AlgaeCal ACDF Bone growth Thoughts?

Tagged: cervical non-union (pseudoarthrosis) after ACDF

Viewing 3 posts - 1 through 3 (of 3 total)

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Coco
Participant

September 21, 2017 at 7:11 pm

Post count: 3

#26429

All of my levels are fused now with the exception of c4/5 and approaching 2 years I’m so frustrated.
I have no pain or symptoms, and the hardware is perfectly intact.. I just don’t want to consider revision surgery in the absence of no symptoms when plenty of people who do fuse properly still have problematic symptoms..I consider my surgery a success for its resolving my problems when others aren’t so lucky. My symptoms at their very worst are mild discomfort occasionally. (To be candid: thats from looking down for 6-8 hours/ day as I try to study for a new path in life once able. I feel like that position over 6-8 hours a day would make anyone uncomfortable.) My miserable pain pre surgery no longer, my range of motion improved, my other symptoms improved.

Me and Doc have discussed the possibility of revision surgery the pros and cons and he was more serious about it before I started the bone growth stimulator if it didn’t help the other levels because I literally had no level of the 3 we worked on show any sign of fusing 1 year post op.. His perspective has since changed.

We initiated the bone growth stimulator 6-8 months ago after he deemed me psedoarthritic 1 year post op my ACDF from C4-C7 with no sites of fusion at any level. Over these months using the bone growth stimulator: all sites have completely fused with the exception of the c4 that has showed no to very little improvement.

After seeing him yesterday: to review my c4 that remains unchanged while he’s not happy it hadn’t caught up to the others he now wouldn’t recommend a revision because of my mild symptaology from self induced positions of long duration, and perfectly intact hardware. He stated that some people similar to me with multilevel ACDF: can have delayed fusions that eventually either fuse on their own years later, or don’t ever fuse and he will do a revision based on symptoms and circumstances with biggest concern adjacent disks, pain, and hardware. That he has gone without having to do a revision at all on some folks that failed to fuse, and were perfectly fine years later and never had any issue as a result of not fusing. That its hard to tell and some actually do though quite delayed eventually fuse on their own..

He said even if he forces a fusion I run the risk of having more pain that I currently don’t have to contend with.. That all we can do is keep an eye out every few months to ensure no worsening symptoms, no hardware changes, etc. That really sucks after 2 years. That I can’t have more peace of mind.
I’ve already had many surgeries these 4 years or so excluding the cervical spine, though thats the concern at the moment.. Still i’ve long waited for the day I can finally feel like I’m on the return back to myself without worrying what could happen every couple months. (4 years of that in general has been maddening). All that stands in my way now is my c4.

In Summary of the visit and what now:
I asked doc what should we do now: should I continue wearing the orthofix collar: that has helped me with the other disks. He mentioned optimal use these 6-8 months have been exhausted and there would be no further benefit not at this point not approaching 2 years.. That the therapeutic window isn’t usually beyond the 8 months I had already tried.
I asked about prescription grade supplements even though I take a hefty dose of vitamin D and K and he didn’t think that would be very beneficial. I asked about Algaecal and he stated he doesn’t know of the long term benefits or effects well enough to even comment on it.

Dr. Correnman My 3 questions for you sir:
1) I suppose I understand the benefits and risks of a revision, but can you please help me with my worries around the risk of doing nothing for this c4 level thats unfused and likely to remain unfused. Whats the danger in doing absolutely nothing now? What are your thoughts on that which I’ve shared pertaining to do or not to do anything and if so what? (Especially if I continue unfused but without symptoms and hardware intact).
2) What are your thoughts on my attempting to take the Algaecal? If doesn’t hurt anything shouldn’t i atleast try it, Im willing to do whatever is needed if even if a slight benefit so long as it outweighs the risk. Do you think it would hurt to give the Algaecal a try?
3)Any other Thoughts or recommendations you may have that we should consider?

Thanks so much!

Donald Corenman, MD, DC
Moderator

September 23, 2017 at 8:42 am

Post count: 8660

#26441

You had a 3 level fusion of C4-7 with delayed union. You then used a bone growth stimulator (I am not clear as to the efficacy) and went on to fuse C5-7 with a C4-5 pseudoarthrosis (non-union) as the residual. Your symptoms are significantly improved from your pre-surgical levels. Your surgeon is concerned about this pseudoarthrosis and wants to consider a revision.

50% of pseudoarthroses in the neck are stable. That is, they don’t move on flexion/extension X-rays, look to be interdigitated (the bony surfaces fit together like a puzzle) and are mostly painless. These particular non-unions are stable and are generally not dangerous. The space that was to be filled in by bone, filled in with tough fibrous tissue. This scar is pretty rigid. Yes, it does not have the tensile strength of bone but is still mainly stable (unless you fall off a cliff or are ejected from a car. I would say that a stable pseudoarthrosis is more stable than an artificial disc replacement.

I have seen stable pseudoarthroses become painful with a significant accident but that is uncommon and have never seen one cause a spinal cord injury (although this could still occur but would be very rare in my opinion).

Alagecal is a simple calcium supplement and would not affect your fusion one way or the other unless you were calcium deficient which would be unlikely.

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.

Coco
Participant

September 26, 2017 at 1:01 pm

Post count: 3

#26497

Thank you so much Dr. Corenman for your very thoughtful and thorough response.
I’m left feeling encouraged with my non union from what you shared. I very much appreciate that. Hope you have a wonderful day!
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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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