Cervical CT Scan Results

Tagged: Continuing symptoms after ACDF

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Donald Corenman, MD, DC
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July 18, 2015 at 12:25 pm

Post count: 8660

#20043

The procedure is called a cervical anterior hardware removal. If you have a solid fusion, this will cause no instability.

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.

323marine
Participant

July 25, 2015 at 1:12 pm

Post count: 5

#20088

Dr. Corenman,

Thank you again for your insight. I recently went to a provider regarding my reoccurring symptoms, related to the ACDF surgery. An MRI was ordered and after reviewing the MRI results, they appeared to be QUITE different from my CT scan results. I’m very confused between both results. If you have a moment, can you please offer your opinion on these latest results? Here are the results as follows:

MRI CERVICAL SPINE WITHOUT CONTRAST
HISTORY: Cervicalgia

COMPARISON: Plain radiographs from 51612014 as well as MRI cervical spine from 51612014
Technique: Sagittal T2, sagittal STIR, sagittal T1, and axralT2 magnetic resonance imaging was obtained of the cervical spine.

FINDINGS: Postsulgical changes are againdemonstrated from anterior cervical spinal fusion at the C5-C6 level consisting of a single plate and 2 screws at each verlebral level. Recent plain radiographs of the cervical spine demonstrate solid osseous fusion between the C5 and C6 vertebraibodies. The hardware appears to be intact with no marrow signal to suggest loosening.

Vertebral body height and alignment is maintained throughout the cervical spine- Minimal straightening of the normal cervical lordosis. The lateral masses of Cl are aligned on C2. No abnormal bone marrow signal is seen. The cord is of normal caliber without abnormal signal.

Remaining findings by level are as follows:

At the level of Cl-C2,there are minimal degenerative changes at the atlanto-dens articulation. Canal remains widely patent at this level and no neural foraminal narrowing is seen.

At the level of C2-C3, there is no evidence of osteophytic ridging, neural foraminal narrowing, facet arlhrosis, or ligamentum flavum thickening. Canal remains widely patent at this level and no evidence of cord compression or abnormal cord signal is seen at this level.

At the level of C3-C4, there is no evidence of osteophyic ridging, neural foraminal narrowing, facet arthrosis, or ligamentum flavum thickening. Canal remains widely patent at this level and no evidence of cord compression or abnormal cord signal is seen at this level.

At the levels of C4-C5, no significant change from prior exam. Mild degeneration of the C4-C5 disc, with small broad-based disc protrusion, which narrows the ventral subarachnoid space. Minimal cord indentation with no abnormal cord signal. The dorsal subarachnoid space is well-preserved. No significant facet disease. No significant foraminal stenosis.

At the level of C5-C6, intact fused level with wide decompression of the canal and neural foramen. No significant facet degeneration.

At the level of C6-C7, mild degeneration of the C6-C7 disc is unchanged from prior. Minimal disc bulge with no significant canal or foraminal narrowing. No significant facet disease.

At the level of C7-TI, there is no evidence of osteophytic ridging, neural foraminal narrowing, facet arthrosis, or ligamentum flavum thickening. Canal remains widely patent at this level and no evidence of cord compression or abnormal cord signal is seen at this level. Paraspinous soft tissues are within normal limits. Limited evaluation of the posterior fossa on T2 weighted images reveals no abnormality. Lung apices arc clear.

IMPRESSION:

No significant interval change compared to prior postoperative cervical spine MRI dated May 6, 2014. The C5-C6 fusion construct appears well intact and solidly fused.
Mild degenerative changes above and below the fusion construct, with no significant canal or foraminal stenosis. No significant facet arthropathy at any cervical level.

Any info you can provide would be greatly appreciated.

Best Regards,

323marine

Donald Corenman, MD, DC
Moderator

July 26, 2015 at 9:38 am

Post count: 8660

#20090

The MRI and the CT are generally compatible but you have found a weakness of the MRI scan in your particular case. MRIs are typical for not defining the exact location of metallic hardware. The MRI is of course a magnet and will be affected by the metal of the hardware, even if this hardware is titanium.

This means that the screw position will be more difficult to interpret on an MRI than a CT where the screw tip can be much more easily seen.

Again, a SNRB (nerve block) might be helpful to find if this screw tip is irritating the root. Temporary relief is an indication that the nerve is irritated by this screw tip but remember that chronic radiculopathy is another possibility.

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.

323marine
Participant

February 29, 2016 at 9:56 pm

Post count: 5

#21457

Hello Doctor,

It’s been awhile, but once again I find myself seeking your insight. Nonetheless, in a recent visit with my neurologist, I was informed that I had a broken vertebral screw and the section (C5-C6) where ACDF surgery was performed has re-herniated. The provider advised me at this point surgery isn’t necessary, and recommended PT and traction. That being said, should I require surgery, what type of surgery am I facing? Any information you could provide would be much appreciated.

Best Regards,

323marine
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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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