ACDF Post-operative Concerns with CT-Scan results

Tagged: Continued cord compression after ACDF

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wgreenlee
Participant

June 12, 2016 at 7:19 pm

Post count: 53

#22377

The CT-Scan states the following:

At C5-6 there is posterior spondylotic change with osyeophyte encroaching 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 n the right narrowing the right foramina. There is no canal stenosis.

Impression: Cervical myelogram demonstrates prior anterior cervical fusion from C5 TO C7. At C5-6 there is posterior spondylotic change with osteophyte including upon on the right side of the spinal cord and abutting and deforming the spinal cord. There is a kink in the glenohumeral spinal canal.

This CT-Scan was taken on the 6/9/2016. So it is the most recent test preformed.

Donald Corenman, MD, DC
Moderator

June 13, 2016 at 10:03 am

Post count: 8660

#22381

Got it. The question is whether the residual symptoms are caused by continued cord/nerve root compression or whether the symptoms are from chronic radiculopathy? See https://neckandback.com/conditions/chronic-radiculopathy/.

This is difficult to determine. Using a SNRB (selective nerve root block) can be helpful but the problem with this procedure is that symptoms will be relieved in the presence of compression but will also be reduced in the presence of chronic radiculopathy. Cord compression is generally painless but can cause symptoms of myelopathy (“https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/”). If the symptoms are caused by continued compression, a posterior decompression (laminectomy or foraminotomy) could be performed to eliminate this compression.

A good physical examination will go a long way to determine what is problematic and an SNRB will be quite helpful too.

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 13, 2016 at 11:08 am

Post count: 53

#22385

Out of curiosity why would there be any cord compression or dislocation or spinal cord deforming after a ACDF? I have spoken to a Neurosurgeon who said that I have and had a small spinal cord to start with. So I asked him what was the best procedure for relieving the cord compression from the beginning and he said that going in from the back would have been the safest and best results because they would have removed some of the vertebrae to open up the canal. Then after looking at the MRI after the surgery he noticed that there was a Osteophyte pressing against the cord and I asked him since that wasn’t there before surgery why would it be there now. He said please don’t make me choose side’s but that was in the area where it should have been removed. I’m just trying to get a straight answer and the pain is awful, but I’m very skeptical about having any further procedures done after this. I appreciate any input.

Donald Corenman, MD, DC
Moderator

June 13, 2016 at 3:25 pm

Post count: 8660

#22386

Cord compression can occur during surgery due to positioning or to the surgical technique. Sometimes the canal is so narrow that the tools used to open the canal can cause inadvertent cord compression. Sometimes, a surgical tool can inadvertently press on the cord and cause compression. Sometimes the spur is not recognized and therefore not totally removed. Rarely for technical reasons, the spur cannot be removed (OPLL or other reasons).

If the spur formation occurs from the front (as most spurs from the disc side do occur in the front), then anterior surgery generally is a better bet (ACDF). If the canal is very tight and the surgeon thinks the posterior decompression is the best and safest technique (laminectomy), then this would be the obvious choice. The potential risks are that the cord, when it drifts back after the laminectomy, stretches the nerve root and temporary (rarely permanently) causes some root palsy and motor weakness.

The osteophyte that was noticed was obviously present before the ACDF (unless somehow a spur was knocked off during surgery that was not removed).

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 13, 2016 at 7:44 pm

Post count: 53

#22387

Dr. Corenman,

I wanted to thank you for at least putting some light on the topic. I obviously still have doubt of having a second surgery, but will definetly be looking for another opinion other than the original surgeon.

Thank you,

Bill

wgreenlee
Participant

June 13, 2016 at 8:04 pm

Post count: 53

#22388

One last question and I promise this will be it.

Before the surgery I was encouraged by the pain management doctor as well as the neurosurgeon to have surgery because I could be paralized if I had a minor fender bender. Well since the surgery and with the new reports in your opinion would I be considered in the same situation as before the surgery and since there is now actually spinal cord direct involvement with the osteophyte.
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Donald Corenman, MD, DC

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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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