Autofusion of vertebrae

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Jellyhall
Participant

October 16, 2013 at 10:34 pm

Post count: 91

#9588

I had two levels of my neck (C3/4 C4/5) fused in an ACDF 11 months ago.
Before surgery four levels of my neck were bad, but only the worst two were fused as they were compressing my cord and I had some signs of myelopathy.

I had a full spine MRI after my surgery and the cord had fluid around it again. However my surgeon told me that the two levels below either had or would autofuse as the disc was practically gone.

Now, I had an EMG and nerve conduction studies done some time before the ACDF and that showed that I had neurogenic changes to the muscles in both arms fed by the lower levels. I think it was my deltoid, bicep and tricep muscles. I was told that the nerves of my neck were being compressed on both sides. I have symptoms of nerve pain and other sensations in both hands, arms as well as my feet and legs and also around my abdomen. (I have herniated discs in my thoracic spine too.)

Now my question is; is it ok to allow my neck to autofuse as the nerves are being compressed? I worry that the nerves will become even more compressed and then it would be very difficult to release them if it was decided that other levels needed to be fused. What is your opinion on this please?

Donald Corenman, MD, DC
Moderator

October 20, 2013 at 9:53 pm

Post count: 8660

#9647

Spines rarely “autofuse”. The levels below (C5-7) will most likely continue to develop spurs that will compress the nerves at those levels (the C6 and C7 nerves). Look at the section on the website under “nerve injuries and recovery”; “Symptoms of cervical nerve injuries” to understand what problems can occur with nerve compression at these levels.

If you are having weakness from nerve compression then more likely than not, you will need surgery. If these levels are so degenerative that they “look like they will auto fuse”, you should have very little loss of motion with an ACDF at these levels.

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.

Jellyhall
Participant

November 6, 2013 at 10:21 pm

Post count: 91

#9764

I have obtained a copy of the report from a full spine MRI scan that was done after surgery. This states that at
C2/3 there is capacious spinal canal and foraminal dimensions
C3/4 capacious spinal canal and foraminal dimensions with no neural compression
C4/5 a small residual osteo discal bar indents the anterior sub arachnoid space without any residual cord compression. Moderate right C5 foraminal narrowing.
C5/6 an osteo discal bar indents the anterior sub arachnoid space without cord compression. Moderately severe right C6 foraminal stenosis, mild left C6 foraminal narrowing.
C6/7 the spinal canal dimensions are adequate, moderate bilateral foraminal stenosis.
C7/T1 capacious spinal canal and foraminal dimensions.
No intrinsic neural lesion.
No focal acute bony lesion.

I am wondering how my EMG and nerve studies indicate chronic neurogenic changes to the muscles of my deltoid, biceps and triceps muscles and why I am still getting nerve pain and symptoms in both hands, wrists and arms. This is worst on my hand beetween the thumb and first finger and there appears to me to be some atrophy of the muscles there. However I am also getting pain and symptoms on my left hand including numbness of the pinky and ring finger. I also get pain along the outer edge of my left hand and a cramping where my palm meets my wrist in line with the pinky and ring finger. Am I correct in thinking that the report does not show compression of the nerves that feed this area? (C7/T1).

I am not sure if I am having weakness in my hands, wrists and arms. My hands, especially my right hand which I use mostly, will become painful if I try to grip anything for long at all. Things like carrying a plate of food, peeling vegetables, holding a toothbrush and lately even picking up a glass will cause pain in my hand so I have to let go or support with my other hand. I can’t use my arms above my head for very long and hanging washing causes my arms to ache where that never used to be a problem years ago.

Is there anything else that could be causing these symptoms in my hands and arms? I am wondering if it could be arthritis.

I am still having the stiffening spasms (spasticity) in both legs and around my abdomen when I start to move in bed as I wake in the mornings. I also get this when getting up from sitting in a chair for a long time. My right foot especially turns inwards with my big toe sticking up.

I do have questions about the report on the thoracic spine and my symptoms, and also on the Lumbar spine but perhaps I should ask those somewhere other than the forum on neck pain.

I thank you for your generosity of your time in answering our questions on this forum.

Donald Corenman, MD, DC
Moderator

November 11, 2013 at 10:03 pm

Post count: 8660

#9775

You have a contined narrowing of the nerve hole at C4-5 on the right (“Moderate right C5 foraminal narrowing”). I don’t believe that this is causing your symptoms. This level should be fused and motion is normally what causes the nerve to become compressed.

You have signficant narrowing of the foramen at C5-6 and C6-7 (“Moderately severe right C6 foraminal stenosis,C6/7 the spinal canal dimensions are adequate, moderate bilateral foraminal stenosis”).

These nerve exit narrowings can compress the C6 and C7 nerves. See under “conditions; nerve injuries and recovery; symptoms of cervical nerve injuries” to understand what symptoms can be generated by malfunction of these roots.

Don’t forget that nerve compression syndromes can occur at the wrist, elbow and shoulder (carpel tunnel, cubital tunnel and thoracic outlet syndromes). These can be identified by physical examination and sometimes by EMG too.

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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Donald Corenman, MD, DC

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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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