ADR FACET AND ARTHRITIS

Tagged: Artificial disc replacement in cervical spine vs. fusion

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meni learn
Participant

October 7, 2021 at 6:25 am

Post count: 236

#34507

i want to Thank you for answering here and your attention in the forum for many general questions I ask for no fee (its your time and u read the comment of people around the world and answer general q (to people ask ) (and also the database you have built and can read)

Meni

Donald Corenman, MD, DC
Moderator

October 7, 2021 at 8:30 am

Post count: 8660

#34508

The jury is still out on artificial disc replacements (ADR) in the cervical spine. I think for the lumbar spine, I would not implant an ADR due to the wear and replacement issues. For the cervical spine, these ADRs can be helpful in some cases but there are significant drawbacks too. Yes, they can help to reduce adjacent segment disease (ASD) by 1-2% (not a high number) but the other point to think about is that these ADRs can fail even many years after implantation.

That number is not factored into the equation. No one has an absolute percentage number of ADR failure but I believe it will be in the 5-10% range over time. If you picked fusion (ACDF), once fused, always fused and if performed correctly, that level won’t need to be addressed in the future.

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.

meni learn
Participant

October 7, 2021 at 9:41 am

Post count: 236

#34509

The jury is still out on artificial disc replacements (ADR) in the cervical spine(u try to say jury mean the number and research (still in test how much its hold (the surgery this start in US (FDA APRROVED FIRST IN 2007 medtronic prestige FOR ONE LEVEL (IN EUROPE MOSTLY IN GERMANY I READ LITTLE ITS WAS early (but i m not read just i know this little also see the thinking this on 1980-1990 (you probably not probably i m sure u know more ON THIS when the first ADR SURGERY HAPPEND ( IN MY COUNTRY I SEE THIS HAPPEND IN 2004 so left before the approved FDA (when u do the first this surgery in your Career)
and i know the FDA approved MOBI C FOR TWO LEVEL 26/10/12 (I SEE VIDEO ON THIS ON YUTUBE CALL ACDF VS ADR
and he give mice info also .
“0 I think for the lumbar spine, I would not implant an ADR due to the wear and replacement issues”
i ear this on your channel talking a bout this subject .( i ear this u talking a bout this https://www.youtube.com/watch?v=N-h6cDhRkAg)
“For the cervical spine, these ADRs can be helpful in some cases but there are significant drawbacks too”
i under stand some of the cases ( like facet not worn out too much )
” Yes, they can help to reduce adjacent segment disease (ASD) by 1-2% (not a high number (what u mean this
adjacent segment disease (facet and disc above and below ?)
“but the other point to think about is that these ADRs can fail even many years after implantation.(i think this dependent i some parameters(what u say a bout facet and (at least 50% of high natural ) also who spine surgeon do u surgery and with good accuracy(to put disc in exactly( i ear one spine surgeon say this surgery compare to ACDF need to take more time because need to put disc in exactly
5.”That number is not factored into the equation. No one has an absolute percentage number of ADR failure but I believe it will be in the 5-10% range over time (so 95% successful so its good number other u left the degenerated and gave to developed arthritis in neck and future some lead to central stenosis and if in severe cases u dont treat u can paralyzed (i also read Myelopathy lead to dead not just paralyzed ( so u do not just can loss the function of body .
6.” If you picked fusion (ACDF), once fused, always fused and if performed correctly, that level won’t need to be addressed in the future”
i read this problem if u fused more two level (its lead to high pressure on above and under the fusion
also listen to a lot (dr say this so maybe u talking a bout one level or even two (one its less o curse )
so i ear disadvantages of this (off curse to unders. more i need to read more and see (in my eyes its going to be better but i m not spine surgeon (i listen read and ask i also ask u )

Meni

Donald Corenman, MD, DC
Moderator

October 7, 2021 at 9:51 am

Post count: 8660

#34510

You misunderstand. The 1-2% ASD reduction is better by itself but when you consider adding the 5-10% late failure rate (which includes autofusion-spur formation that takes a movable implant and essentially turns it into a fusion), the numbers are less favorable.

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.

meni learn
Participant

October 7, 2021 at 10:29 am

Post count: 236

#34511

u say a some different in the left comment and i answer in part like u can see.what u mean i not understand . i m misunderstand u mean a bout this subject “Yes, they can help to reduce adjacent segment disease (ASD) by 1-2% (not a high number) but the other point to think about is that these ADRs can fail even many years after implantation”
ok i m can say u i m really not understand this good what u really mean (when u see the fail and what is big issue to fail ( You did not refer to what I wrote about it
you :but the other point to think about is that these ADRs can fail even many years after implantation
i write (i think this dependent i some parameters(what u say a bout facet and (at least 50% of high natural ) also who spine surgeon do u surgery and with good accuracy(to put disc in exactly( i ear one spine surgeon say this surgery compare to ACDF need to take more time because need to put disc in exactly.
what dependent big factor for the failed (if the parameters are good before ( i read in your website one specific cases (that someone come to u (but u say him it did work and he travel to found surgery in GERMANY ( AND ITS FAILED BUT THIS IS going to failed from the start (u r know that so u include this number on the 5 cases who failed on this story (https://neckandback.com/conditions/failure-of-cervical-artificial-disc-replacements/) (i also their on Q IT how much the implant can be use inside (because have least 15 or 20 years .
when u do this first surgery in your career ?
i not say i m understand fully all what u say say but i have good idea in some (also read in your website and other website and some lecture and youtube channel .

Meni

Donald Corenman, MD, DC
Moderator

October 7, 2021 at 11:14 am

Post count: 8660

#34512

You need a long distance consultation so we can talk directly.

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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