cervical radiculopathy post acdf and laminectomy

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mom4kids4cats
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March 28, 2014 at 9:43 pm

Post count: 6

#10635

Dr. Corenman:

I have had an ACDF at the C5-C6 level in 2003 and an anterior laminectomy/foraminotomy in 2004 at this same level. Immediately after the first surgery I had excruciating pain in my right arm. When I went back to the surgeon he claimed that he did not notice the severe arthritis which covered the exiting nerve and did the second surgery to take out the bone. I had been coughing (have a hx of bronchitis/asthma and pneumonia) and was concerned about having the first surgery which I expressed at the hospital. They did a chest x-ray and proceeded with the acdf. I had no instrumentation and the bone graft was from a cadaver. As a result, the bone plug settled in the wrong position-which I didn’t find out until much later. Result: cervical radiculopathy at C6-C7, continued right arm pain (10+ years), and another fusion surgery-this time with instrumentation and peek cage devices(?) from C3-C5 in 2009. Since then I have had a complete tear, partial tear and cyst in the right rotator cuff with tendinosis (surgery in 2013) and continued weakness and pain. I am also left with a retrolisthesis at the initial graft site and a crooked cervical spine. I am now having issues with my left arm-pain, paresthesia in the triceps area, some tingling in the fingers, and pain in my left shoulder blade. Occasionally I have a serious stabbing pain in that left shoulder blade with certain movements of my neck. My most recent MRI shows no new nerve compression. Bottom line question: can cervical radiculopathy worsen/spread to the other side? Is this just muscular? Why would my neck still crack and pop when my fusions are considered “stable”?

Donald Corenman, MD, DC
Moderator

March 31, 2014 at 2:55 am

Post count: 8660

#10648

The results of an ACDF can lead to a pseudoarthrosis (failure of fusion) even in the best of hands. The fusion rate increases with good carpentry (surgical technique) the use of autograft (your own bone) and the use of a plate.

It appears that your first surgery (ACDF C5-6) resulted in continued or increased compression of the C6 nerve root for some unknown reason. Your surgeon “did not notice the severe arthritis which covered the exiting nerve and did the second surgery to take out the bone”. That, I assume decompressed the root and took away your arm pain.

I am unclear as to the next series of events. You found a pseudoarthrosis at C5-6 some years later “the bone plug settled in the wrong position-which I didn’t find out until much later”. You then note this led to “cervical radiculopathy at C6-C7, continued right arm pain (10+ years)”. How a pseudoarthrosis at C5-6 led to a C6-7 level problem I don’t understand.

You then note another surgery at C3-5. Did you have the C5-6 pseudoarthrosis corrected and another ACDF at C6-7? Did the C3-5 fusion go on to fully fuse?

You have a retrolisthesis at the initial graft site. Do you mean the C5-6 level or the C6-7 level? Is this level fused?

You have new left sided symptoms. Much of the origin of these symptoms depend upon whether you have a fusion of the lower cervical levels or if you have a pseudoarthrosis. Arm symptoms can be generated by the shoulder and by nerve impingement (thoracic outlet syndrome) not associated with the neck.

Cracking and popping in the neck normally is associated with degeneration of the facets. You have open levels in the neck (C2-3, C7-T1) and possible movement from any non-fused but operated levels.

“Stable fusions” are not the same thing as solidly fused levels.

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.

mom4kids4cats
Member

April 4, 2014 at 1:30 am

Post count: 6

#10666

Hello Dr. Corenman:

Thank you for the reply. I have not had a c6-c7 fusion. I am fused from c3-c6. C3-c5 is fused with those metron peek devices (that are contraindicated by the manufacturer for the cervical spine) and a plate with screws (2009). C5-c6 is a cadaver bone fusion alone. As I stated, it is my humble opinion (and it can be seen on the x-ray/Mri) that the bone plug shifted after the 2003 surgery because I was coughing so bad. This caused my neck to lose the normal curvature. The neurologist said that the c7 nerve damage happened during the time I had my first two surgeries (2003 & 2004)and the c8/t1 nerve damage is of unknown cause.

I was wondering if the nerve damage/radiculopathy dx. on the right side can possibly affect the left side over time? I have been having some burning and tingling in the left arm and hand and woke up last week with a completely dead left arm (like I had a nerve block)-and I didn’t sleep on that side. My last MRI didn’t show any new nerve compression but did show mild facet sclerosis at the c5-c6 level and mild narrowing at c2-c3-this in conjunction with the curvature issues. I also wonder why my upper back, shoulder, and neck pain increase when I am sitting or trying to sleep?

I am off to see a pain doc who will want to do pain injections (again). At this point, I have had so many different opinions from those who read my radiology reports, doctors and even treatments that I am exhausted and skeptical.

Thank you-

Donald Corenman, MD, DC
Moderator

April 4, 2014 at 8:24 pm

Post count: 8660

#10669

If you have a fusion of C3-6, the C6-7 level certainly can develop degenerative changes. If the bone plug at C5-6 migrated after a coughing attack, this level by definition was not fused.

It is uncommon but possible that compression of the right side can cause some symptoms on the left. Normally not any weakness but on rare occasion I have seen migrating pain. This is due to the crossover of sensory tracts in the spinal cord. There is some speculation that the nerves that cross from one side to the other can excite the opposite nerves that lie right next to these active nerves.

You need a good workup from an experienced spine surgeon who can take the time to uncover your disorder, educate you regarding the disorder and design a good treatment program.

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.

mom4kids4cats
Member

April 9, 2014 at 1:06 am

Post count: 6

#10700

Thank you-that is very helpful information! I will be taking screen shots of some of my MRI’s to the next guy. Unfortunately, everyone knows everyone in this town. The last surgeon I saw is in the same office as the first surgeon who did the bone plug fusion. He was unusually cool to me at my appointment for MRI results in 2012. I have different opinions from those who read the MRI’s and the doc’s I have seen. They only read the final impression-I had thyroid lesions and now an ovarian cyst totally missed by my primary care doc because they did nor read the entire report. I only found out because I asked for the reports! For my third surgery-the doc had to leave the state because of his high rate of failures (he is now in Texas. I don’t trust anyone to tell me the truth! I only wish I could have a consult with an objective doc. I really appreciate your comments!

Donald Corenman, MD, DC
Moderator

April 14, 2014 at 8:11 am

Post count: 8660

#10722

Please keep us informed about your progress.

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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