Extensive Neck Surgery

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Holger
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August 30, 2013 at 2:57 am

Post count: 16

#9293

Hello Dr. Corenman,
I was at my second appointment with my orthopedic spine surgeon who has 27 years of experience, and this time I was able to ask the right questions. Research is one of my hobbies and now I had written down everything in detail that was important to ask. First and foremost, I took my wife with me as an advocate and a second pair of ears. I asked him specifically what surgery would correct my injury. After the first visit I was under the impression that he was performing an ACDF on one disk and that would take care of the problem. However, after examining the MRI a second time, he focused much more on the problem at hand. He explained that I had the most compression of my spinal cord on C5/6/7 and T1. He further mentioned that there also was not enough spinal fluid around my spinal cord to protect it. I have herniated discs on C1 through C7 but the major problem was the misaligned shift of my vertebrae at C5/C6/C7 as well as T1. Since I was now familiar with the MRI image, I saw the problem for myself. In order to relieve the pressure of the spinal cord, he is going to take out C5/C6/C7 and T1 vertebrae with an ACDF as well as a Posterior Laminectomy with fusion using screws and rods. He stated that the actual surgery would have to be performed at a hospital and not at his facility as it is way too extensive. The procedure would take five hours. Needless to say that I am very concerned and I was wondering about the success rate of this procedure. He said that if I choose not to have the surgery than the chance of damaging my spinal cord further would be very great. I was unaware and very surprised that several vertebrae could be removed and replaced by an allograph and secured in place by a titanium plate in the front and rods and screws in the back. I am 47 years old 6’ 1” 240 lbs. What do you think? By the way, yes I am scared as it appears to be a major surgery!!

Donald Corenman, MD, DC
Moderator

August 31, 2013 at 5:35 pm

Post count: 8660

#9305

Without the benefit of your physical examination and images, I can only discuss surgical theory, If you have spinal cord compression of C5-T1 with instability, I would assume that you would need surgery to prevent continued compression of the cord.

Generally, an anterior surgery only (multiple level ACDFs) is what I use to decompress the spinal cord and stabilize the vertebrae in the face of spinal cord compression. There are rare circumstances that a posterior laminectomy and fusion should also be used.

In good hands, the risks of surgery are low. You do have to remember that living with cord compression by itself is a risk. I am surprised that this surgeon feels that he or she cannot perform the surgery as this is “bread and butter” for a spine surgeon (unless the rare case that he or she does not perform cervical 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.

Holger
Member

September 6, 2013 at 7:47 am

Post count: 16

#9334

Thanks so much for your reply.

I finally read my doctors medical report. He is planning of performing an anterior cervical vertebrectomy of C-6 and C-7 and an anterior and posterior fusion of C-5 to T-1. According to his report, this is the best way to decompress the canal and cord. If pressure is left on the cord a permanent neurological change is possible. I show already signs of weakness in the right upper body region as well as weakness in my arm and hand. I could have a more severe injury if left untreated that could result in quadriplegia.

Well,it appears to me that surgery seems to be the best option in my case as the MRI showed that two vertebrae shifted towards the spinal cord and herniated the disks. Obviously I do not want to walk around with this fear in the back of my mind.

Did you perform this kind of surgery and do you have any suggestions what I can or should do to get myself ready for this type of surgery? Do you think I should prepare a living will as well as a will? Just want to cover my bases.

Thanks so much.

Donald Corenman, MD, DC
Moderator

September 6, 2013 at 8:50 pm

Post count: 8660

#9335

If you have cord compression and signs of cord dysfunction (myelopathy-see website), I would agree that surgery is necessary.

Corpectomies in my opinion are a harder surgery to recover from so I tend to stay away from these corpectomies for cord decompression (removal of the entire vertebral body). That is, in cases other than trauma or tumor where corpectomies are necessary. It is my opinion that corpectomies are usually not necessary as ACDFs are more stable and easier to heal.

I have not reviewed your images and there are occasions that corpectomies can be necessary. Sometimes it is the experiences of the surgeon that makes the surgical plan and I am certainly not against corpectomies. I don’t want to second guess any surgeon so if he or she thinks this is necessary, then please go ahead.

The chance of mortality is extremely low with this surgery but a living will is something to use for all occasions (unexpected horrific traffic accidents or heart attacks) so I think it is good to have around in any case.

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.

Holger
Member

September 12, 2013 at 4:22 am

Post count: 16

#9358

Thank you so much for your response.

I will definitely follow your advise. I just received my appointment for a second opinion from another orthopedic surgeon. However, this doctors specialty does not include spinal surgery but is in the network. From my extensive studies of this surgery, anatomy, MRI studies, etc, etc, I saw that it is the best option to get the desired results to relieve the compression. I will keep you in the loop of my upcoming surgery. Again, thanks so much for your input!!

Donald Corenman, MD, DC
Moderator

September 12, 2013 at 7:48 pm

Post count: 8660

#9361

For a second opinion, you do need a surgeon who specializes in spine surgery. A consultation from a non-specialist probably will not be helpful.

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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