Cervical Radiculopathy

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John Woods
Participant

October 16, 2014 at 1:36 am

Post count: 7

#11532

I’m a long-time sufferer of Cervical Radiculopathy. 25 years or so. In February of 2014 it deteriorated to profound weakness in right deltoids and bicep. In May I relented to surgery and the Cleveland Clinic performed a Laminoplasty and Foraminotomy on C3-6. My neck feels great. My problem is that that there has been little or no improvement in strength. I know it takes time but I have my doubts that the C5 nerve compression has been fixed. It appears you think that only the ACDF can fix this problem. If that’s the case can it be done after a Laminoplasty? Will an ADR be as effective? Will it likely just take a few more months before my strength returns and stop worrying about it? Thank you for this informative website!

Below is the post-op MRI report:

There are postoperative changes of the cervical spine from C3-C6. There has been resection of the spinous process at C3. Lamina remain. There has been resection of the spinous process and right laminotomy with probable right-sided lamina bone graft and right laminar bar at C4 and C5. Partial resection of the spinous process at C6. There is no fluid collection within the operative bed. Recommend clinical correlation and correlation with surgical history.

There is straightening of the cervical spine from C2 through C4-5. There is slight reversal of curvature from C5-C7. Alignment is otherwise anatomic. No fracture or subluxation seen. Cervical vertebra are normal in height. Marrow signal is within normal limits.

There is mild loss of disc height at C5-6 and C6-7. There is loss of
disc signal from C2-3 through C5-6.

The craniocervical junction is normally related. Cervical spinal cord is normal in caliber and contour. No cord signal abnormality seen.

C2-3: No significant disc protrusion. No central canal stenosis. Mild bilateral uncovertebral joint hypertrophy and left facet arthropathy combine to result in minimal bilateral neural foraminal stenosis..

C3-4: No significant disc protrusion. No central canal stenosis. Mild bilateral uncovertebral joint hypertrophy and moderate right facet hypertrophy result in moderate right and mild left neural foraminal stenosis.

C4-5: Postoperative changes at this level. No significant disc
protrusion. No central canal stenosis. There is bilateral uncovertebral joint hypertrophy. There is right facet arthropathy. Moderate right neural foraminal stenosis. Mild to moderate left neural foraminal stenosis..

C5-6: Postoperative changes at this level. Mild broad disc osteophyte complex. No significant central canal stenosis. There is bilateral uncovertebral joint hypertrophy and facet arthropathy resulting in mild to moderate right and mild left neural foraminal stenosis.

C6-7: For a mild broad disc ossified complex. Mild central canal
stenosis. Bilateral uncovertebral joint hypertrophy results in moderate right and mild left neural foraminal stenosis.

C7-T1: Negative.

.
IMPRESSION:

1. Postoperative MRI as described.

2. There are postoperative changes of the cervical spine from C3-C6.
There has been resection of the spinous process at C3. Lamina remain.
There has been resection of the spinous process and right laminotomy with probable right-sided lamina bone graft and right laminar bar at C4 and C5. Partial resection of the spinous process at C6. There is no fluid collection within the operative bed. Recommend clinical correlation and correlation with surgical history.

3. Cervical spondylosis as described.

Donald Corenman, MD, DC
Moderator

October 16, 2014 at 9:03 pm

Post count: 8660

#11541

Laminoplasty and laminectomy work well for decompressing the central spinal canal for compression of the spinal cord. Foraminotomy can be effective for some disc hernations but is much less effective for nerve compression from uncovertebral joint hypertrophy (see section on radiculopathy under cervical disorders to understand this problem).

The best way to decompress the nerve root in the cervical spine is from the front of the spine as this is where the bone spur occurs that compresses the nerve root. A posterior approach cannot remove this spur. This was the case with Peyton Manning where a posterior foraminotomy was unable to fully decompress his nerve root and an ACDF was required.

This is reflected in your MRI report (“Moderate right neural foraminal stenosis. Mild to moderate left neural foraminal stenosis”). I assume this MRI was performed after your laminoplasty.

Artificial disc replacement (ADR) can be a good alternative to an ACDF (fusion( but there are circumstances that would preclude the use of an ADR. See the cervical ADR section to understand these limitations.

Even with an ACDF or an ADR, this does not guarantee that you will gain full motor strength back. Surgery gives the best chance for the nerve to heal by the decompression but the nerve has to heal and that is mother nature.

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.

John Woods
Participant

October 24, 2014 at 2:10 am

Post count: 7

#11578

Thank you for your response doctor. So you believe in all likelihood that I still have a compressed c5 nerve and will require ACDF/ADR to fix it? How long should I wait to see if the Foraminotomy worked and give the nerve a chance to heal before I have an ACDF/ADR?

Donald Corenman, MD, DC
Moderator

October 24, 2014 at 10:40 pm

Post count: 8660

#11585

If you undergo a foraminotomy and have continued symptoms, I would wait 3 months to determine if the symptoms will abate. After three months without relief, I would consider an ACDF (fusion) of this level. In my opinion, a new MRI is warranted as well as a new physical examination to make sure the symptoms have not changed and the pathology is still present.

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.

John Woods
Participant

November 13, 2014 at 5:32 am

Post count: 7

#11737

If I send my August 2014 MRI and X-ray, 3 months post-op, could you look at them and determine a bone spur is the likely culprit or do we have to assume this because the weakness persists? My shoulder has become somewhat of a pain problem lately. I presume due to my weak deltoids taking away stability.
I really am ready to do whatever is necessary to fix this. I could fly to CO anytime. Confirm you’d take an Aetna PPO.

Donald Corenman, MD, DC
Moderator

November 13, 2014 at 10:02 pm

Post count: 8660

#11744

At this point, the only images I can currently review are from certain airline pilot organizations and sport teams that I have agreed to review. I am planning a download file system that has enough security to satisfy HIPPA guidelines that I can then review forum individuals but that is still in the works. You are certainly welcome to visit us in Vail. Please call the 888 number above or the 970 476-1100 number.

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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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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