Esophageal Perforation post ACDF fusion

Tagged: Esophageal perforation?

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irelandigo
Participant

August 4, 2018 at 9:13 pm

Post count: 7

#28877

Hello Dr. Corenman,

I sent you a message some time ago, had been struggling with instability in my neck at C4/C5 and compression at C6/C7 but was not getting the help I needed, Rather a bit of a run around. I was at the same time having some odd symptoms with weakness in muscles to include swallowing issues. You had suggested might have more than one thing going on, possibly lyme or deficiencies or something as the muscle stuff came on after a high fever and sore through. We suspected myositis but I have had trouble getting into neuromuscular doc to do a biopsy or adequate testing. It’s been so unusual. One day I am putting in 10 -15 miles a day and then suddenly I can’t stand up.

At any rate a positional MRI back in Feb while I was in Minn for a visit, confirmed my C4/C5 was tipping completely over when I moved my neck. I had already returned home before I knew the results and then ended up with a neurosurgeon here at home telling me he needed to get in there right away or risk paralyzed. Well he ended up up being much more aggressive than I had hoped.

He took out my C5/C6 plate and then put in a C4/C5 plate. But then he also went in the back cutting me from the back of the head down through my shoulder. And did a posterior 4-6 fusion. Which when I woke up was quite shocked. I figured if he had to go in the back at all it would be just a small incision. I was also worried because I knew the 6/7 was offset and not in good shape and was told previously if they did 4/5 I would need to do 6/7 as well if not before long as it would not hold. I had felt that the 6/7 was giving me the most trouble, although I clearly had cord compression someone when upright, on films looked like both places.

Sadly, it has been a long haul and not felt right since I awoke from surgery. Having be an athlete all my life I am a stickler to doing everything right, with recovery. But this has been a nightmare

From day one I felt it moving around It would feel like the posterior rods would slide over the top of other facets maybe above and below. And with each passing day the pain got worse down my shoulders and down my arms. Then I heard and felt a couple clunks, and pops and my neck now looked tilted to the left. PT was never happy as my throat was clear off to he left, very painful. I looked crooked just to look at me. Where as before I did not.

When I had my C5/6 back in 2009 I never had problems like this, I was up and walking the next day and never stopped. This time is has felt like any tissue, or ligament or muscle in the neck have not healed and are detached . I can not even touch my larynx it is so painful and just burns. If I tip my head down at all the pain is awful all the way down the chest and up to the face and feels like the larynx collapses.

I went to the Er the other night again, in horrible pain woke me from my sleep it was around my nose mouth but deep inside and down to the larynx and I could not swallow at all. Never felt so much pain and scared. Then I noticed I could not even drink water without severe pain.

To top it off it feels like all my C6/C7 is just hanging by a thread, all the muscle pull from the head to the chest. I seem to have to put my hands back and push the C6/C7 area forward to feel like my Tspine will come back into place and the pressure off my chest. I can feel it move back and forth and sideways where the vertbar meets the shoulders. Sometimes it feels broke there, and if it shift to much to the right or left I have more issues as mentioned. The right the worst into the head. Until it snaps back into place I am in miserable pain. My chest is always tight like you have a band around it. And as of late my vitals are all over the place. One minute my BP is 116/80 the next 80/60 and I am weak and then I feel like I have angina. Which I am guessing is from the neck. My heart always checks out fine.

I can’t even raise my arms over my head without choking, and I can not turn my head to the right or my eye droops on that side, my speech goes and I look like I am having a stroke, but I am not. Its like nerves and vascular are being compressed. I still think my brachial plexus is messed up on that right side and that is the worst side where my BP will just drop fast other times it feels like its down the front on both sides and I don’t have enough pressure into my head.I feel weak in the brain.

Anyhow, so I’m at the ER and they decide to do a CT of my soft tissue in my neck. The ER doc says oh, well it looks like you have this= “the esophagus is interposed between fusion plate and trachea”= that is probably why you are in so much pain in your throat and it hurts up into your head and down to your stomach. I am also nasally and it feels like something is pulling from the back of my nose down my throat. Very odd.

I said well what do we do, I guess see your neurosurgeon. Sadly I am looking for another surgeon as a couple weeks after surgery the surgeon kind of checked out when he saw I was having so many problems. Argh…..my luck seems to be running out I guess.

This has become all too frightening, I am a go getter and want to be well, deserve to be well. Will do whatever I need to do – to get well.

I had two weeks were I finally felt my walking getting better with alot of work, and now after what felt like several changed in the neck in the last three weeks, I am back to square one, but worse.

I never had pain in my neck before surgery, it was just floppy and I could feel it shift and then I would get zingers up into my head and into my throat And I definitely had myelopathy. I walked like a drunk had to hold my head to walk.

Just since the throat worsened Thursday I am dizzy, pale, feel awful, chills and shakes and my vision blurs even when I lift my shoulders. And the pain down the throat argh, I even sound nasally and it feels like someone has their hands around my throat.

Tis’ too much to sort out online, I know, forgive me.Especially without seeing me. I am four months post surgery and should have my life better and not moving backwards. And now, I do not know if I need to hurry and get help or what since nothing has gone as planned.

Do you think this could be a perforation and I should really push to get help?

Thank you for your time- feel silly, but starting to feel desperate.
Mary

Donald Corenman, MD, DC
Moderator

August 5, 2018 at 6:15 am

Post count: 8660

#28878

I am somewhat confused here. You initially had a C5-6 ACDF in 2009 that went well. You then were noted to have a degenerative spondylolisthesis of C4-5 and C6-7 with the C4-5 level developing instability. You had a surgeon complete a C4-5 ACDF but then also perform a posterior fusion of C4-5 and C5-6 with a very large posterior incision.

You think you might have an esophageal perforation. This perforation would likely cause an infection in the front of the neck and more severe symptoms that you have now so this perforation is unlikely. You might have impingement of the esophagus from the plate so possibly a consultation with an ENT specialist might be in order.

You do need another opinion as things seem to be amiss. Find a well experienced spine surgeon who will take the time to figure out why you are having these symptoms.

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.

irelandigo
Participant

August 5, 2018 at 12:10 pm

Post count: 7

#28886

Dr Corenman,
Thank you so very much. You sorted out the surgeries spot on. I had felt like the poster was just too much and it made things worse. At any rate can only move forward. I do have terrible pain in the throat radiating to the front and down the chest but they did not see infection on the soft tissue CT. So perhaps it is the esophagus.

I will look for another surgeon who is willing to sort this out for me.

Maybe I will have to make a trip to Colorado. We are sure very fortunate to have you educate and answer our questions.

Thanks for the support!
Mary

irelandigo
Participant

August 5, 2018 at 12:13 pm

Post count: 7

#28887

Dr Corenman,
Thank you so very much. You sorted out the surgeries spot on. I had felt like the poster was just too much and it made things worse. At any rate can only move forward. I do have terrible pain in the throat radiating to the front and down the chest but they did not see infection on the soft tissue CT. So perhaps it is the esophagus.

I will look for another surgeon who is willing to sort this out for me. I really think someone is going to have to see me in person rather than just reading the scans?

Maybe I will have to make a trip to Colorado?

We spinal folks are sure very fortunate to have you educate and answer our question.

Thanks for the support!
Mary
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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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