3 Fusions-1 failed, bilateral neuroforaminal narrowing at C6-7

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3timescharm
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August 5, 2014 at 7:38 am

Post count: 2

#11255

I really would appreciate your suggestions and help on what to do next. I’m scared, lost and frustrated. I’ve had 3 cervical fusions in the past 4 years, C3-C6-fused perfectly, C6-C7 was fused a year+ later and that fusion failed. It was re-done 7 months later and it appears to be fusing at this time, however, I now have severe pain in both middle fingers, my arms are numb when I wake up in the morning (this goes away) and my elbows get sharp pains when I lean on them. I had the elbow pain and the numbness/tingling in my left arm prior to the fusion, but now my right arm has the same pain and it seems to be worse than the left arm! The middle finger pain is a new symptom. I got an MRI which showed that I have mild/moderate spinal canal narrowing at C6-7. Stable mild spinal canal narrowing from C3-C4 through C5-6. I have moderate bilateral neuroforaminal narrowing at C6-C7 and moderate right and mild left neuroforaminal narrowing at C5-6.I also have mild C7-T1 degenerative disc disease. No spinal canal or neural foraminal narrowing. The neurosurgeon said I could try Lyrica for the nerve pain to see if that helps, or I could try an epidural (I’ve had 3 in the past that didn’t work for the arm issue),or he could do another surgery to try and open the area where the nerves exit. I’m really nervous about getting a 4th surgery especially since he will be cutting open the back of my neck this time! My fear is that nothing else will help (long term) but surgery. I would greatly appreciate any advice, thoughts or suggestions that you could offer. Thank you so much!

Donald Corenman, MD, DC
Moderator

August 5, 2014 at 9:31 am

Post count: 8660

#11256

First you must slow down. Your symptoms might not originate from the cervical spine. There are conditions called peripheral nerve entrapments that can occur in your shoulders (thoracic outlet syndrome), elbows (cubital tunnel syndrome) and wrist (carpel tunnel syndrome) that can cause similar symptoms. See the website for a description of these disorders.

It really sounds to me like cubital tunnel syndrome in your case but I would not rule out the other two without an examination. Do not undergo another cervical surgery until this is ferreted out. This might simply require a physical examination or as much as an EMG/NCV test (look at the website for a description).

If these disorders for some reason do not pan out as your diagnosis, you might consider a selective nerve root block to determine if the foraminal stenosis is your pain generator. This would require keeping a pain diary (again-see website) for diagnosis.

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.

3timescharm
Member

August 5, 2014 at 11:26 pm

Post count: 2

#11258

Thank You very much for responding!I very much appreciate your help and insight.
I should have mentioned that I had and EMG evaluation (and MRI) last week. EMG showed no indication of Carpal Tunnel. There was indication of “old” nerve damage (minimal) from prior surgery on left side. Ortho Surgeon also thought possible issues with Ulnar nerve. Performed physical examination, and, in his opinion, this is not a concern. Are there more definitive tests for Cubital tunnel or Thoracic outlet? The Ortho Surgeon did not mention a “nerve block”, but did offer an epidural? I am not familiar with a “nerve block”. Would this be preferable vs.an epidural?
I am currently enrolled in Physical therapy, and have had a medical massage as well. The Physical Therapist has shared that the back of my neck is very tight and “knotted up”. And as I mentioned previously, when I awake in the morning, my neck is swollen and upper arms are numb and tingling. This disappears in a while once I am up and moving around. Do these symptoms lean more towards Thoracic outlet?
The Ortho Surgeon started me on Steroids (prednisone) approximately 6 weeks after my last surgery. While on the steroids, I was symptom-free. As soon as I discontinued the steroids, all of the symptoms returned.
The middle finger on both hands does not seem to function properly and has considerable pain. General dexterity and grip in these 2 fingers is very poor. Any thoughts on this specific symptom, since this is a new symptom after my 3rd surgery?
In your opinion, would “moderate bilateral neuroforaminal narrowing at C6-7” be something that would likely require surgery in the future? or this something that one can live with and not have any issues?
Again, I cannot thank you enough. Prior to your response, I WAS seriously considering a 4th surgery. You have given me hope!! Thank you!!!

Donald Corenman, MD, DC
Moderator

August 6, 2014 at 1:26 am

Post count: 8660

#11261

The EMG/NCV for nerve compression in the forearm is not always accurate. If you have numbness/paresthesias (pins and needles) in your ulnar distribution (the non-thumb side of the hand) and pressure on the inside of the elbow (the ulnar nerve or “funny bone”) creates these symptoms, more likely than not you have cubital tunnel syndrome. If the examiner “taps” firmly on the nerve in the groove (cubital tunnel), a “zapping” sensation should radiate down the nerve to the fingers (called a Tinel’s sign).

If this Tinel’s sign is not present, these symptoms certainly could be from thoracic outlet syndrome or originate from the cervical spine. You could also look into interosseous nerve entrapment syndrome but this is much less likely.

A selective nerve root block of the C7 root and a pain diary kept after this might diagnose this disorder (see website).

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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