Advised to have ACDF ASAP!

Tagged: New herniation level below an artificial disc replacement in neck

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Donald Corenman, MD, DC
Moderator

March 3, 2019 at 6:52 pm

Post count: 8660

#30205

You do have some stenosis at C6-7 but it is considered “mild” by this radiologist. He or she does not comment on the canal opening at C5-6 where the ADR and that might be from the metal of the disc obscuring the canal.You “neck being on fire” still after the ADR might indicate that the ADR could be causing pain or the level below could be a pain generator.

You have had multiple injections but I am not clear if you had diagnostic injections around the C5-6 or C6-7 levels. This might shed some light on your pain generators. See https://neckandback.com/treatments/diagnostic-therapeutic-neck/.

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.

lakegirlmn
Participant

August 4, 2019 at 2:27 pm

Post count: 7

#30804

Hello Dr. Corenman,

After months of feeling significantly better (minimal to none) in terms of neck pain, I suffered a major setback.

A week ago today, I decided to replace the drawer pulls on my dresser using a screwdriver instead of a drill. Bad decision. I didn’t feel any neck discomfort right away, but two days later I woke up with a stiff neck and sharp, stabbing pain along my shoulder blade. I was in so much pain I had to call into work. The stiff neck symptoms significantly improved and the stabbing shoulder blade pain nearly subsided later that same day of Tuesday. I went to work on Wednesday with only minimal discomfort. Thursday I had zero pain. Friday I woke up with awful right posterior neck pain, which traveled down my right arm and down my right shoulder. A combination of constant, dull pain, with sharp stabbing pain centered at the medial edge of my right shoulder blade. I felt pain and numbness down my right arm, and complete numbness of my right anterior neck.

Awful timing to be in pain, as I had planned to spent the entire day cleaning my house for a houseful of guests arriving in town for a 40th birthday party. I somehow was able to suck it up and did spend the entire day cleaning, yet felt worse with each passing moment.

Fast forward to yesterday. I woke up in excruciating pain (7/10). The pain worsens when sitting or lying down. The pain is only tolerable when standing still. At this point I could not function any longer. I ended up missing the birthday party and went to Orthopaedic Urgent Care where I had an MRI. I was advised to follow up with my neurosurgeon and start PT. She also recommended use of heat/ice and NSAIDs.

Today my pain is 9/10 at rest. I did not sleep well last night. I have a high tolerance to pain, but this is maddening pain. I guess I am wishfully hoping that there is a chance I can recover from this without surgery or steroid injections. As I mentioned earlier in the thread, my life was flipped upside down after the trigger point injections. I am not willing to trade relief from pain for worsening of my erythromelalgia symptoms (visibly red, hot feet, hands and face) as I am certain steroid injections clearly triggered the development of it, as well as temporary 50% loss of scalp hair, eyelashes, eyebrows, temporary development of facial hair, and having my period for 7 weeks straight.

In your opinion, is there a chance I can avoid surgery with physical therapy alone? I am a single mother of an active son. Another surgery will create significant hardship. However I can’t physically function with this level of pain. I am terrified. I can’t lay down comfortably , sit or sleep right now . The only slight relief I get while lying down, is to lie down on the floor completely flat on my back without moving.

Below I have attached my MRI results.
Thank you doctor

Exam: MR Cervical Spine WO IV Cont
Completed: 08/03/2019 4:10 PM
Signs & Symptoms: right cervical radiculopathy hx prior cervical disc replacement

IMPRESSION
INDICATION: right cervical radiculopathy hx prior cervical disc replacement
TECHNIQUE: MRI of the cervical spine without contrast.
COMPARISON: MRI of the cervical spine from 4/2/18
FINDINGS: The visualized midline posterior fossa structures are unremarkable. No definite
abnormal spinal cord signal, however artifact from artificial disc prosthesis at C5-C6
limits evaluation at C5-C6. No suspicious marrow edema, however hardware artifact limits
evaluation at C5-C6. Stable postsurgical changes of artificial disc placement at C5-C6.
Disc desiccation again seen throughout the cervical spine. Straightening and mild reversal
of the cervical lordosis is again seen. Normal enhancement. Mildly prominent multilevel
cervical nodes are again seen, and do not appear significantly changed.
Level by level:
C2-3: Spinal canal and neural foramina are patent.
C3-4: Spinal canal and neural foramina are patent.
C4-5: Small central disc protrusion effaces the ventral thecal sac and mildly flattens the
ventral spinal cord, similar to prior MRI. Neural foramina are patent.
C5-6: Surgical changes of artificial disc replacement. Artifact from surgical hardware
limits evaluation. The dorsal thecal sac appears patent. There may be moderate left neural
foraminal narrowing secondary to uncinate spurring. Possible mild right neural foraminal
narrowing secondary to uncinate spurring. Findings are unchanged.
C6-7: Right central disc protrusion which effaces the ventral thecal sac has increased
with now probable severe proximal right neural foraminal narrowing. Left neural foramen is
patent.
C7-T1: Spinal canal is patent. Unchanged mild right neural foraminal narrowing secondary
to uncinate spurring. Left neural foramen is patent.

