c7 Weakness

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brianc7
Member

October 9, 2012 at 9:53 am

Post count: 3

#7137

Hi Dr. Corenman,
I herniated my c6c7 disc in May, 5 months ago. I had terrible pain in my neck, right tricep and shoulder blade lasting 2 weeks. I had an EMG in May when the pain was much less. EMG said I have significant right tricep weakness, and moderate finger and thumb extensor weakness as well as my latissimus dorsi. my tricep had no reflex. I visited a spine surgeon in May. He said the Prodisc ADR was an option. After discussing the emg report, which stated that if strength was beginning to return, I could follow conservative measures. I felt the pain was lessining and my triceps, finger and thumb strength was getting slightly better, definitly not getting weaker. So I told the surgeon I would like to try to wait and see if it continues to improve. I had started to lift some weights in to strengthen my arm further. About a month ago I started to get some pain in my shoulder blade, and even a little in my forearm. I still have some tricep weakness, but not as bad as it once was. original Report stated a 3/5 and now a 3+/5 or 4/5. depending which doctor.

Originally I thought I had 6-12 months to have good surgical results. Now after reading internet posts and people saying they have not gained any more strength 1-2 years post op,I’m not sure.

Being a c7 nerve, what should my expectations be if I were to have the ADR at about 7 months after injury?

If I do not have the surgery, what are the chances of losing the use of my right arm/hand? I never had any numbness or pins and needles, just weakness.

MRI: Mild central canal stenosis and moderate bilateral neural foraminal stenosis at c6-c7.

Thank you for your help and knowledge on this scary injury,

Brian

Donald Corenman, MD, DC
Moderator

October 9, 2012 at 4:42 pm

Post count: 8660

#7141

Generally, I recommend a decompression surgery for significant motor weakness of an important motor group. For the neck, there might be some room to wait as the cervical nerves seem to be “more forgiving” of delayed decompression than the lumbar nerves. C7 is one of the more forgiving nerves. If the patient chooses, I typically will wait three months for recovery of patients that have triceps motor weakness. Most individuals want to have surgery more quickly than that to have a better chance to recover the motor strength.

In my opinion, if the strength has not returned after five months, I generally recommend surgery to give the nerve the best chance to recover. There still is a chance that the nerve can recover on its own but the chances are much less than a surgical decompression can allow.

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.

brianc7
Member

October 10, 2012 at 4:49 am

Post count: 3

#7146

Dr. Corenman,

I agree, surgery would give the nerve the best chance to recover. But I might be willing to take the chance with what I have gained and the small chance to gain a little more without having the surgery. This because as I mentioned my ADR surgery would be done at about 7 months and my spinal surgeon, well respected, who has been doing spinal fusions for many years, has only done about 3 cervical Prodisc ADR’s. So my best chance to recover is perhaps limited. I am concerned about things like, new pain in the neck.

Because I have gained some strength back, and a lot less pain than originally, does that indicate the c7 nerve is healing a little?

Thank you,
Brian

Donald Corenman, MD, DC
Moderator

October 10, 2012 at 8:05 am

Post count: 8660

#7147

The C7 nerve is “healing” somewhat. You can take the risk of trying to live with it in the expectations that the nerve will continue to improve.

I however have to think in terms of percentages. That is, yes there is a chance that the nerve will improve but at 7 months you have the law of diminishing returns. The longer you wait, the chances increase that it will not heal.

The ADR from Synthes (Prodisc) is not that hard to implant for a skilled spine surgeon. There are some pearls to know but essentially, the implant technique is not too different from an ACDF. It is the indications for implantation that are so different than the ACDF.

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.

brianc7
Member

October 25, 2012 at 5:11 am

Post count: 3

#7249

Hi Dr.

Could you tell me, if the Prodisc had to be removed for some reason in the future,
Is there room for a plate and screws at that same level (c6-c7)? (used to help it fuse) or would it be likely to have to put a plate at the level above (c5-c6) and /or below the disc being removed, to help stabilize it?
I am wondering because of the cut outs for the “keels”
would it affect the bones, therefore, cause you to modify a standard c6-c7 acdf?

Thanks again, Brian

Donald Corenman, MD, DC
Moderator

October 25, 2012 at 10:44 am

Post count: 8660

#7251

The Prodisc can easily be converted to an ACDF and yes, there is plenty of room for a plate and screws. I have revised two Prodiscs to ACDFs (implanted by other surgeons) from patients who had continued pain after this implant. I each case, the revision was easy. The keel is not too deep and can be filled in with autograft which in turn incorporates into the host bone.

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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