[Donald Corenman, MD, DC]

#24733

There should have been resolution of the cord and root compression from the initial ACDF. Continued compression means that the surgery was unsuccessful. Yes, continued and worsened symptoms of nerve and possibly cord compression along with a pseudoarthrosis means you should consider a revision surgery. I am not sure you need a corpectomy (removal of the entire vertebral body) as I generally don’t have to perform a corpectomy for revisions but I am not there to review the images. Make sure that the revision surgery will be performed from the same side or have an ENT consult to look at your vocal cords to make sure the recurrent laryngeal nerve is functioning well.

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]

#24734

Hello Dr. Corenmam,

Trying to figure out what was actually done in the hour and 17 minutes that I was cut open. Pre-surgery MRI states.

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

Post-operative MRI

C5-6: Large marginal osteophytes protrude posteriorly on the right side, making contact with the spinal cord and slightly displaces it the left side. Moderate-severe bilateral Nueral Foraminal stenosis. DJD of bilateral facet joints.

C6-7: Uncovertebral joint spurring causes mild-moderate bilateral Neural Foramina stenosis. Marginal posterior osteophyte causes mild-moderate narrowing of the central canal and making contact with the cord.

I also would like to add a MRI that was done by the VA in 2012. The first 2 MRI’s were both in 2015.

MRI cervical spine: Asymmetric disc protrusion is seen to the right C5-6 cord indentation and compression of the right C6 nerve root.

I have been back to the original surgeon and the only response I have gotten is that you have a lot of arthritis in your neck. This was after the post MRI.

The questions I would like your feedback on are as follows:

1) The surgery for a 2 level ACDF took one hour and seventeen minutes. Would this timeframe suggest that the surgeon opened the neck and put the distractors in the vertebrae and then put a plate and six screws in without removing the disc and clearing osteophytes anx foramina? Is that at all a possibilty?

2) The above information from the MRI’s clearly indicate in my view that the bare minium was preformed in this procedure. How could one show that this surgery was not as it is indicated on a post-operative report? By the way the post-operative report indicates the surgery was succesful foraminotomy was preformed and all nerve roots and dura was well decompressed. Osteophytes anterior and posterior were drilled with a midas drill.

3) Is it possible for the central canal to widen by only putting in distractors to pull apart the vertebrae to get more height and make a 1 to 3 mm difference in width size of the central canal?

I look forward to your answers and hopefully your input will verify what I believe actually happened.

[Donald Corenman, MD, DC]

#24735

That short time would be a world record for me in a 2 level ACDF. More likely for me, it would take 2 1/2 hours (if I also used autogenous iliac crest bone graft A-ICBG). 2 hours 15 min if no A-ICBG.

Some surgeons are more meticulous than others. Some less fastidious individuals will open the disc space and place a graft which will enlarge both the central canal and the neuroforamen but not go after the posterior spurs. This technique (which I do not endorse) does work in some situations but still leaves the spurs intact.

This surgeon could make an argument that he (or she) did the best he could but some spurs were inadvertently left. This can happen but based upon the new imaging, the surgeon probably did not “do his best” and did not spend time to take out the uncovertebral or posterior discal spurs.

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]

#24737

Have you ever heard of a surgeon performing a 2 level ACDF in that time frame? It seemed odd to me as well. The other part was the follow-up visits. The longest visit I had with him was 1:46 seconds. The last visit I had I had to call his office to schedule the 6 month to see if the fusion even had fused. At that visit as I was sitting in the chair with feet planted on the ground he did a reflex test by tapping below my knees. Is that normal? It seemed to me to be difficult to get a reflex if the patients feet are flat on the ground. Also I wanted to thank you for giving me a honest opinion.

[wgreenlee]

#24738

I also wanted to let you know I appreciate your input very much. If I could I would travel out there and let you preform the second surgery. I’m not very secure with any local guy’s.

Thank you again

[wgreenlee]

#24739

I was also going to let you know I have had issue’s swallowing since the surgery in 2015. Every time I eat something it get’s stuck in the throat. The first bite that is. There are two reactions. One it comes back up or I finally get it down after a minute or so and then get hiccups. Not fun. I guess I’m telling you this because I had a modified swallow test and the doctor told me that the muscle that controls the esophagus expanding is hitting the metal plate. Of course when I told her I needed that documented for the next surgery so the next guy could possible fix it. She didn’t document it. I guess my question would be is that part of the laryngeal nerve? If so any suggestions on what to do about it?

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