4 Months

Tagged: How to work up poor results after an ACDF

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aprokop
Participant

May 4, 2018 at 1:48 pm

Post count: 22

#28222

Dr. Corenman,

I’m 4 months PO of a one level ACDF C5/C6. Is it common to still experience pain, inflammation, and stiffness at this point? My x-rays look good and I have been doing Physical Therapy two times a week for the last month. It doesn’t seem to help much. I’m 39 and I’m in pretty good shape. My surgeon said I should be feel pretty good by now. The x-rays show that I’m showing signs of fusion. Also is it safe to start take Advil etc?

I’m concerned.

Thanks,
Andy

Donald Corenman, MD, DC
Moderator

May 4, 2018 at 3:49 pm

Post count: 8660

#28223

Is the pain in the neck, shoulder or arm? Does pain radiate from one spot to another. What motions or actions increase the pain. How intense is the pain (0-10)?

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.

aprokop
Participant

May 7, 2018 at 8:55 am

Post count: 22

#28229

Dr. Corenman,

My neck is tight and sore most days. My right upper shoulder is stiff and I don’t have a lot of strength when I use arm above my chest. I rarely use my right arm for anything. I could not throw a baseball or anything like that. However if my arm just hangs there I don’t have pain. I have pain in between my shoulder blades as well with quite a bit of swelling in that region. I seem to have some swelling in the upper neck around my right ear. My right thumb is still numb but I’m used to it.

One of my biggest concerns is a pressure feeling that I get whenever I bend over or when I have to yell or get stressed. I’m a football, wrestling ,and track coach so I often need to project my voice and when I do I have pain that radiates down my neck and into my upper shoulder and between my shoulder blades. Stress also seems to aggravate the pressure pain. This pain is new since the surgery and its hard to describe but it can bother me to a level 7/10 at times. Not sure if that is considered nerve pain or muscle pain or both?

I have some tingling and pins and needles pain in the right armpit area however I would describe it as a 2/10 feeling. This really doesn’t bother me but it is there.

The positives is that I have good bicep and grip strength and I sleep pretty well. I usually wake up feeling better but by 11:00 I start to feel pretty crappy. I would says most days are 6/10 pain. I’m always trying to stretch and put heat and ice on my pain. I’m a middle school teacher so my work is done either in front of a computer or walking around with my students.

Right now all I take is Tylenol and occasionally a muscle relaxer. I ‘m trying to stay away from taking more stuff but I’m at the point I wanting to take something stronger because I’m wearing down. Not sure if Advil would help or if that is safe to use yet at 4 months PO. At 3 months I was showing signs of fusing but still had a lot of dark spots in the x-rays.

Thanks for your advice and help. I really thought I would be feeling pretty good by now after a one level fusion. The surgeon thought I would be golfing by April and I’m not even close to be able to do something like that.

Also the surgeon said the nerve was very calcified and irritated when he went in for the surgery and he said there was a lot of calcification on the disc as well. Not sure if that makes a difference on my recovery.

Thanks again for helping me out. This has been the hardest 4 months of my life! I want to be able to coach again and right now the pain after a day of teaching is keeping me away from the profession I love.
Andy

Donald Corenman, MD, DC
Moderator

May 7, 2018 at 8:01 pm

Post count: 8660

#28230

My first thoughts are of a pseudoarthrosis of C5-6 (non-fusion). Your symptoms of “My right upper shoulder is stiff and I don’t have a lot of strength when I use arm above my chest. I rarely use my right arm for anything. I could not throw a baseball or anything like that” could be from a C5 or a C7 radiculopathy. These are the two nerve above (C5 nerve at the C4-5 level) and below (C7 nerve from the C6-7 level). The deltoid muscle (C5 nerve) lifts the arm up over your head and the C7 nerve is responsible for throwing (the triceps muscle-think Peyton Manning). See https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/

Another potential disorder that might fit your symptoms is Thoracic Outlet Syndrome- see https://neckandback.com/conditions/thoracic-outlet-syndrome/.

Finally, a rotator cuff tear could be one cause. See https://neckandback.com/conditions/rotator-cuff-syndrome-shoulder-impingement-syndrome/

I think a good physical examination and new imaging studies are called for. Maybe a new MRI and/or CT scan along with X-rays.

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.

aprokop
Participant

May 10, 2018 at 8:05 am

Post count: 22

#28236

Dr. Corenman,

Thanks for your reply.

Wouldn’t four months be too early to consider to have a non fusion? (pseudoarthrosis) My surgeon said it could take a year for my bone to completely grow. He says the x-rays look good. He is worried that I may have a problem at c3/c4 but I don’t think that follows any of my symptoms.

Lastly do you let your patience use advil at the four month mark or not?

Have a great weekend,

Andy

Donald Corenman, MD, DC
Moderator

May 11, 2018 at 7:50 am

Post count: 8660

#28239

You can get a reasonable idea of the chance of fusion via flexion/extension X-rays and if necessary, a CT scan. Some ACDFs will heal late but there can be some obvious signs that this fusion “might not take”. The C4 nerve root (C3-4 level) does not go below the shoulder and does not affect arm strength or motion (other than pain inhibition).

I let my patients use Advil after three months as the inflammatory portion of bone healing passes after three months and Advil affects only that stage.

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

Average rating:

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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