5 Level Cervical Laminectomy w fusion

Tagged: cervical muscle spasms, pain after 360 fusion

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westie California
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February 28, 2021 at 12:25 pm

Post count: 138

#33666

Good afternoon Dr. Corenman,

I hope your well and healthy. My question is in regard to cervical laminectomy with fusion and hardware, in particular five levels (C3-C7) procedure. I’m still having a lot of pain, muscle spasms, tingling in fingers, dizziness, bicep pain and occipital headaches. My head at times feels like its too heavy for my neck, I’m told that I’ve developed post laminectomy kyphosis and the measurement is 3.1 cm. A recent consultation with a spine surgeon mentioned that part of my problem is that the “Nuchal Ligament” was removed and basically the muscles are fatiguing in order to hold my head. I’m also told there’s no fix for this.

I’ve spoken to several surgeons and never heard of this. Have you heard of Laminectomies where Nuchal Ligament is removed and causing issues? I’m also wondering if the hardware should of been left in to strengthen the construct.

Thanks in advance

Donald Corenman, MD, DC
Moderator

February 28, 2021 at 2:06 pm

Post count: 8660

#33667

I assume that you are post-surgery from a “cervical laminectomy with fusion and hardware, in particular five levels (C3-C7) procedure”. How far out are you from this procedure?

You note you have developed “post laminectomy kyphosis” and that the reason is “the ‘Nuchal Ligament’ was removed”. If you are undergoing a laminectomy, by definition the nuchal ligament is removed as this ligament is attached to the spinous processes which have to be removed for a decompression.

If you did not have an instrumented fusion (“fusion and hardware”), then it is not uncommon to develop a kyphosis. You however report you did have this instrumented fusion which means that you have developed hardware failure.

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.

westie California
Participant

February 28, 2021 at 3:09 pm

Post count: 138

#33668

Hello Dr. Corenmen,

My first laminectomy was performed in 2013 (C3-C7), however it was determined that a revision procedure was required due to “defects”. So in 2017 a revision surgery cervical laminectomy with foraminotomies, medial facetectomies C5-C7 and segmental instrumentation C4-T2 was performed. In 2018 removal of hardware C4-T2, excision, debridement of upper back and neck wound, and reconstruction of right and left trapezius myocutaneous flaps was performed.

In 2018, I also developed cervical thoracic kyphosis. I recently spoke to a surgeon who mentioned that close to 40% of patients who undergo cervical laminectomy develop post laminectomy kyphosis due to nuchal ligament removal. The head tilts downward and causes pain, neck muscle fatigue, etc. My question is, would adding back hardware alleviate neck muscle fatigue by avoiding head from tilting downward?

Donald Corenman, MD, DC
Moderator

February 28, 2021 at 6:49 pm

Post count: 8660

#33669

So, your original laminectomy was in 2013. Then, in “2017 a revision surgery cervical laminectomy with foraminotomies, medial facetectomies C5-C7 and segmental instrumentation C4-T2 was performed. In 2018 removal of hardware C4-T2, excision, debridement of upper back and neck wound, and reconstruction of right and left trapezius myocutaneous flaps was performed”.

It sounds like you then had a fusion during the second surgery (the reason for the segmental instrumentation C4-T2). It then appears you had an infection requiring the removal of hardware and debridement/flaps to cure the infection and tissue loss.

Most likely, you have a failed fusion that is falling into kyphosis which is normal for your condition. If this is all true, you probably will need an anterior fusion (ACDF) to stabilize your neck if you can’t live with it.

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.

westie California
Participant

February 28, 2021 at 9:06 pm

Post count: 138

#33670

I’ve had the following ACDF’s also:

1. 2012-ACDF with Plate C5 & C6

2.2013-ACDF with Plate C3,C4,C7

3.2015-ACDF C7/T1 Peek Cage

4.2019- Re-exploration of ACDF with removal of cage & instrumentation & plate partial Corpectomy C7 and Diskecotmy C7- T1.Placement of cage biomechanical device into corpectomy defect, anterior instrumentation C7-T1.

2020 CT Scan shows solid fusion. What can be done to stabilize my spine, since I’ve now developed cervical thoracic kyphosis? Would adding instrumentation back help? How can one develop kyphosis if one is fused anteriorly and posteriorly from C3 -T2? Thanks

Donald Corenman, MD, DC
Moderator

March 3, 2021 at 7:20 am

Post count: 8660

#33686

You are not a stranger to spine surgeons! You should have a solid fusion from C3 to T1 with both anterior and posterior fusion techniques. I will assume that you don’t have a kyphosis from C3 to T1 but are developing kyphosis below that T1 level. You would need a posterior fusion from T1 to T5 (assuming the apex of your thoracic curve is below T6-7) with instrumentation up into the C4 or C5 levels. If your kyphosis is very stiff, you might need preoperative traction first to “loosen” the curve.

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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