[Donald Corenman, MD, DC]

#7904

This procedure uses an incision, an arthroscope type device (camera on the end of a wand) and another type probe that has an ablator (laser or other type device).

There are many problems associated with this technique. First is that there are significant blood vessels (epidural arteries and veins) that can obscure visualization. Second is that using laser, thermal damage can occur to the dural sleeve or even nerve root. Bone spur does not respond well to laser ablation and damage can occur to the nerves or cord with this technique.

These groups have yet to publish their findings regarding success rates and complications. I cannot recommend this technique.

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.

[exercise453]

#8216

Dear Doctor

I anticipate a new mri, both cervical and thoracic. Two years ago the mri was done at a stand alone imaging center, an outpatient extension of a local hospital. It was1.5 tesla I believe to be adequate and an adequate facility. Many spine surgeons recommend a facility they affiliate with and most are tesla 1.5. It is an easy matter to go back to the same facility, more difficult to uncover a facility using 3.0 that is on the insurance. They seem to be few and far between.

1- Is a tesla 1.5 mri adequate or do you recommend going through whatever is necessary for a 3.0??? (You did mention your clinic has 3.0)

2- On the website you say that you can go back to doing most anything after a single level fusion but a two level carries greater restrictions and a three level even greater than that. Can you provide some specifics, especially regarding activities, sports and general daily lifting. What is this life.???

3- Is the choice of using cadaver bone for multi-level fusion still the same as single level. I have read that two and certainly three levels begin to require your own bone???

Thank you

[Donald Corenman, MD, DC]

#8218

A 1.5 tesla MRI is an acceptable machine. Much depends upon the technician that performs the scan and the number and type of images generated. I have seen scans that never acquire the STIR images (important for discovery of edema and reactive changes). I have also seen scans that use increased thicknesses of cuts (to reduce the scan time) and degrade the images. Both of these poor techniques require less time in the scanner so more patients can be scanned (more money to the facility) but with less quality to the scan (less diagnostic images). If many spine surgeons use this facility, I assume it is acceptable.

A one level fusion allows any activity without restriction. A two level fusion would have me restrict the patient to avoid contact sports (football, soccer, rugby). A three level fusion would also include impact sports (long distance running, tennis). These restrictions are relative. A three level fusion does not fully preclude running but with the genetics of this type of neck, running could increase the possibility of further breakdown of another disc so should be avoided. I do have patients that continue to run understanding the risks.

The greater the number of levels involved with an ACDF, the greater the chance that one of these levels will not fuse. You own bone (autograft) has a greater chance of fusing than cadaver bone (allograft) by 10 or more percent in a multilevel fusion. There have been many three level fusions performed with allograft with good results. It simply is a question of percentage risk that the patient is willing to take.

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.

[exercise453]

#8490

Dear Dr

I have bulging/herniated discs into the canal from c4-7, caused by two overhead weight lifting accidents 7 years ago. C4-5 wipes out 90% of the canal…….c5-6 and c6-7 about 65%. The cord is untouched, there is ample fluid behind the cord and the signal is good. What foraminal stenosis symptoms I have has not caused weakness. There are no mylopathy signs.

Aside from chronic neck pain I have strong symptoms of irritation (pins and needles???) centered between the shoulder blades at these levels and below. It was said I do not have stenosis. I do not understand this with discs well into the canal.

I take: 800 mg gabrapentin (2×400)
125 mg ultram (1×50…1x 75)
800 mg advil (1×800…most days)

The medication drops the symptoms from a debilitating level to chronic functional discomfort.

Are these debilitating symptoms of irritation typical from degenerated/ herniated discs into the canal without something more ominous going on to worry about????

Are they from the discs, the intrusion on nerves in the canal…both????

Thank you

[exercise453]

#8491

Sorry…as usual I forgot something…tightness
Is long standing tightness caused by the intrusive discs???
In the above scenario is tightness a source of concern???

[Donald Corenman, MD, DC]

#8562

The neck can cause four types of symptoms; neck pain from the discs and facets, shoulder and arm pain from the nerve roots, headaches from the upper cervical nerve roots and facets and finally, myelopathy from cord compression. “Bulging discs” can certainly cause tightness and local neck pain. Your medication use certainly looks appropriate at first glance.

If I have to trust the radiologist report, there is nothing dangerous going on that I can see.

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.

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