Anterior Cervical discectomy with fusion of the c5/c6

Tagged: ACDF without relief of symptoms

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Paula Gior
Participant

January 23, 2020 at 8:21 am

Post count: 4

#31972

Dear DR. Corenman, I had a ACDF surgery on May 31st 2019 I was told that i was bone on bone and the surgery would help me with the pain and numbness in my right and left arm as well as the pain in my neck. I still have all the same symptoms that I had before the surgery, I can not sit in a chair or even drive my car without getting sharp pains in my neck and that goes up into my head and even on the right side of my temple area that are so debilitating. My surgeon stated that I will get better and that I have fibromyalgia, my medical doctor states that I don’t have fibromyalgia. I went to a neurologist and he stated that there is no nerve damage on the outside of the nerves but he can’t see the inside of the nerves. He stated if I get an epidural injection the pain and weakness in my arms will go away. I also get a burning feeling in my right wrist and shoulder. I never get a actual answer on why I still am in pain. I am not sure if I want to get the epidural in my neck because I had one for my lumbar area and I lost control of my bladder the day I received the injection as well as burning in my right foot and ankle, which I still have. I left 2 messages with the surgeons coordinator and she has not gotten back to me, I was never given a follow up appt. So now I have pain in the upper and lower part of my body along with weakness in both legs if I go up stairs or a slight hill I have to stop and rest before I can continue .I had 3 MRI without contrast 2 of the cervical and one of the lumbar. The lumbar MRI showed that my L4/L5 and L5 and S1 disc bulge and stenosis. How long does it take to feel better after having a ACDF? And could this be from the nerves?

Donald Corenman, MD, DC
Moderator

January 25, 2020 at 3:26 pm

Post count: 8660

#31980

You are noting symptoms from two different areas, cervical and lumbar. Your lumbar complaints “weakness in both legs if I go up stairs or a slight hill I have to stop and rest before I can continue” associated with your interpretation of your MRI report “showed that my L4/L5 and L5 and S1 disc bulge and stenosis” could indicate central lumbar stenosis. See if this fits with your lower back complaints. https://neckandback.com/conditions/lumbar-spinal-stenosis-central-stenosis/

In regards to your neck, what workup did you have to indicate that this level was causing your symptoms? Did your physical examination match your neck and arm pain? Did you have diagnostic blocks (SNRB, ESI, Facet) See “https://neckandback.com/treatments/diagnostic-therapeutic-neck/.

What level was your ACDF? Your current complaints ” I can not sit in a chair or even drive my car without getting sharp pains in my neck and that goes up into my head and even on the right side of my temple area that are so debilitating” tend to indicate upper cervical problems (C2-4).

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.

Donald Corenman, MD, DC
Moderator

January 25, 2020 at 3:28 pm

Post count: 8660

#31981

Sorry as your level of surgery was not in the body but in your title (C5-6). What were your symptoms before the surgery and how did they change?

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.

Paula Gior
Participant

January 27, 2020 at 12:01 pm

Post count: 4

#31987

My symptoms before the surgery was pain in my neck and arm. I also had the burning in my wrist and weakness. I drop things all the time. Sitting and driving was before the surgery and my arm would have numbness and tinkling. I still have the same symptoms and pain after having surgery, what I didn’t have before the surgery is the sharp pain that goes up into my head and temple area. I also have a constant ringing in my ears that never goes away this I did not have before the surgery. My Post MRI states that c5c6 has new surgical changes from ACDF without evidence of recurrent stenosis. No cord or nerve root abutment. C1/c2 states no significant arthritic change or stenosis c2/3 normal disc space and facet joints without stenosis. C3/4 no posterior disc abnormality. No significant foraminal stenosis. C/5 normal c6/7 and c7/t1 normal. I was told that after having the surgery I would be a 100 percent better . This is not the case for me. I used to have biceps I have none and if I try to use 5 pond weights I can only do 5 at a time before my arm goes weak. When I ask what is going on and what is causing this I am told it is the nerves.
I started with these symptoms about 3 years before the surgery. I was being treated for shoulder pain and tennis elbow pain. It was the physical therapist who stated ( I think you should get a MRI of your cervical). She stated she felt there was something else going on besides the tennis elbow . She was right. I had physical therapy after surgery but my insurance wouldn’t pay anymore.I did go to a chiropractor and a nuerologist. The nuerologist stared to have injections and my strength in my are will come back and the pain in my neck , arm and head will go away. My primary doctor Said he doesn’t think that is a good idea because of the symptoms I had with the injections in my lower back. Which I didn’t get any relief from. I still can’t stand for long or walk for long. Stairs and goin up hills still bother me.
So frustrating.

Paula Gior
Participant

January 27, 2020 at 12:15 pm

Post count: 4

#31989

The symptoms that is in the article regarding the lower lumbar of the L4/L5 and L5/S1. I do have to lean over to get relief when walking or standing to long. When I come up my driveway I stop and lean forward before I can go any further. At times I stop three times before I get to the garage. The MRI stated moderate bilateral neural foraminal stenosis at L5-S1 secondary to disc bulge and facet arthropathy. My orthopedic said it’s not so bad. But I am in pain.

Sm2019
Participant

January 27, 2020 at 2:17 pm

Post count: 3

#31990

Hi Dr Corenman,

What does it mean after ACDF fusion C5-6. when they take X-rays . they say “There appears to be step off welding at the C5-6 disc level” ?

What is a Step off welding ?
Will that cause pain now and in the future?

Thank you,
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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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