congenital cervical fusion

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mjk
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November 6, 2017 at 10:55 am

Post count: 5

#26771

I have suffered my whole life with chronic headaches, neck/shoulder tension, and forward head posture. Within the last year, my arms started going numb, which led to me getting fusion surgery on C5-6 and C6-7. I’m only 34 years old and generally otherwise healthy and had no trauma or anything to cause these problems. After the fusion, my symptoms are much worse, with debilitating headaches, and it feels like I can no longer move my head into a comfortable resting position, so my neck muscles are constantly strained. It feels like I’m now stuck in a very uncomfortable forward head position.

The radiologist noted on my post-operative x-rays that I had a fusion on the posterior side at C2-3, which my surgeon told me is probably a congenital fusion. I suspect that the congenital fusion is the root cause of my lifelong neck issues and debilitating pain.

I’ve consulted with 2 surgeons who both told me that they didn’t recommend surgery for the congenital fusion, despite my debilitating pain. They haven’t been able to recommend any treatment other than the fusion that was already done, which I regret because it just made things so much worse.

Is there anyone who can do a surgery to undo the congenital fusion? I’m desperate for some relief. It seems like it should be possible to cut the bone where it’s fused.

mjk
Participant

November 6, 2017 at 11:48 am

Post count: 5

#26772

Here are the flexion/extension x-rays where the radiologist noted congenital fusion on C2-3.

mjk
Participant

November 6, 2017 at 11:49 am

Post count: 5

#26773

flexion
extension

Donald Corenman, MD, DC
Moderator

November 6, 2017 at 5:14 pm

Post count: 8660

#26774

First, I am not convinced that you have a congenital fusion at C2-3. There is no obvious signs of obliteration of the facet joints at that level. There may or may not be motion still present. The best way to determine a congenital fusion is with a CT scan but before you do that,lets go back to the reason for your ACDF at C5-7.

Did you have severe arm pain and/or weakness of both of the levels that were operated on? Did the arm numbness go away after the surgery? Did the headaches get better? What did your surgeon tell you about the reasons for surgery and the expected results?

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.

mjk
Participant

November 6, 2017 at 10:00 pm

Post count: 5

#26779

Thank you so much for your response! Yeah, I thought it looked like there might be a little movement at C2-3, but I don’t really know what I’m looking at. One radiologist noted it on one x-ray, but nobody else noted it, and I’ve had several x-rays and a CT scan. I guess I was hoping a congenital fusion would pinpoint the source of my trouble, but maybe it’s not that simple.

I’ve always had a tendency towards forward head posture, and the associated muscle tension has been a cause of headaches for years. But before my surgeries, it felt like I could move my head back to a comfortable position to get relief, and PT and exercise helped a lot to keep it at bay. Since the surgeries, it feels like I can no longer access that resting position, and I’m stuck in a forward head posture position with constant tension and headaches. It feels like the part of my neck that is fused won’t move back like I need it to to achieve a resting position.

Before the fusion surgery, I had intermittent numbness down my right arm, from my thumb to middle finger, the palm in that area, and on my forearm. I would only get the numbness when doing specific motions, such as moving my arm in front of my body, such as when doing a push-up. I could make the numbness go away by stretching my arm back. Occasionally, I seemed to notice weakness in that bicep when doing weight lifting. I tried months of PT and injections into the cervical spine, but the intermittent numbness did not improve. I saw a neurosurgeon who recommended fusion. I was concerned about mobility and a locked neck position, but he assured me that I wouldn’t notice a significant decrease in ROM and that it should only improve my posture. He said disc replacement was contraindicated because he thought there was a problem with the facets.

I had surgery on June 30 of this year. After surgery I had terrible headaches and felt like I could no longer move my head over my shoulders, like it was stuck in a forward position. I also lost a tremendous degree of flexion, to the point where I couldn’t look down at all. My surgeon told me that it would go away with PT, but even after 6 weeks of PT I saw no improvement. The headaches were constant and excruciating. Additionally, I still had the same intermittent numbness in my right arm, but I now had constant numbness in my left arm, extending to my thumb. The new numbness in my left thumb has never gone away. I also had x-rays that suggested that screws may be loose. I thought perhaps the screws came loose because my neck was constantly under tension from being stuck in a forward head position.

I found another surgeon who said that he could revise it using artificial discs. I had the revision done on September 25. He was able to put in an artificial disc at C5-6 but couldn’t do it for C6-7, due to the disc space being too large to fit an artificial disc after removing the hardware from the initial fusion. He said that screws were very loose and he suspects it was because they had entered the disc space.

I noticed an improvement immediately after the revision surgery. I regained some of the flexion I had lost with the first surgery, but it’s still significantly reduced from what I had originally. I also feel as though my head will move more over my shoulders than before, but it also does not go all the way back like it did originally. I still have headaches and feel like I’m stuck in a forward head position. While it’s much improved from the results of the first surgery, it would still be awful to have to live with this for the rest of my life. As far as the numbness, I still have the numbness in my left thumb, but I have not yet noticed the intermittent numbness in my right arm. Since it was intermittent, it’s hard to say for sure whether it’s really gone yet. I haven’t had any imaging done since the revision.

My understanding is that it’s not expected that you could be stuck in a bad postural position with fusion surgery; if anything I thought posture should improve. I was hoping that a congenital fusion might explain why I seemed to have this issue. Do you have any other information about whether this can occur or whether there might be other issues causing this sensation? I also realize my revision was only done about 6 weeks ago, so it may still improve with time, but it feels like I’m hitting the limits of the joints trying to tuck my chin back to a resting position.

Donald Corenman, MD, DC
Moderator

December 23, 2017 at 6:58 pm

Post count: 8660

#27134

Position of fusion depends upon the original deformity and the ability of the fusion to correct this deformity. Generally, it is not typical to convert a fusion to an artificial disc replacement as the prolonged isolation of motion that the fusion creates allows fibrosis of the facets. Regaining motion is a crap shoot for pain relief as fibrotic facet capsules can be quite painful to move.

Did your C6-7 level fuse? Does the C5-6 level move normally and align normally in the normal relaxed position? Flexion/extension x-rays and a CT scan can reveal this. Did you have these done after this revision surgery?

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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