on May 25, 2017.

Patient Copy

Generated on: 25-Aug-2017 13:05

Page: 2

see evidence to suggest loosening of the hardware or abnormal displacement of
the same.
Adjacent segment degenerative change is present at C2-C3 with slightly
diminished intervertebral disc space and a 2 mm grade 1 degenerative
spondylolisthesis. Minimal anterior subluxation is present at C3-C4.
Additional intervertebral disc space loss is present from C7-T1 through T2-T3
levels. There is expected straightening of the cervical spine from the
surgical findings.
C1-C2: Minimal hypertrophic degenerative changes are present at the
atlantoodontoid junction, otherwise unremarkable.

Copy

C3-C4: Mild facet arthropathy is present. There is minimal endplate spur.

C4-C5: Expected postsurgical changes are present with solid interbody fusion.
Mild facet arthropathy is present. Suspect minimal partial ankylosis of the
facets.
C5-C6: Expected surgical changes from solid interbody fusion. There is mild
facet arthropathy. There is minimal partial ankylosis of the facets.
C6-C7: Mild facet arthropathy is present. There is a minimal endplate spur
formation. Uncovertebral hypertrophy is present with mild left-sided neural
foraminal encroachment.
C7-T1: Moderate right and mild left facet arthropathy are present. There is
minimal disc bulge.
T1-T2: Minimal disc bulge is present, otherwise unremarkable.
This printout was generated through Patient Online Services and was the most current version as of the date and time generated.

Copy

C2-C3: Mild facet arthropathy is present. There is mild degenerative anterior
subluxation as described above.

Patient Copy

Generated on: 25-Aug-2017 13:05

Page: 3

T2-T3: Mild facet arthropathy is present.
Electronically signed by:
17-Aug-2017 13:31

Copy

Copy
This printout was generated through Patient Online Services and was the most current version as of the date and time generated.

wbwalsh
Participant

August 30, 2017 at 10:24 am

Post count: 3

#26247

EMG Test pasted below:
Patient Copy

Generated on: 24-Aug-2017 09:13

17-Aug-2017
Study Number: 1

Page: 1

Electromyography

Final Report

Referred for: Neck pain
Referral Code:
011 019
314

Copy

Nerve conduction studies of both upper limbs were
normal. Concentric needle examination of selected right upper limb and right cervical paraspinal
muscles demonstrated long duration, high amplitude motor unit potentials in the pronator teres
muscle only.
CLINICAL INTERPRETATION: Abnormal study. The findings are most compatible with an old, inactive
right C7 radiculopathy. There is no evidence of an active right cervical radiculopathy or right
upper limb mononeuropathy or left median mononeuropathy on the current study.
E. Dimberg (127 or (78)3-9741)
NERVE CONDUCTIONS

Temperature: 34.5 ?C

Record
Rep
Normal
Normal Distal Normal F-Wave F-Wave
Nerve
Type Site
Stim Side Amp Amp
CV CV Lat Lat Lat Est
————————————————————————————————–abductor
pollicis
Median
motor brevis
L 10.8 (> 4.0) 55 (> 48) 3.3 (< 4.5)
This printout was generated through Patient Online Services and was the most current version as of the date and time generated.

Copy

SUMMARY: Prior to starting the procedure, the patient’s identity was verified, pertinent available
records were reviewed, the nature of the procedure was explained, the appropriate sites of the
exam were confirmed directly with the patient, and a pre-procedure pause was performed for final
verification of all of the above.

Patient Copy

Generated on: 24-Aug-2017 09:13

Median
Ulnar
Median
Median
Ulnar
Ulnar

Page: 2

abductor
pollicis
motor brevis
abductor
motor digiti minimi
sensory wrist
sensory wrist
sensory wrist
sensory wrist

R

8.0 (> 4.0) 56 (> 48) 3.5

(< 4.5)

R 11.0 (> 6.0) 63 (> 51) 2.3 (< 3.6)
L 148 (> 50.0) (> 55) 1.7 (< 2.3)
R 109 (> 50.0) 63 (> 55) 1.8 (< 2.3)
L 37 (> 15.0) (> 54) 1.6 (< 2.3)
R 38 (> 15.0) 61 (> 54) 1.7 (< 2.3)

NEEDLE EMG

This printout was generated through Patient Online Services and was the most current version as of the date and time generated.

Turns

Copy

Copy

Ins Spont MUP
Recruitment Duration Amplitude Phases
Muscle
Side Act Fib Fasc Normal Activ Reduced Rapid Long Short High Low %
————————————————————————————————–First Dorsal
Interosseous R NL 0 0 NL
Extensor
digitorum
communis
R NL 0 0 NL
Pronator
teres
R NL 0 0
1+
1+
Biceps
brachii
R NL 0 0 NL
Deltoid
R NL 0 0 NL
Triceps
brachii
R NL 0 0 NL
C7 paraspinal R NL 0 0 NL
Patient Copy

Generated on: 24-Aug-2017 09:13

Donald Corenman, MD, DC
Moderator

August 31, 2017 at 3:47 am

Post count: 8660

#26252

To reiterate your symptoms: “I have constant pain in the base of my skull, pain/pressure in neck, right shoulder, numbness/pain right arm/outer fingers. Pain move to left side, down back and legs as my activity increases”.

To dissect out symptoms, pain at the base of the skull can typically originate from degenerate facets, normally at C2-3 and C3-4 but occasionally at C1-2 (rare). There is noted degenerative facets at C2-3 (“Adjacent segment degenerative change is present at C2-C3 with slightly diminished intervertebral disc space and a 2 mm grade 1 degenerative spondylolisthesis”). This could be causing your base of neck pain.

Since you have had a fusion at C2-3, please explain the rationale why that level was operated on and how the results went both initially and now. However, there is a discrepancy in your reporting. You note a fusion at C2-3 (“February 17 which included installing a cage at C2-C3” but your CT report notes “anterior cervical fusion is present from C3 through C7, with stand-alone cervical cage fusion at C3-4 without loosening of hardware but without evidence of bony bridging across the disc space”. Did you mean you had a fusion at C3-4?

You have a fusion at C4-7 after an initial fusion at C5-6. What were the reasons and the results after those two surgeries?

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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