C5,c6 severe spinal chord compression pre-op and post op acdf

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ReneeA
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February 27, 2013 at 9:59 am

Post count: 4

#8092

Hello everyone, I am new to this forum.. I need guidance. I am a 43 yr old women. 7 years ago had a stiff neck..went to chiropractor who dx me with muscle spasm and MRI that showed cervical lordosis otherwise impeccable MRI. April 12 started jogging to lose weight, developed stiff neck. Went to chiropractor who Did X-rays and gave me first adjustment same day. Next day went back for 2 nd adj and X-ray results. Was explained I was having muscle spasms and arthritic area. He proceeded with cervical adjustment . Instantly after getting off table I felt like a knife was in my shoulder blade area. Took Motrin and went to bed. Next morning upon weakening walked downstairs and felt my foot wasn’t touching stair. Heavy feeling in legs. Dog got out and ran to get her and legs wouldn’t work in sync. Called chiro told him and was said ” nothing I did, neck doesn’t control legs.” So I called md.. Ordered me in ASAP, performed MRI and mra. MRI showed c5c6 severe cord compression, herniated disk among canal stenosis and bulging disks below c2 to t1… Forminal narrowing and lots of other crazy stuff.. Told immediate surgery on c5c6. Acdf ASAP. Post acdf now pitosis , emg shows c5 radiculopathy. Pain in forearm ,can’t lift or hold arm in “phone” position without hurting once I real ease phone.. shoulders two mths post surgery! Hard to lift with right arm. Neck rotation limited and pain daily. MRI post 10mths acdf says flatten cord, spinal stenosis and forminal narrowing improved now mild. Bulging disks still present. MRI says more than I’m saying now. Guess my question is what does flattened cord mean now? And c5 chronic radiculopathy now according to emg. Feel like 80 yr old now. Help me understand my future and what to expect. Can I get worse.

Donald Corenman, MD, DC
Moderator

February 28, 2013 at 5:25 am

Post count: 8660

#8102

You had a disc herniation after a chiropractic adjustment which is rare but does happen. This herniation unfortunately compressed the spinal cord at C5-6 which explains your leg symptoms. The emergency ADCF surgery was necessary to prevent further damage to your cord. Ptosis (drooping eyelid) after an ACDF indicates injury to the sympathetic plexus (Horner’s syndrome) which runs along the outside of the cervical spine and is rarely damaged by the surgery itself.

C5 nerve root dysfunction is typically related to foraminal stenosis at the C4-5 level. Flattening of the cord indicates that there is cervical stenosis also present at that level. If there is cord compression, there is danger of cord injury. If there is enough foraminal stenosis present to cause weakness of the C5 muscle group (deltoid), surgery may be the best way to control both these problems.

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.

ReneeA
Member

February 28, 2013 at 7:44 am

Post count: 4

#8104

Thank you for your comments. I am still not clear on this. This is what my pre op MRI says vs Post op. the surgery was in May 2012. Btw had a MRI of cervical spine that said unremarkable study.
2012:
C2-c3 is unremarkable
C3-c4 and c4-c5 posterior endplate ringing, and mild central disc bulging, producing mild canal stenoisis new from previous
C5-c6 bilateral uncovertebral arthropathy, posterior endplate spurring, diffuse disc bulging, more prominent along both paracentral regions with a superimposed small left paracentral disc herniation and ligamentum flavum hypertrophy producing sever canal stenosis with compression of the cord. Moderately severe right and moderate left neural forminal narrowing at this level.
C6-c7 small central disc bulge and ligamentum flavum hypertrophy producing mild to moderate canal stenosis and mild bilateral neural forminal narrowing.
C7-t1 bilateral uncovertebral joint arthropathy ligamentum flavum hypertrophy and mild bilateral facet arthropathy producing mild to moderate neural forminal narrowing.

