C6-C7 ACDF recovery, lingering weakness...

Tagged: ACDF, atrophy, C7 radiculopathy, weakness post ACDF surgery

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Addy992
Participant

December 8, 2020 at 2:20 pm

Post count: 2

#33454

Hello! I am 28 years old male. I am graphic designer who spends a lot of time on a PC. English is not my native language and I am sorry if I make any mistakes.

My problems started in early May 2020 when I had a pain in the neck that didn’t subside for days. I was very active and I thought it was some kind of muscle strain so I did some stretches that were very painful and probably irritated my neck further. A week or two later when I was doing warm ups on bench press I realized that I lost a lot of strength in my right tricep. Soon after that my pec muscle, tricep and lattisimus dorsi on the right side started twitching and I felt pain radiating down my right arm. In the following weeks most of the pain was gone but I was starting to feel tingling sensation down my arm and my index finger and thumb started to feel numb. The numbness and tingling would intensify in certain neck positions. Twitching stopped about the same time. Soon those muscles (pec, triceps and lat) atrophied and I wasn’t able to fully activate them.

I was scheduled to do MRI in september (4 months after my initial symptoms) and it showed c6-c7 extrusion and c5-c6 bulging. By the time I did MRI most of my symptoms were gone. No pain, no twitching, no numbness. Still, my muscles were very weak and atrophied and I wasn’t able to fully activate them. Also, I would still feel occasional tingling sensation going mostly from my elbow to between index and middle finger.

I did an EMNG in september and neurologist said that it showed signs of moderate to severe chronic c7 radiculopathy. He said something like third of my motor units are gone. As if I had something for a long time and I didn’t notice it. I don’t want to believe that.

On october 23rd I travelled to Turkey (my country wasn’t doing surgeries due to COVID crisis) and I had C6-c7 ACDF with standalone peek cage (arion osimplant). My NS told me that c5-c6 didn’t need surgery at the moment but I have to be careful in the future.
After the surgery tingling sensation that was dependant upon neck position has completely disappeared. But my muscles are still weak and atropied. I feel low dull pain when I press those muscles with hand and I can’t completely activate them.
I started PT a week ago and I am doing some strengthening exercises but I don’t really feel those muscles firing up.

MRI report day before my surgery (it was translated from Turkish)

Cervical lordosis has flattened.
Vertebral body heights and signal distributions of the bone structures are normal
Signal loss secondary to degeneration is seen in cervical discs. On C3-C4,C4-C5 diffuse bulging is seen.
On C5-C6 level, diffuse bulging has occluded anterior subarchnoid space and it causes indentation to spinal cord.
On C6-C7 level, diffuse bulging and right foraminal disc protrusion have narrowed right lateral recess and right neural foramina. Right C7 root compression is seen.
Diameters of spinal canal are normal.
Craniocervical junction formations are normal.
No prominent pathology is detected in soft tissues of paravertebral region.

RESULTS:
Flattening in cervical lordosis.
Signal loss secondary to degeneration in cervical intervertebral discs,
On C3-C4, C4-C5 level, diffuse bulging
On C5-C6 level, diffuse bulging has occluded anterior subarchnoid space and it causes indentation to spinal cord
On C6-C7 level, diffuse bulging right foraminal disc protrusion, narrowing in right lateral recess and right neural foramina, right C7 root compression.

I have several questions/doubts.
Could my weakness and atrophy be caused by something else or I have to wait for nerves to regenerate? How long can that take considering my timeline? Can I have some permanent nerve damage?
What about activities, when can I go back to weightlifting?
Can you share your opinion or any thoughts you have about my case. Thanks

Donald Corenman, MD, DC
Moderator

December 8, 2020 at 4:32 pm

Post count: 8660

#33457

By the way, your English translation is excellent! You have a classic C7 radiculopathy (compression of the root in the C6-7 foramen). Compression of the nerve root can cause permanent injury but in my experience, the cervical nerve roots are much more forgiving of injury than the lumbar roots. You are only 6 weeks out from decompression at this point and that is a very short time period for root recovery. I will attach the recovery information for the nerve root here:
https://neckandback.com/conditions/how-muscles-recover-from-nerve-injuries-neck/

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.

Addy992
Participant

December 10, 2020 at 1:20 pm

Post count: 2

#33464

Thank you very much for your answer. I’ve read the article and it’s very informative.
The last couple of months have been very hard for me and made me very anxious. I am afraid that something might be overlooked in my diagnosis. I might worry needlessly but I have to ask.
Could the weakness and atrophy I wrote about in the previous post be caused by C6 radiculopathy because I’ve read online that thumb numbness is more of a C6 root. And also I have slight weakness in wrist extension on the right side which is also connected to C6 if I read correctly.
Could that herniation on C5-C6 that wasn’t treated with the surgery be causing the weakness and atrophy (triceps, pec, lat) or it’s all about C7.
I will make an appointment with neurologist to be certain but I would appreciate your opinion.
Thanks for your patience.

Donald Corenman, MD, DC
Moderator

December 12, 2020 at 9:16 am

Post count: 8660

#33469

There is a possibility that you developed Parsonage-Turner syndrome and that would explain why some motor group weaknesses expands beyond the typical C7 root motors or you could have some compression and weakness of the C5-6 level. Generally, the biceps is a C6 root muscle so if you have no biceps weakness, I wouldn’t be too concerned about the C6 root. Yes, the thumb is more related to C6 but crossover of root distributions do occur.

https://neckandback.com/conditions/parsonage-turner-syndrome-neck/

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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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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C6-C7 ACDF recovery, lingering weakness…