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  • ajpf52
    Participant
    Post count: 3

    Hello Dr. Corenman

    I have gone to 2 surgeons who both recommended surgery soon and both said fusion surgery was recommended. As a mechanical engineer I have some strong reservations with the Fusion surgery and the loss of flexibility of the spine. It would seem to me disc replacement would be a good alternative, but when I ask about it they don’t recommend it for no other reason than they dont do it. What is the criteria for disc replacement as I have read many comments from people that get them and are very impressed with the results. I realize one type of treatment doesnt fit all situations but I feel like it is fusion or nothing. What is your opinion? I have included below my MRI results.

    IMPRESSION:

    1. Discogenic abnormalities as described below, most significant at C5-C6 where there is discogenic cord compression. See additional comments about other levels.

    PROCEDURE:

    Multisequence, multiplanar MR imaging was performed on a 1.5 Tesla System.

    IV Contrast: Not administered as per protocol/request.

    COMMENT:

    Comparison exams: None available.

    Discs: There is disc desiccation at all cervical levels. There is also narrowing at C3-C4, C4 dear C5 and C5-C6. This is compatible with degenerative disc disease. There is also degenerative joint disease at the C1-C2 articulation.

    Vertebral Bodies: There are no destructive lesions or compression fractures.

    Alignment: There is reversal of the normal cervical lordosis. Additionally,there is a retrolisthesis of C5 on C6 by approximately 3 rom.

    C2-C3: There is a symmetric ventral disc/ridge complex that impresses but does not efface the ventral subarachnoid space, touch the ventral surface of the cervical cord nor displace or compress the cord. The foramen are patent.

    C3-C4: There is a diffuse, but asymmetric right-sided ventral disc/ridge defect that effaces the ventral subarachnoid space, and mechanically contacts and indents the ventral surface of the cervical cord, but does not posteriorly displace the cord. The CSF posterior to the cord is effaced. There is bilateral foraminal narrowing.

    C4-C5: There is a symmetric ventral disk/ridge complex that effaces the ventral subarachnoid space, and mechanically contacts and indents the ventral surface of the cervical cord, but does not posteriorly displace the cord. The CSF posterior to the cord is he faced at this level. There is bilateral foraminal stenosis.

    C5-C6: There is a diffuse but asymmetric ventral disc ridge complex that is more prominent in the left parasagittal region. It contacts and deforms the ventral surface of the cervical cord, posteriorly displaces it and compresses it. There is no residual CSF remaining posterior to the cord at this level. There is no evidence of myelomalacia at the site of compression. There is bilateral foraminal stenosis.

    C6-C7: There is a symmetric ventral disc/ridge complex that impresses but does not efface the ventral subarachnoid space, touch the ventral surface of the cervical cord nor displace or compress the cord. The foramen are patent.

    C7-Tl: There is no disc herniation, canal or foraminal stenosis ..

    There are no intrinsic cord abnormalities.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    Fusion surgery (ACDF) for the cervical spine is not as deleterious as you might think. A one level fusion is consistent with play in the NFL (think Peyton Manning) and should not significantly change the outcome of surrounding levels.

    Nonetheless, artificial disc replacements (ADRs) are good implants in the right circumstances. In my opinion, those circumstances are herniated discs causing cord or root compression with a relatively normal (mildly degenerative) disc space. ADRs do not work if the disc space is significantly degenerative or there is bony stenosis (narrowing of the canal due to bone spur) which by your report is most likely your case.

    The reason that ADR is not a good selection for significant bony spinal stenosis is that ADR allows motion. Bony canal stenosis can require significant vertebral endplate removal to make sure the canal is open. The technique for implanting an ADR requires preservation of the endplates of the vertebral bodies. If there is residual bony compression of the canal and now you increase motion of the segment, there is a chance for compression of the spinal cord. This is what you are trying to avoid with a surgery at this level.

    I understand that you want to preserve motion, especially with the degenerative changes in your neck, but you still have to pick the correct surgery to match the desired outcome (reduction of the risk of spinal cord injury).

    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.
    ajpf52
    Participant
    Post count: 3

    Thank you for your quick reply. My concern is that a 3 level fusion is recommended. It just seems like locking up 4 inches of your spine is a last resort. Have you ever performed multiple ADR and was the outcome good?
    I guess I am disappointed with the options presented to me. One surgeon stated that I would lose 30% of my mobility with fusion surgery.

    Would you be willing to look at the MRI if I send a CD to you for your opinion. If you feel you can help me, I am willing to come to your facility for the procedure.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    A three level ACDF will stiffen your neck and increase the load on levels above and below. However, it might be helpful for you to measure the motion from flexion to extension on the lateral motion X-rays. IF you have a highly degenerative neck to begin with and the motion of these three segments is less than ten degrees total, a three level fusion will not cause a significantly notable difference to you.

    Surgeons can perform hybrid surgeries. That is a combination of ADR and fusion. You might be a candidate for that procedure but again, this depends upon the quality and degenerative nature of your discs.

    I can review your MRI and X-rays if you like. Please call the 888 number and talk to Margaret.

    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.
    ajpf52
    Participant
    Post count: 3

    Hello Dr. Corenman

    I hope all is well with you. I had spine surgery with you a few years ago where you had fused C5-7. I am sure you cant recall every surgery but I was having serious with neck upper back and shoulder pain. I have been treated for these problems with injections but they are becoming less effective. The pain radiates from my neck through my shoulders down my arms to the tendons of my thumbs. I was told it is most likely an impingement in the nerve. I am scheduled for an MRI and wanted to know your opinion as I was very satisfied with the previous treatment I received from you and your staff.
    Andrew

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    As a previous patient who lives at a distance from the clinic, I would be happy to review your MRIs and X-rays. Please call Diana, Sarah or Becky at 970 476-1100 and let them know your interest.

    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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