[Donald Corenman, MD, DC]

#7434

You can certainly send your MRI images and I will be happy to review them. Please call 888 888-5310 and talk to Margaret for details.

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.

[Auric]

#7584

I’m posting here because of the poster’s comment on the uncertainty of the doctor’s more aggressive diagnosis.

Recently I talked to a physiatrist who defended what I thought to be an aggressive recommendation from a surgeon for three level cervical fusion, C4 to 5, 5 to 6, and 6 to 7. “What your doctor is thinking,” the physiatrist explained, “is pay me now or pay me later.”

The answer brought little comfort, as I had chosen only the C6 to C7 surgery about 14 months ago. But the larger approach had a practical ring I admit. I am aware of adjacent disk syndrome. And on a larger existential plane, all bodies decay. Why not fix the whole engine as long as you’ve got the hood up now?

So the real question is, when cervical disks start going bad (objectively, as seen on the MRI’s) and the surgeon’s already going to work in the neck, could fusing the next two higher vertebra be seen as preventative measure? And what are the stats on single-fusion patients needing more work on adjacent vertebra over time?

According to some forums, man, ACDF is an eighteen month standing appointment. “Then I had this one done, and then that, and then those started to act up.”

Thanks.

(I know that motion is increasingly lost the higher you go. But it is less noticeable near the base of the neck.)

Thanks. What a gift you were in that unwelcome season of ACDF in September of 2011.

there any wisdom fusing the next two discs up from C7?

[Donald Corenman, MD, DC]

#7586

In my opinion, surgery should generally only be performed for the levels that are symptomatic. There are rare times that a non-symptomatic level should be included. This would be suggested when the level can be predicted to break down in the future or is a clear threat to the cord or roots (severe cervical stenosis for example).

I just had a patient yesterday that had incapacitating lower back pain and had failed all treatments. The patient had severe isolated disc resorption of L5-S1, severe DDD at L4-5 with minimal endplate fractures and a normal disc at L3-4. A discogram workup revealed that L5-S1 was the pain generator, the L4-5 disc was severely degenerative but caused no pain and the L3-4 disc was normal.

Here is a case where we don’t know what will happen to the L4-5 disc in the future. There may be as much as a 50/50 chance that this disc will become a pain generator but there are no studies at this point to clarify this (I am currently gathering data but will not have an answer for some years). This is where I explain the pros and cons to the patient and let them make their own decision to involve L4-5 in the surgical process or leave it alone.

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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