Arthrodesis question

Tagged: nonsense treatment for cervical radicuolpathy

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DrTony
Participant

June 20, 2016 at 4:34 pm

Post count: 5

#22440

Dr. Corenman,

Do you have an opinion regarding the use of iliac crest stem cells in the application of posterior cervical arthrodesis without instrumentation?

If the intention is fusion at the facet joint in an attempt to treat mono cervical radiculopathy, #1 how does the matrix of plasma created and placed via the use of a cannula stay in place? #2 how does this address central cord and neuroforamenal root compression symptoms in the short-term? It is unclear to me how this can be decompressive.

A neurosurgeon in consultation proposed preparing each level using radiofrequency followed by the application of “plasma concentrate” to help each disc heal and resolve the radiculopathic symptoms. I was told the procedure has been used successfully for many years. No clear explanation was given as to how this could increase disc height, or reduce osteophyte compression of the cord or nerve roots, other than to say, ..”it helps your discs heal.”

What do I have wrong or am I misunderstanding? This sounds way too good to be true.

Thanks for clarifying…………….Tony

Donald Corenman, MD, DC
Moderator

June 20, 2016 at 11:30 pm

Post count: 8660

#22443

The information you received does not make physiological sense. Posterior arthrodesis of the cervical spine requires cleaning the facets of cartilage and capsule, “injuring” the cortical surfaces using a bur to expose cancellous bone, placing bone graft to induce the bone to “think” it is fractured and then immobilize the bone to prevent motion from destroying the fragile healing process.

Injecting stem cells into a facet will do nothing but cause these stem cells to die. The intraarticular environment is essentially avascular so there is nothing to cause the stem cells to morph into bone cells or even to survive. Even for the sake of argument, the surgeon can magically cause the stem cell to turn into osteoblasts (a bone forming cell), there is nothing to attach to. Maybe the capsule can somehow calcify. I even don’t think that injecting BMP (bone morphogenic protein) into the facet will cause ossification.

The principle of causing facet fusion to cure radiculopathy is also something that makes no sense to me. The surgeon physically needs to decompress the nerve root foramen (or the central canal in the case of central canal narrowing) to free up the respective neurological structure. Fusion by itself does not do this.

Radio frequency ablation of the medial branches of the nerves has nothing to do with radiculopathy or central stenosis. This treatment is reserved for facet generated pain and does not allow for “preparing each level using radio frequency”. That statement makes no sense either.

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.

DrTony
Participant

June 21, 2016 at 9:11 am

Post count: 5

#22448

Dr. Corenman,

Thank you for the reply!

I don’t know if it helps but here is the written description of the procedure I was given:

“First your surgeon numbs the whole area with local anesthesia so you feel only pressure.

He then makes a very small incision about the size of the tip of your pinky nail, inserts something called a jamshidi to harvest the bone and marrow from the back of the pelvis.

This is then concentrated into something called “plasma concentrate” that will be put back in to help your discs heal.

Another incision is made the same way on the back of your neck. Then small retractor is placed in the incision and a small cannula about the size of a Bic pen is inserted into the incision. The cannula is repositioned though the same incision to reach each operative level. Though this working channel the surgeon can do everything he needs to.

Next, an instrument using radio frequency is inserted though the working channel, and used on each operative level to prepare it for the bone and plasma concentrate.

Finally, the “plasma” created from spinning down the bone and marrow is inserted into the operative levels to regrow healthy tissue with your own natural cells including stem cells so it regrows stronger and better.

All the instruments come out, a few sutures are placed, a dressing is applied and your surgery’s over.”

Unless he means the plasma is being injected directly into the discs, it does not make sense to me.

Thanks again…………..Tony

Donald Corenman, MD, DC
Moderator

June 21, 2016 at 10:20 am

Post count: 8660

#22449

So, the surgeon uses a biopsy needle to remove bone marrow aspirate from the pelvis. He then spins this down to concentrate the potential stem cells. He then uses an operating tube at each posterior cervical level (usually about 10-18mm wide) to access the facet joint.

At this point, he uses an ablative tool (radio frequency means thermal energy) to do what? Does he open the capsule of the facet, completely remove it or????

Where and why he “injects” the stem cell mixture is conjecture but whatever he does will not allow the joint to “regrow stronger and better”.

He cannot gain access to the disc from the posterior approach so nothing goes into the disc space.

What he does makes no sense to me.

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.

DrTony
Participant

June 21, 2016 at 10:55 am

Post count: 5

#22451

Thank you again for your time and reply!
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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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