Assistance Reading Post ACDF MRI

Tagged: Continued cervical stenosis after ACDF

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Sdc1213
Participant

November 1, 2020 at 9:51 pm

Post count: 8

#33333

Good Evening Doctor,

I had an MRI done of my Cervical spine and I’m having some issues understanding the area under C6-C7. I understand the stenosis part, but when it gets to the part about flattening the “Ventral Cord”. I’m not sure if this was a typo on the doctors part? Mind you, this is post ACDF surgery at that level. I thought the Ventral Cord was essentially the Spinal Cord? I guess do these findings cause a big concern?

Thank You in advance!

“Cervical vertebral alignment is maintained. Vertebral body heights are preserved. Remainder of intervertebral disc space heights are preserved. No acute fracture or subluxation. The bone marrow signal shows no significant abnormality. The craniocervical junction is normal for age. The cervical spinal cord is normal in size and signal intensity without syringohydromyelia. Partially visualized posterior fossa structures are within normal limits. Prevertebral and paraspinal soft tissues are unremarkable.

C2-3: Unremarkable.

C3-4: Small central disc bulge. No spinal canal stenosis or neuroforaminal stenosis.

C4-5: Small annular disc bulge indents the ventral thecal sac. Mild uncovertebral joint hypertrophy. No spinal canal stenosis or neuroforaminal stenosis.

C5-6: Small annular disc bulge with bilateral foraminal extension indents the ventral thecal sac. Mild uncovertebral joint hypertrophy contributes to moderate left and mild right neuroforaminal stenosis.

C6-7: Broad-based disc osteophyte complex flattens the ventral cord and results in moderate spinal canal stenosis. Uncovertebral joint hypertrophy contributes to severe left greater than right neuroforaminal stenosis.

C7-T1: Small central disc protrusion indents the ventral thecal sac. No spinal canal stenosis or neuroforaminal stenosis.

IMPRESSION:
Status post anterior interbody fusion at the C6-C7 level, no acute complication.

Multilevel cervical spondylosis most prominent at the C6-C7 level.

Moderate spinal canal stenosis, severe left greater than right neuroforaminal stenosis at the C6-C7 level.

Moderate left and mild right neuroforaminal stenosis at the C5-C6 level.

No severe spinal canal stenosis at any level, no cord compression or myelomalacia.”

Donald Corenman, MD, DC
Moderator

November 2, 2020 at 5:28 am

Post count: 8660

#33335

The C6-7 level I assume has a solid ACDF type of fusion. There is still continuing central canal narrowing and foraminal stenosis, left greater than right.However, there is the statement “No severe spinal canal stenosis at any level, no cord compression or myelomalacia”.

If there is no “severe” spinal stenosis and no cord signal change, this is a good sign. Once the level is successfully fused with no “severe” findings and no sign of cord injury (“no cord compression or myelomalacia”), this level is much less likely to be injured with a fall or impact.

What are your current symptoms? Do you have any symptoms of myelopathy or radiculopathy? See https://neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/ and https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/

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.

Sdc1213
Participant

November 4, 2020 at 8:28 pm

Post count: 8

#33350

Good Evening Doctor, Yes I had an ACDF on C6-C7 a year ago. As of recent, I have been having complications. Severe pain at the base of the neck and severe cervicogenic headaches that have come back. We recently found through Xray, a possible (99.9% likely as it’s apparent) fracture in the screw in the C6 endplate. I just went in today for an epidural steroid shot in my C5/C6/C7 as the pain has been excruciating. I will have a CT scan, but it’s a week way to find out if the bone fused successfully and if this was a late notice on the broken screw (coincidence to the pain and pain may come from the stenosis) There has been a gap of 7 months (March to October) between X-Rays because I had my second epidural steroid shot and that helped a good bit. I’m thinking possible Pseudarthrosis as a lot of the pain has come back and they noticed that the bone wasn’t healing/fusing as quickly as they wanted it to back in March.

This was my Xray results as of last week:

“FINDINGS:

Anterior fusion C6-7 levels identified with possible subtle lucency midportion of the superior screw appearing since prior exam. Metallic hardware including interbody spacer is otherwise unremarkable and in satisfactory position.

No visualized fracture. Vertebral bodies are well aligned.

No prominent osteophyte production.

Intervertebral disk heights are maintained.

IMPRESSION:

Possible fracture through the screw along inferior endplate of C6 vertebral body appearing since prior study. Repeat x-ray with oblique views or CT scan is suggested for further evaluation.

Exam is otherwise unremarkable”

I’m just not too sure what “possible subtle lucency midportion of the superior screw” means. Some type of possible fracture/breakage of the hardware?

Thank You!

Donald Corenman, MD, DC
Moderator

November 5, 2020 at 7:29 am

Post count: 8660

#33352

Actually, your current situation might be somewhat beneficial for you. If you had a solid fusion with continuing nerve and spinal cord compression (and continuing symptoms), then you might have more of a problem solving your issues. However, it seems like you have a pseudoarthrosis (non-fusion) due to the lucency seen on X-ray and the presence of a broken screw. Both are an indication of pseudoarthrosis.

A careful look at the CT scan and review of flexion/extension X-rays will confirm this problem. A non-fusion means you are a candidate for an anterior revision of this level which can solve most of your problems. Removing the plate and graft, revision of the residual bone spur compression of the cord and root and re-fusion could be accomplished. I would advise using your own bone (iliac crest bone graft) if you do have this surgery as this is the best technique to get a pseudoarthrosis to heal from the front. The broken screw tip might have to stay in as sometimes removing it is more destructive than leaving it. As long as it is embedded in bone, it should be OK.

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

November 5, 2020 at 7:29 am

Post count: 8660

#33353

Actually, your current situation might be somewhat beneficial for you. If you had a solid fusion with continuing nerve and spinal cord compression (and continuing symptoms), then you might have more of a problem solving your issues. However, it seems like you have a pseudoarthrosis (non-fusion) due to the lucency seen on X-ray and the presence of a broken screw. Both are an indication of pseudoarthrosis.

A careful look at the CT scan and review of flexion/extension X-rays will confirm this problem. A non-fusion means you are a candidate for an anterior revision of this level which can solve most of your problems. Removing the plate and graft, revision of the residual bone spur compression of the cord and root and re-fusion could be accomplished. I would advise using your own bone (iliac crest bone graft) if you do have this surgery as this is the best technique to get a pseudoarthrosis to heal from the front. The broken screw tip might have to stay in as sometimes removing it is more destructive than leaving it. As long as it is embedded in bone, it should be OK.

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.

Sdc1213
Participant

November 5, 2020 at 9:35 am

Post count: 8

#33355

Thank you for the great input. The only issue now is that prior to surgery I had two things going on; Myelopathy and Moderate to severe spinal stenosis. Even after waking up from the procedure I had complications during the healing process.m Major pain going down the arm, shoulder, etc. I ended up getting a second opinion through a well known Neurosurgeon in my area who deals with both brain and spine and he said you’re fixing one issue, but not the other. The disc has been replaced but the bone spurs are pressing on the nerve on the back of the vertebrae.

The question is, would it be more beneficial for a revision as a posterior fusion and foraminotomy instead of going through the front again? if they have to release the pressure on the nerve in the back anyway, would it make more sense to fix the disc that way?

I’m assuming they can’t do a foraminitomy anteriorly since there’s bone and nerve bundles blocking the access to the back?
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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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