extruded disc

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ashley
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March 30, 2012 at 1:43 am

Post count: 25

#5897

Hi Dr,

I have a large (neorosurgeon said it was the largest he had ever seen) extruded c6,c7 markedly impinging my spinal cord. Weakened muscles on right arm, numb fingertips on right side too. Nerve pain is bearable. I also have a small disc bulge at c5,c6 with neural foraminal stenosis. No signal cord changes.

I am otherwise in excellent health, female and in my late thirties. I have tried conservative treatment but am told by a neurosurgeon here that I will definitely need surgery. I am in complete shock.

It takes a month here in Canada to get a copy of my mri report. I have also had a ct scan and both neck and back xrays.

I will be having an acdf. I have not been in an accident of any kind. So I am wondering how I caused this?

The only thing I can think of is I had a small fall off a chair a year and a half ago. But I had no symptoms. I was fine until now. Then 2 months ago I went to pick up my 15 lb baby and felt the disc herniate. I feel really guilty if my small fall almost 2 yrs ago could have caused this to happen. Is that possible?

And after surgery once someones fusion is strong and has fully fused, how careful do you have to be? I ask because I play soccer and in soccer you have the occassional fall.

If someone had a fully fused fusion and had a small fall would they be paralyzed? I am just trying to see how careful someone has to be after fusion has taken place.

Thank you for your time, you are providing some answers to people like me, a bit in shock to need surgery.

Donald Corenman, MD, DC
Moderator

March 30, 2012 at 9:23 am

Post count: 8660

#5903

Once you have a fusion of that level and it becomes solid (time to fusion depends upon the method and graft used) you will never have another problem with the fused level. The levels below or above will still have about the same risk or slightly higher risk of herniation as before the surgery. You could go play in the NFL (US) with a one level fusion.

Genetics is the best answer for why this hernation occurred. Trauma and other problems can produce herniations but by far, the most common cause of herniation is genetics.

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.

ashley
Member

March 30, 2012 at 10:16 am

Post count: 25

#5904

Thanks Dr Corenman,

The 1st neorosurgeon that I saw said he had never seen such a large extrusion and he said it looked like I had suffered massive trauma. I told him I had not. So I am just making sure I am understanding you correctly.
So a small fall with no neck symptoms 2 yrs prior would not be the kind of trauma for such a massive extrusion?

And most likely unfortunately my genetics were the culprit?

As far as recovery goes, my baby boy is now 6 months old, barring the surgery goes well, how soon after an acdf do you think I could pick him up again? He is 20 lbs now.

Thank you so much for your time. I really appreciate not only your knowledge but also your kindness.

Thanks again,Take care.
Ashley.

Donald Corenman, MD, DC
Moderator

March 30, 2012 at 8:52 pm

Post count: 8660

#5907

I cannot tell you how long it will be to pick up your baby boy as this depends upon the surgeon’s technique and particular requirements for rehab. I would say that in my practice, you could hold him while you were sitting on the couch immediately but could not pick him up for about 5-6 weeks.

Genetics tends to be the culprit. The tensile strength of the collagen is the factor at play.

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.

ashley
Member

March 31, 2012 at 1:11 am

Post count: 25

#5913

Thank you for your great explanations. You put things in clear, concise context for me.

And yes I am sure genetics plays a huge factor in my injury. I am also only 5’3 inches and weigh only 100 lbs and I was repeatedly lifting my 15 lb baby with my upper body only 4 to 5 times a night when I was nursing.
I guess my neck just eventually gave way. I wish I had been more careful but hindsight is 20/20.

The first neurosurgeon I saw reviewed my mri but only said I would be needing a 1 level fusion. My extruded c6,c7. Yet I have a small bulge at c5,c6 also.

Do you think a 1 level fusion would be sufficient?
I guess what I’m really wondering is if you think I will eventually need the adjacent c5,c6 level fused inevetably?

Or is that just a matter of wait and see?
Obviously I want to avoid any further surgeries. If possible of course.

Also for the last 5 yrs I have had some difficulty swallowing, sometimes double swallowing to get food down. Other times a pill may get stuck. It has been constant these past five years though. Not something that comes and goes like with MS. I have been to an ear nose throat specialist who found nothing.

I did however get sent for the radioactive iodine test and they found a benign thyroid nodule in my neck. They thought this may be causing my swallowing difficulty. They also thought it may be due to GERD as I do have frequent heartburn.

Anyway,I never had the nodule removed because it wasn’t too bad, however I know one of the side effects after acdf is difficulty swallowing.
Do you think swallowing will be even more of a difficulty for me?

Here in Canada it is quite a wait to get an appt with a neurosurgeon. My 2nd referral went in a month ago and I havent yet got an appt date for the initial meeting. It is very helpful to be able to ask you a few questions.

Lastly, the first neurosurgeon said my c6,c7 extrusion has not only pushed my spinal cord off to the right but said the extrusion is also ascending and descending. I think he was concerned it might turned into a sequestration.

Am I at any real risk of paralysis while I wait for an appt with the second neurosurgeon?

I basically lie in bed propped up all day and no longer lift anything. Anything else you would recommend?

Again, thank you for your valuable time. I appreciate it more than you know.

Donald Corenman, MD, DC
Moderator

March 31, 2012 at 10:02 pm

Post count: 8660

#5922

Picking the number of levels required for surgery has to do with both the pathology at the level and the symptoms the patient has. By your description, the problems lie at the C6-7 level and the C5-6 level is either not causing significant symptoms or is non-symptomatic. If the C5-6 level does not need surgery, it is not likely that it will in the future but without reviewing the images and seeing you, there is much speculation here.

Dysphagia or difficulty swallowing is not uncommon after an ACDF surgery but in most patients, disappears within the first month.

I cannot comment on a risk of paralysis without seeing you as a patient.

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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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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