ACDF Post-operative Concerns with CT-Scan results

Tagged: Continued cord compression after ACDF

Viewing 6 posts - 1 through 6 (of 39 total)

1 2 3 … 5 6 7 Next

Author

Posts
wgreenlee
Participant

June 10, 2016 at 9:17 pm

Post count: 53

#22366

Hello Dr. Corenman,

I had a ACDF surgery on the 11 june 2015 and have had issue with numbness,burning pain, and especially weakness in the arms. I had a CT-Scan the other day and confused and concerend. Hopefully you can help me understand these results.

At C5-6 There is posterior spondylotic change with osteophyte encroachment upon the right half of the spinal canal and abutting and deforming the spinal cord. The spinal cord on the right is displaced posteriorly. There is no foraminal narrowing.

At C6-7 There is uncovertebral facet hypertrophy on the right narrowing the right foramina. There is no canal stenosis.

The Impression: Cervical myelogram demonstrates prior anterior cervical fusion from C5 TO C7. At C5-C6 there is posterior spondylotic change with osteophyte including upon the right side of the spinal cord and abutting and deforming the spinal cord. There is a kink in the glenohumeral spinal canal.

Very confused seeing that the post-operative report states that the osteophyte’s were removed with a Midas RX Drill. I appreciate any input and will be having a EMG done this month, but deforming and displaced doesnt sound very good after having a surgery in that particular area.

Bill G.

P.S. I have also read a little bit on the success rate of second surgeries and it doesn’t appear to be very good.

Donald Corenman, MD, DC
Moderator

June 11, 2016 at 2:15 am

Post count: 8660

#22367

First question would be what were your symptoms prior to the surgery and what changes to the symptoms occurred after the surgery? How has the arm weakness changed since surgery? Do you have any myelopathic symptoms before or after surgery (https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/)?

There is still compression of the right side of the cord at C5-6 after the ACDF. Comparing before and after images could be helpful to see how this compression has changed. The hopeful news is that I assume there is a fusion now of C5-6 which would mean the cord compression is less problematic. Motion of the segment tends to be the cause of cord injury and if there is a solid fusion, the chance of injury drops.

At C6-7, there still is foraminal stenosis so this could be causing some right C7 nerve root symptoms. See the section https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/ to understand what C7 nerve dysfunction looks like. An EMG might not be too effective in shedding light on the nerve problems. See https://neckandback.com/treatments/emgncv-electromyograms-and-nerve-conduction-studies-neck/.

Revision anterior surgery to remove spurs can be quite successful depending upon the prior surgery undertaken and what grafts were used.

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.

wgreenlee
Participant

June 11, 2016 at 9:27 am

Post count: 53

#22368

Hello again,
Symptoms before surgery where burning, tingling, and some weakness in both arms. Current symptoms are burning in the arms and tingling also in the shoulder blades, which wasn’t present before the surgery. Also I wish I could sen you a copy of the photo from the MRI.

As for MRI results as of 25th April, 2016:
this
C5-6: Endplate spurring is noted most pronounced at the right subarticular zone producing mild cord flattening. The AP diameter of the spinal canal is mild stenotic A.-9mm. Mild to moderate right foraminal stenosis is noted. The left foramen is mildly narrowed.

C6-7: Subarticular endplate spurring is noted. The midline diameter of the canal is mildly stenotic at 9mm. Slight cord flattening worse on right Extensive right foraminal stenosis is again seen. The left foramenis at least moderately stenotic.

Hopefully, this bit of information will be helpful. As for myelopathy symptoms. I’m glad you had a description on your site of this I would have not known that some of my symptoms are or could be that. I’m diabetic and before surgery I never had a problem with the nureopathy in the legs, but about 5 weeks post-surgery the pins and needles started firing up in my calf area. Just thought it was diabetes kicking in. I thought it was odd since my blood-sugar levels where pretty good. So I would have to say those conditions that are related to myelopathy probably started around 3 to 4 weeks post surgery.

wgreenlee
Participant

June 11, 2016 at 8:38 pm

Post count: 53

#22371

Also before the surgery took place the MRI stated this at those 2 levels where the surgery took place.

C5-6: Moderate posterior disc osteophyte complex asymetric to the right. Central canal stenosis with residual AP canal diameter of 7 mm. Right greater than left uncovertebral joint facet joint degenerate spurring with bilateral neural foraminal stenosis.

C6-7: Large posterior disc osteophyte complex with central canal stenosis and cord compression. There is complete effacement of the surronding cerebrospinal fluid. The residual AP canal diameter is approximately 6.5 mm. Bilateral uncovertebral joint facet degenerate spurring with bilateral neural foraminal stenosis.

This MRI was taken before the surgery the last comment was done last month and the first results in the conversation was a CT-Scan done last week.

As for the symptoms the pain level has actually increased since the surgery and the weakness in the arms has gotten worse. Any additional input would be greatly appreciated.

Donald Corenman, MD, DC
Moderator

June 12, 2016 at 10:28 am

Post count: 8660

#22374

OK-It looks like the stenosis at C5-6 is improved (canal went from 7mm to 9mm). Not a huge improvement but with some size improvement and fusion, the cord is further protected from injury. At C6-7, there has also been improvement (“mildly stenotic” now at 9mm) but certainly better than the original narrowing (“AP canal diameter is approximately 6.5 mm”). I assume that the new MRI did not note any new cord signal change.

What were the results of the CT scan?

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.

wgreenlee
Participant

June 12, 2016 at 11:16 am

Post count: 53

#22376

Hello Dr. Corenman,

Bill asked me to type this for him. He said that the CT-SCAN results were in the opening statement. If you need it again he can get the paperwork and have me retype it.

Thanks for all the input.

Bill
Author

Posts

Viewing 6 posts - 1 through 6 (of 39 total)

1 2 3 … 5 6 7 Next

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