IMPRESSION:
1. Stable changes of surgical disc replacement at C5-C6 are again seen. Again, this
somewhat limits evaluation at this level. Previously described right paracentral
protrusion at the C6-7 level has increased from prior with probable severe proximal right
neural foraminal narrowing. Consider correlation for right C7 radicular symptoms. Other
degenerative changes appear unchanged.
2. Mildly prominent cervical lymph nodes are again seen but do not appear significantly
changed from the prior MRI.

Donald Corenman, MD, DC
Moderator

August 4, 2019 at 3:46 pm

Post count: 8660

#30805

You now have a disc herniation at right C6-7: “Right central disc protrusion which effaces the ventral thecal sac has increased with now probable severe proximal right neural foraminal narrowing. Left neural foramen is patent”. This can occur regardless of an ADR (artificial disc replacement) or an ACDF at C5-6. You could ask your neurosurgeon if he would give you an oral steroid. If that is not helpful, you could try a selective nerve root block af C6-7 which may help. Finally, if those are not effective, then another surgery would be in order. If that ADR at C5-6 is one of the types that can have another ADR at C6-7, you could consider that. If the ADR was not designed to have a juxtapositional ADR, you could have an ACDF.

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.

lakegirlmn
Participant

August 7, 2019 at 7:49 pm

Post count: 7

#30814

Thank you for your insight Dr Corenman. I called my neurosurgeon’s office and was offered a work-in appt for September 5th. Crossing my fingers I can tough it out until then! This is an absolute nightmare.

I have two final questions for you.
Is it possible that my C6-7 disc could magically heal on its own?
Is it usually a herniation that causes the neural foraminal narrowing, a bone spur, or simply arthritic causes?

Thank you again,
Nicole

Donald Corenman, MD, DC
Moderator

August 8, 2019 at 8:40 am

Post count: 8660

#30817

Yes the C6-7 disc herniation can over time become less symptomatic but that is less certain.

Normally the ratio of nerve compression symptom causes is 80% bone spur and 20% herniation. Bone spurs result from “arthritic causes”.

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.

lakegirlmn
Participant

September 2, 2019 at 4:58 pm

Post count: 7

#31022

I thought I would provide an update. I ended up seeing my neurosurgeon on 8/22. My arm and shoulder blade pain was unbearable at this point. She recommended selective C7 cervical nerve root block which I had the folllowing day. The procedure was painful, but provided immediate relief which slowly faded over the weekend. My pain increased in severity over the following days. I couldn’t take it anymore and went to the ER early Thursday morning. Another MRI was ordered which showed worsening since the MRI earlier in the month. I was admitted to the hospital and had emergency C6-7 disc replacement the following day. I feel like a new person now! My arm and shoulder blade pain is gone. Only normal swelling and slight tenderness from surgery. My surgeon said one of the disc fragments was one of of the largest she had ever seen. I am grateful to finally be pain free.
Here is my MRI report if you’re interested. Thank you again for the insight you provided me.

Impression:
Study compromised due to underlying metallic susceptibility artifact
from C5-C6 disc prosthesis.
1. Worsened right central/subarticular/foraminal disc extrusion at
C6-C7 since the comparison MRI from August 3, 2019. This finding may
impinge right C7 nerve root.
2. Postsurgical change of C5-C6 disc arthroplasty with associated
regional cervical kyphosis with at least moderate to severe spinal
canal stenosis. Degree of kyphosis appear similar to comparison.
Underlying cord signal cannot be assessed due to artifact.
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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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