[westie California]

#30772

Good Morning Dr Corenman,

I appreciate your feedback and will dictate my operative note from August 18, 2015:

DATE OF OPERATION: August 18, 2015.

PREOPERATIVE DIAGNOSIS: Herniated disc and spondylolisthesis C7-Tl.

POSTOPERATIVE DIAGNOSIS: Herniated disc and spondylolisthesis C7-Tl.
OPERATIONS:
• Anterior cervical decompression at C7-Tl and fusion at C7-Tl.
• Placement of cage biomechanical device in disc space at C7-Tl.
• Anterior instrumentation C7-Tl.
• Use of local bone graft.
• Fluoroscopy.

ANESTHESIA: General endotracheal.
INDICATIONS: This is a XX year old with a history of multiple previous spine surgeries who has been having progressively increasing neck pain and kyphosis. Imaging studies showed an anterior subluxation of C7 and Tl and therefore surgery is recommended after risks, benefits and complications were explained.

INTRAOPERATIVE FINDINGS:Narrowing of the disk space at C7-Tl. Good restoration of disc height at the end.

PROCEDURE IN DETAIL: The patient was brought to the operating room and placed in supine position. After the appropriate monitoring lines were placed, the patient underwent general endotracheal anesthesia.The patient was positioned supine and the anterior part of the neck was prepped and draped in the usual sterile fashion.Once this was done, a transverse skin incision was made. Dissection continued through the soft tissues. The prevertebral fascia was identified. The trachea and esophagus were retracted medially. Carotid sheath was identified and retracted laterally.Longus colli muscles were elevated. The previous plate was then identified thereby localizing the correct level the bottom of the plate. Once this was done, a distraction pin was placed in Tl and #11 blade was used to incise the annulus.Curettes were then used to remove the disk material down to the level of the PLL. The distraction was then applied and the decompression completed all the way down to the uncovertebral joints. The endplates were prepared for fusion.After decompression was completed and a 6 mm PEEK off the cage was impacted into the centered of the disk space. Once this was done, the screws were then affixed to the spine using 16 mm screws were placed in Tl and 14 mm in C7 and the locking caps were placed. Once this was done, hemostasis was obtained.Final fluoroscopy showed satisfactory positioning of the instrumentation.Wound was copiously irrigated with antibiotic irrigation. A JP drain was left in place and tunneled through a separate incision. The wound was closed in layers using 3-0 Vicryl for the platysma and deep dermis and 4-0 Monocryl for the skin. Clean sterile dressing applied to wound.The patient turned off the operating table, extubated in operating room and transferred to recovery in stable condition. No apparent complications. SSEP and motor evoked stable throughout the procedure.

My MRI’s are very confusing since it keeps referring to a disc. Per procedure above, I have a peek cage.

What Xray or MRI should I request from my doctor to check for displacement of cage? From what I see online, it appears measurements should be taken before and after surgery and something about distance between cage posterior marker and posterior margin of the vertebra should be greater than 2mm to provide reassurance that the cage is not invading the spinal canal?

Thanks again Dr Corenman, any help would be appreciated.

[Donald Corenman, MD, DC]

#30907

Unfortunately, the operative report is inconclusive as the surgeon dictation during the indications (required on every operative report) does not mention any prior surgery or fusion posteriorly. All he dictates is an ACDF surgery with a PEEK cage not mentioning any prior surgeries.

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.

[westie California]

#31049

Good afternoon Dr Corenman,

My doctor’s ordered new scan’s, i.e CT, MRI and X-rays. CT report states “status post laminectomies from C3 through C7, discectomies from C3-C4 through C7-T1 with fused interbody bone grafts and anterior instrumented fusion from C3 through C4 and from C6 through T1. Intact hardware with no evidence of loosening. Alighnment of the cervical vetebra is anatomic. Straightening of cervical lordosis. There is degenerative osseous fusion of bilateral facets from C3 through T1. Dorsal epidural soft tissues at all levels from C3-C4 through C7-T1 is most likely granulation tissue. There is no significant canal or neural foraminal stenosis in the cervical spine.

Mri report states:

At C2/C3 disc space level, disc herniation is noted deforming the thecal sac abutting the spinal cord contributing to mild central spinal stenosis in conjuction with posterior ligamentous hypertrophy.

C3/4-C6/7 postsurgical changes are noted with anterior fusion plate and anterior fixation screws transversing the C3-C7 vertebral bodies. Hypertrophic changes are noted at each level deforming the anterior margin of the thecal sac. C3/4 mild left neural foaminal narrowing is noted in conjuction with facet and uncinate hypertrophic changes.

Facets joints and uncinate processes exhibit some sclerosis.

At C7/T1, disc bulge is noted deforming the thecal sac. Loss of disc signal is noted with loss of disc space height anteriorly. Cervical spine straightening is noted.

Radiographic examination report states” Large cassete AP and lateral scoliosis plate films reveal 3.9 cm C2 to T1 alighnment. Alighnment and appearance of the hardware is satisfactory.There is accentuation of the lumbar lordosis. There is a slight pelvic tilt with the right iliac crest higher than the left.

My MRI was performed in a load bearing position (upright), so I’m not sure if this is playing into my peek cage level C7/T1, in that when I’m upright that level goes down, because it’s flexible although fused?

My question is what should my next course of action be with these findings? thanks in advance

[Donald Corenman, MD, DC]

#31050

The MRI report must be old as the report notes “At C7/T1, disc bulge is noted deforming the thecal sac. Loss of disc signal is noted with loss of disc space height anteriorly. Cervical spine straightening is noted”. You had surgery at this level which is not noted by the report so this report must be older than your surgery.

You do have degenerative changes above the fusion (C2-3) which can cause upper neck pain and headaches. “At C2/C3 disc space level, disc herniation is noted deforming the thecal sac abutting the spinal cord contributing to mild central spinal stenosis in conjuction with posterior ligamentous hypertrophy”.

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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