ADR and Zero-p

Tagged: ACDF

Viewing 5 posts - 1 through 5 (of 5 total)

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BPat
Participant

July 5, 2015 at 8:44 pm

Post count: 9

#19978

Thanks in advance. Three questions relating to my C6/C7.
3weeks ago I woke up to a “large” herniation. Verified per MRI with pain in shoulder, triceps, elbow and forearm … and meaningful triceps weakness to further clinically triangulate on C6/C7.

Background – I had a C5/C6 Foramenotomy 2yrs ago for pain – largely successful after some bumpiness the 1st 6mo. My C4/C5 isn’t pretty either per the MRI (disc bulge and foramenal stenosis but asymptomatic). I’m 42 and active (golf, ski, kids)

I have seen 3 surgeons and gotten 3 recommendations all agreeing its C6/C7 and all saying act to decompress soonish to maximize chance of Triceps recovery. But the specific recommendations differ : 1) Vanilla ACDF (cadaver and external plate), 2) Zero-p ACDF and 3) ADR.

So as I try to decide the approach – I’m trying to understand these 3 things (thanks again)
A) Two of my surgeons have indicated ADR won’t help with adjacent levels. This seems to disagree with this 2013 study I found “ProDisc-C and Anterior Cervical Discectomy and Fusion as Surgical Treatment for Single-Level Cervical Symptomatic Degenerative Disc Disease.” Are they dated? Or is this study an outlier or not well regarded?
B) IF that is right, and there is no adjacent level improvement from going with ADR, why ever get an ADR? What is the logic if not that?
C) Any thoughts on the Zero-P? Internal fixation that sits in disc space and screws up and down (at angles) into vertebrae above and below. With integrated cage. No external plate to upset esophagus. The one study I found made it seem great (high fusion rates, lower complication re esophagus). But seems new and at a min lacking long term data. Also doesn’t seem like many are using it – curious? Is this something you use or would vs “gold standard” external plate?

Thanks … 3 dissenting approaches (all from credible guys) has my head spinning

Donald Corenman, MD, DC
Moderator

July 7, 2015 at 7:31 am

Post count: 8660

#19982

I would agree that with significant pain and weakness associated with a large herniation at C6-7, a surgical procedure would be indicated.

The three choices are not bad but there is a ranking order in my opinion. The cervical ADR will help maintain range of motion but will not help with adjacent segment disease (ASD-the wearing out of the level above or below). This adjacent segment disease is most likely from the genetics of the discs and not from the surgery. Also, ADRs will eventually wear out and have to be replaceD by an ACDF somewhere in the future. It might be 10 or 20 years (or possibly never).

The standard ACDF with allograft (donor bone) is probably the most successful of the three surgeries. The fusion rate is pretty good and the “external plate” has almost never been a problem in my hands.

The Zero-P is a spacer made of plastic (PEEK) and metal. As such, this reduces the biologically active fusion surface area and makes this device less likely to fuse successfully. This would be the last on the list if I were considering this surgery.

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.

BPat
Participant

July 7, 2015 at 8:26 pm

Post count: 9

#19993

Thanks so much. This is very helpful to narrowing a decision. One last question – are all 1 level ACDF “external plates” more or less the same. One surgeon highlighted his success with a low profile TWO screw external plate (I may have misunderstood) – while another surgeon suggested two screw external plates were not common or best practice (vs a 4 screw external plate). Is this an important decision point?

BPat
Participant

July 7, 2015 at 8:56 pm

Post count: 9

#19994

… Or should I care if a single hole per level playing system is used (e.g., Vertical In-Line Plate or SlimFuse)

Donald Corenman, MD, DC
Moderator

July 9, 2015 at 12:50 pm

Post count: 8660

#20004

Almost all anterior cervical plates are of the four screw variety. If you eliminate two of the screws, the plate can toggle which makes for lessened stability. Having two extra screws makes the plate a parallelogram which significantly increases strength. The “extra” two screws are of enough consequence that they should not be eliminated by a two hole plate.

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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