Cervical issues

Tagged: cervical prior fusion with neck pain

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sshelton
Participant

September 27, 2018 at 3:50 pm

Post count: 4

#29432

Dr. Corenman,

I am having severe pain/burning in my neck and into my shoulder and bi-cep, also when I bend my neck down from chin to chest I get tingly and go numb from the waist down, I got my MRI and x-ray results and they say At the C3-4 level: There is mild posterior disk osteophyte complex. At the C4-5 level: There is moderate posterior disk osteophyte complex. Mild spinal canal narrowing. There is severe right neuroforaminal narrowing. X-ray showed Mild retrolisthesis at C4-C5. I went to see the Neurosurgeon today and I didn’t get to see him I only saw the NP and she said there is nothing wrong with my neck. It appears from my MRI that there is a problem. Could you please explain to me what this means.

Donald Corenman, MD, DC
Moderator

September 28, 2018 at 1:00 pm

Post count: 8660

#29435

What is the percentage of neck pain vs. shoulder and biceps pain? Do you have more central neck pain as in 70% or even higher or is your pain more equal (neck=shoulder arm). Neck pain can be caused by degenerative discs, facets or occasionally, nerve compression. Your description of degenerative levels at C3-4 and C4-5 could be the cause of your neck pain. I would disagree with the NP when she stated “there is nothing wrong with my neck”.

Your paresthesias complaint (“when I bend my neck down from chin to chest I get tingly and go numb from the waist down”) does not fit with your imaging if described correctly.

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.

sshelton
Participant

September 28, 2018 at 1:59 pm

Post count: 4

#29436

I have much more neck pain than the shoulder and arm, the neck pain hurts pretty consistently where the shoulder and arm pain are more like stabbing shooting at various times throughout the day. I’m not sure what the problem could be when I bend my neck down, I have had 2 other disc fusions at C5-6 and C6-7 and the neck pain is very similar to that but the tingly numbness when I bend my neck down I have never experienced before.

Donald Corenman, MD, DC
Moderator

September 28, 2018 at 3:36 pm

Post count: 8660

#29437

You have had ACDFs at C5-6 and C6-7? If so, what for? How did you do after surgery? Were your issues at the time resolved? Also, are these two levels solidly fused? Are they in appropriate angulation (alignment in lordosis)?

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.

sshelton
Participant

September 28, 2018 at 3:51 pm

Post count: 4

#29438

I was in a bad car accident that caused C6-7 to rupture and C5-6 to severely bulge, they did the first surgery for C6-7 and I didn’t have the surgery for C5-6 until a couple years later when it was severely compressing the nerves till I had almost no feeling or circulation in my arm and hand. So they were done separately. I’m not sure anybody has told me if they are in appropriate angulation but after both surgeries I did well and have had no issues for 10 years until now, I was told by my neurosurgeon that having even the first surgery would probably weaken the discs above it causing problems in the future. The MRI shows. I copied the report from my cervical MRI below.

Study Result
Impression
1. Status post ACDF of C5-C7.

2. Moderate degenerative change at C4-5 with mild spinal canal narrowing and severe right neuroforaminal narrowing.

Narrative
9/13/2018 9:35 AM

HISTORY/REASON FOR EXAM: Cervical radiculopathy, per rx. Neck pain, bilateral arm pain, weakness.

TECHNIQUE/EXAM DESCRIPTION: MRI of the cervical spine without and with contrast.

The study was performed on a G.E. Signa 1.5 Tesla MRI scanner. T1 sagittal, T2 fast spin-echo sagittal, T1 postcontrast fat-suppressed sagittal, and gradient-echo axial images were obtained of the cervical spine. 9 mL Gadavist contrast were administered
intravenously.

COMPARISON: None.

FINDINGS:

Postsurgical change from ACDF of C5-C7. There is anterior fixation hardware of C6-C7

No evidence of destructive marrow lesions. Alignment of the cervical spine is normal. There is a normal cervical lordotic curvature.

No abnormalities are present in the visualized prevertebral soft tissues.

The visualized portions of the posterior fossa and cervical spinal cord are normal in appearance.

At the C2-3 level: There is no appreciable disk osteophyte complex or spinal canal narrowing. There is no right and no left neuroforaminal narrowing.

At the C3-4 level: There is mild posterior disk osteophyte complex. No spinal canal narrowing. There is no right and no left neuroforaminal narrowing.

At the C4-5 level: There is moderate posterior disk osteophyte complex. Mild spinal canal narrowing. There is severe right and no left neuroforaminal narrowing.

At the C5-6 level: There is anterior fusion. No posterior disc osteophyte complex. No spinal canal narrowing. There is no right and no left neuroforaminal narrowing.

At the C6-7 level: There is anterior fusion. No posterior disc osteophyte complex. No spinal canal narrowing. There is no right and no left neuroforaminal narrowing.

At the C7-T1 level: There is no appreciable disk osteophyte complex or spinal canal narrowing. There is no right and no left neuroforaminal narrowing.

sshelton
Participant

September 28, 2018 at 3:55 pm

Post count: 4

#29439

They also did x-rays and I copied the report below.

Study Result
Impression
1. No compression deformity or acute fracture.

2. Mild retrolisthesis at C4-C5.

3. Postoperative changes at C5-C7.

4. No focal instability noted on flexion extension views.

Narrative
9/13/2018 9:26 AM

HISTORY/REASON FOR EXAM: Muscle weakness and neck pain and arm weakness and lymphoma

TECHNIQUE/EXAM DESCRIPTION AND NUMBER OF VIEWS:
Cervical spine series, 4 views.

COMPARISON: None.

FINDINGS:
There is no evidence of acute fracture in the cervical spine. No focal compression fractures are noted.
There is mild retrolisthesis at the C4-C5 level.
There is moderate degenerative disc disease and facet arthropathy. Postsurgical changes are noted with anterior fusion at C6-C7. Fusion across the disc space is also present at C5-C6.
No focal abnormal displacement is noted between flexion and extension views.
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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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