Facet Joints

Tagged: chronic neck pain - multiple surgeries

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Donald Corenman, MD, DC
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June 24, 2018 at 4:25 pm

Post count: 8660

#28611

By this report, you do not have a fusion at C2-3 or C4-5. Is that true? The levels fused seem to be solid according to this radiologist and there is no posterior screw that is affecting any of the roots by his eyes. If C4-5 is not fused and it rests on a long segment fusion (C5-T1) with a fusion above (C3-4), the C4-5 level can wear faster, especially with a prior laminectomy. Why the surgeon wants to remove posterior hardware if these screws are not irritating the roots, I would wonder about. Now, if you had local pain in the posterior neck, sometimes removing hardware can be helpful to reduce this local pain.

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.

westie California
Participant

February 13, 2019 at 6:25 am

Post count: 138

#30153

Good morning Dr Corenman,

A few months ago my surgeon performed removal of C4-T2 posterior segmental instrumented fixation and fusion exploration. Plastic surgeon was consulted due to an open wound of the neck and upper back along with inter operative extensive scar tissue. Excision and debridement of the upper back and neck wound and scar was performed. Reconstruction with right and left trapezius myocutaneous flaps was completed.

The pain at the base of the neck never improved, and i still have left and right bicep, and shoulder pain. To answer your previous question in reference to C4-C5, I’m not sure why the CT scan does not show a fusion at this level? per my surgical notes an ACDF includes this level and Laminectomy/fusion includes this level also.I’m very thankful you pointed this out.

I completed two months of physical therapy and no improvement. Was told by two therapist, that there is significant muscle spasms in my traps, and my pain radiating into the shoulders, arms, and back of head, does not appear “local it’s deeper than that”. After hearing this, I sent a number of my scans and reports to surgical center’s for a free review. A couple reported that a peek implant for ACDF especially below a C3-C7 fusion would be extremely likely to have a failed fusion.

My question is can one have pseudarthrosis at C7/T1 although they have a peek cage acdf and posterior fusion? and second question is if the radiologist is correct and I’m not fused at C4/C5 can that cause base of neck pain, arm and shoulder pain? Thanks again Dr Corenman!

Donald Corenman, MD, DC
Moderator

February 13, 2019 at 12:37 pm

Post count: 8660

#30154

Your information seems to be incomplete. You have an open wound in the posterior neck which indicates very poor wound healing or an active infection. Why did you have an open wound? When the fusion mass was explored, what was the conclusion? Did you have a solid fusion or were there segments of non-union?

PEEK cages are more commonly associated with pseudoarthrosis and can be one of your pain generators. A pseudoarthrosis at C4-5 can contribute to your 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.

westie California
Participant

February 13, 2019 at 2:25 pm

Post count: 138

#30159

Hello Dr Corenman,

My second procedure in 2013, there was a dura leak and it appeared that I had a cord injury.After 10 days in the hospital, was discharged to a sub acute facility for seven weeks, it was during my time there that i developed two large boils on the back of my neck (towards the base). I was transfered back to the hospital for consultation, and no-one knew what it was, some said CSF fluid still leaking, one doctor said it could be an infection. Over time the boils disappeared and I developed this very large dehiscence.

In reference to fusion mass exploration was told I have a solid fusion. My surgeon is scratching his head, the base of neck is tight and when i turn to left and right a few times i can hear crackling and it tightens even further. It’s becomes at times unbearable, and i have radiating pain into shoulders and arms. I also feel at times pain in ring finger and pinky finger left side more than right.

Is it possible to have a non union at that peek cage level (C7/T1) that would not be picked up from a posterior fusion exploration? There has to be something that’s being overlooked. Thanks

westie California
Participant

February 19, 2019 at 6:57 pm

Post count: 138

#30170

Dr Corenman,

I have an additional question please? If one is diagnose with an ACDF Peek Pseudarthrosis at C7/T1 my understanding is the best treatment option is a 360 degree fusion. If one was to have a posterior fusion (180 degrees) to correct a C7/T1 non union, does a posterior fusion exploration confirm fusion for 360 degrees or just 180 degrees? Thank you

Donald Corenman, MD, DC
Moderator

February 23, 2019 at 1:08 pm

Post count: 8660

#30174

If you had large “boils” after a posterior spine surgery and then a dehiscence, my first thought would be infection. I would not rely on a “solid fusion” report after a posterior surgery with dural leak and infection to try and fix a pseudoarthrosis at C7-T1 ACDF with a PEEK cage. I would be much more comfortable with a fine quality CT scan to let me know of your fusion status.

A posterior fusion is an acceptable practice for repairing an anterior non-union (pseudoarthrosis) but I then don’t understand why you developed a dural leak as there was no reason to go into the canal and that is the only way to develop a dural leak unless it was hardware entering the canal (which however would also explain why you might have had a spinal cord injury-“My second procedure in 2013, there was a dura leak and it appeared that I had a cord injury”).

The best way to fix a pseudoarthrosis is a “360” but commonly, that is unnecessarily too much surgery. Many times, taking out the PEEK cage from the front, filling the space with iliac crest bone graft and then using a small plate will take care of the pseudoarthrosis.

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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