Post op
C2-c3 unremarkable
C3-c4 and c4-c5 posterior endplate ridging and mild focal central disc buldging producing mild canal stenosis unchanged from previous.
C5-c6 bilateral uncovertebral joint arthropathy and mild broad based posterior endplate osteophyte formation producing decreased canal stenosis now mild with mild flattening of the cervical cord and interval resolution of previously visualized bilateral neural forminal narrowing
C6-c7 small sent real right paracentral broad based disc bulge slightly decreased in size from previous and ligamentum flavum hypertrophy producing canal stenosis decreased from previous now mild and no significant neural forminal narrowing
C7-t1 bilateral uncovertebral joint arthropathy ligamentum flavum hypertrophy and bilateral facet arthropathy producing mild to moderate right and mild left neural forminal narrowing unchanged

Basically these words are confusing. Is this arthritis and based on MRI in 2004 what the heck happened. I should explain that I went to the chiropractor for a stiff neck. I have straightening of cervical area. Guess I want to know why all this? I do know that the following day after second adjustment I had left leg weakness and stabbing pain near shoulder blade. Now I have right forearm pain. Emg said c5 however doctor thought is would have showed c6. I have neck , shoulder and now elbow to hand pain. Will I get worse? Why stenosis? And should I see a spinal neurosurgeon. I was active person who enjoys skiing, jogging. Now I’m scared I will do something to my cord? Please help me understand more of the jargon. Thank you so much

Donald Corenman, MD, DC
Moderator

February 28, 2013 at 11:41 am

Post count: 8660

#8106

I cannot comment on the changes from 2004 to current as with all radiological reports, we are looking at them through the eyes of the radiologist and every report has an interpretation that varies. There could have been significant degenerative changes on the MRI of 2004 that were not identified. As a good example, for the two MRIs that you list the results, there is no comment on foraminal stenosis of C4-5, either before or after surgery.

In the first report “C3-c4 and c4-c5 posterior endplate ringing, and mild central disc bulging, producing mild canal stenosis new from previous”. There is no comment on any foraminal narrowing. In the second report, the same problem is noted “C3-c4 and c4-c5 posterior endplate ridging and mild focal central disc buldging producing mild canal stenosis unchanged from previous”. Again, no comment regarding foraminal stenosis.

Interesting enough that the radiologist does comment on foraminal stenosis at C6-7 on each report.

The EMG is helpful only for motor weakness and will not be positive in the face of only pain and sensation loss as the pain nerves are too small (C fibers) to be picked up by an EMG. The best way to determine pain generation is to use selective nerve root blocks (SNRB-see website) to determine what is causing the arm pain.

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.

ReneeA
Member

March 2, 2013 at 4:34 am

Post count: 4

#8113

Thank you for taking the time to reply. I guess I am wondering what long term effects this can have on me. Is cord flattening anything to be concerned about? Is all these cervical issues of underlying arthritis? I know c5c6 was result of adjustment. Immediate pain and leg weakness, and feeling loss the next day. Brain and leg not in sync. Now that is fixed, do I need to worry about cord in future?

Donald Corenman, MD, DC
Moderator

March 2, 2013 at 10:51 am

Post count: 8660

#8115

Cord flattening or central cervical stenosis can be concerning depending upon your activity involvement and the severity of the narrowing. The central cervical canal changes in volume with flexion and extension (bending your head forward and back). A forced extension can significantly narrow the canal and “pinch” the cord causing something called central cord syndrome (see website).

If you involve yourself in sports that have a risk of a face plant at speed (snow or water skiing, biking-especially mtn biking, horseback riding and others), you have an increased risk of this injury. If you are more sedentary, the risk is less. Also, as I discussed before, the MRI interpretation is colored by the radiologist’s bias. One radiologist’s “minimal’ might be the next one’s “moderate”. These is less risk if the CSF (cerebral spinal fluid) surrounds the cord vs. “flattens” the cord on one side.

Unfortunately, I cannot give you the risks in terms of percentages. I know how many individuals develop central cord syndrome but do not know the denominator. That is, how many individuals have this disorder but never develop central cord syndrome. Your risk might be 1% or 10% (also depending upon your activity level).

Yes, all these issues can be thought of as “arthritis” but that is a bad term for this disorder. It really is called degenerative disc disease and is quite common in most everyone.

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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