ACDF CRACKED GRAFT

Viewing 6 posts - 1 through 6 (of 6 total)

Author

Posts
brad60
Member

January 22, 2014 at 1:39 am

Post count: 3

#10201

4 MONTHS POST SURGERY, MY FOLLOW UP X-RAY SHOWS THE BONE GRAFT ( DONOR) IS CRACKED VERTICALLY. C4-5 FUSION WITH HARDWARE. SURGERY AND RECOVERY WENT VERY WELL. AT 2 MONTHS POST SURGERY I STARTED NOTICING EXACT SAME SYMPTOMS, RADIATING PAIN IN FORE ARMS TO INDEX FINGERS AND CONSTANT HEADACHES. SAME SYMPTOMS PRE-SURGERY. I HAVE TO TAKE XANAX OR NORCO TO GET A DECENT NIGHTS SLEEP. FOLLOW UP MRI SHOWS NERVE IMPINGEMENT IN C5-6. SO, 2 POINTS, WILL THE EXISTING GRAFT STILL HEAL? OR SHOULD I PUSH FOR A RE-DO AND INCLUDE C5-6?

Donald Corenman, MD, DC
Moderator

January 23, 2014 at 9:12 pm

Post count: 8660

#10210

You sound like you have two problems going on. The allograft (donor graft) cracked as some can. This donor bone is brittle and there are rare instances that a crack can occur. This graft can still go on to heal but needs to be watched carefully.

I am not sure that the exact symptoms are occurring now to you but I am sure they feel the same. You had the C4-5 level operated on to decompress the C5 nerve. The C5 nerve does not radiate pain or numbness to the fingers (this nerve stops at the mid upper arm).

The C6 nerve (originating from the C5-6 level) radiates pain and numbness into the index fingers. You sound to have involvement of the level below. Do you have any weakness of the biceps?

There are many ways to handle this problem. Some depend upon your physical examination but without that knowledge I can give you a thumbnail idea. You could consider a selective nerve root block (SNRB-see website) as this can diagnose your condition and potentially treat it too. If that is successful, you could continue to watch the graft at C4-5 to see if it heals or if it goes on to a non-union.

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.

brad60
Member

January 23, 2014 at 10:32 pm

Post count: 3

#10212

Thanks for you for opinion! Regarding the allograf, the posterior of it is currently in non union, so in general what time frame should I be considering regarding fusion? I know this is like shooting in the dark. Second, I am confused as well as my original complaint was for pain in my forearms and fingers, not my biceps. I do not have weakness in my biceps. Since my post, my GP has ordered Prendisone 20mg to attempt to reduce swelling in the c-6. so far arm pain has lessened, head aches continue. A follow up MRI shows impingement on c-6, post surgery. With indicated impingement a second surgery for c-6 seems inevitable? Thanks again for your time.

Donald Corenman, MD, DC
Moderator

January 24, 2014 at 3:06 am

Post count: 8660

#10213

If the anterior portion of the graft has incorporated, then the back half of the graft should eventually also incorporate. X-rays are not the best option to determine if fusion has occurred. A CT scan is the gold standard.

I am confused as well as to why you had a surgery at C4-5 with symptoms that extended down to the fingers.

Do you need a surgery at C5-6? Please see the section regarding “When to have neck surgery” to understand when surgery could be necessary. You could try nerve blocks as these injections can be effective.

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.

brad60
Member

March 24, 2014 at 11:11 pm

Post count: 3

#10609

UPDATE;
Approved, finally for a C5-6 ACDF. So we will remove the hardware from C4-5, complete the C5-6 w allograf and hardware that will connect both the C4-5 and the C5-6. Also during the C5-d we will decompress both sides where the nerves exit the spine area toward my forearms and fingers. Also in hopes this will alleviate the constant headaches in the process. I am a 53yr old guy on great shape, that enjoys moderate to heavy, (curl 40-60 lbs) weight lifting 5 days a week. My “day ” job is at a desk, no lifting. On my first ACDF I did not use a collar, should I expect to use a collar this round? .
In general, how long should I stay away from my “day” job? As far as the gym what time frame am I looking at.
As always, thanks for the great insight and service you provide. As you know, information is priceless ( even in the “general” form)
brad

Donald Corenman, MD, DC
Moderator

March 27, 2014 at 9:04 pm

Post count: 8660

#10627

The use of collars after ACDF are surgeon dependent. If this is a one level fusion, the graft fits well, a plate is used and the carpentry is good, there really is no need for a collar. I like to use a collar for about one week to protect the incision and remind the patient that they had surgery.

It takes about 6 weeks for an autograft (your own bone) to heal and about 12 weeks for an allograft (donor bone). Nonetheless, I think that at 6 weeks, a PT program can be started in either case. No weight lifting for at least six weeks and possibly twelve if allograft is used. This depends upon the six week X-ray.

If your “day job” is not physical, you can go back to work in my opinion within 3 days. For a strenuous job, you can’t go back to work for at least six weeks,

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.
Author

Posts

Viewing 6 posts - 1 through 6 (of 6 total)

You must be logged in to reply to this topic.

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel