Failed Cervical Fusion?

Tagged: Reoccurence of cervical stenosis....

Viewing 6 posts - 1 through 6 (of 6 total)

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Bestie2023
Participant

March 4, 2023 at 7:53 am

Post count: 3

#35495

Hi Dr. Corenman,

Hoping you might be able to help me with my issue.

2008 c6/7 ACDF
2016- left c4/5 foraminotomy
2019- c5/6 ACDF
2020- c4/5 ACDF

All ACDF’s have been successful, except it has come to light that the neck pain that started a few months after my June c4/5 2020 ACDF was never psuedathrosis, but instead was the same moderate cervical stenosis that I had in 2016 and part of my herniated c4/5 disc in 2020. Unfortunately, I wish I would have pursued why I was still having neck pain between 2020 until it hit me like a brick in November 2022, because I am one of the poor folks for whom c4/5 causes breathing issues. It’s a chest anvil as I call it. I have gone as far as having another left foraminotomy/partial laminectomy/facetomy and it’s helped a little, but the chest pressure remains. Also, at the same time, I had a minor accident and now per imaging and obviously feeling it, my c5/6 hardware has some type of protusion pressing on my thecal sac and even my fused c6/7 now has dorsal bone spurs causing some canal stenosis (which I have never had before). I have always wondered (never wanted to find out) what does one do after being fused and new stenosis or other issues happen? I should be scheduled next week for injections and certainly hoping the c4/5 one works the most, but what about long term, what does one do?

Donald Corenman, MD, DC
Moderator

March 4, 2023 at 9:35 am

Post count: 8660

#35496

“I had a minor accident and now per imaging and obviously feeling it, my c5/6 hardware has some type of protusion pressing on my thecal sac and even my fused c6/7 now has dorsal bone spurs causing some canal stenosis”.

Normally, bone spurs occur due to abnormal motion. I have not seen new bone spurs form with a solid fusion. In addition, your C5-6 instrumentation level should not shift or change position with a solid fusion. Do you have a CT scan and flexion/extension films that demonstrate a solid fusion?

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.

Bestie2023
Participant

March 4, 2023 at 2:46 pm

Post count: 3

#35497

Yes, original imaging showed nothing on any levels.. did new mri,ct scan and xrays, per that radiology report, pseudarthrosis was suggested but original surgeon feels there was sufficient bridging on c4/5 and wanted emg and injections, but I dont think he even looked at new imaging and report. I didn’t develop c5/6, and c6/7 arm pain again for no reason, i know the minor accident obviously had some type of affect..and again, I am so unhappy with myself that since 2020, I didn’t go back for my “new” neck pain if only to find out that I had any level of foraminal stenosis that had never really resolve post c4/5…didn’t picture I would be this miserable again less than 3 years later…whether injections help or not and now 7 weeks post posterior foraminotomy with a little improvement…does my situation sound like I might be eligible for some type of acdf revision.?

Donald Corenman, MD, DC
Moderator

March 4, 2023 at 3:16 pm

Post count: 8660

#35498

An ACDF revision is not a small undertaking if there is a solid fusion present. Maybe, since you are 2 months out from the foraminotomy, give it another month’s time to “settle down”. If you have had no improvement in that period of time, another opinion might be in order.

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.

Bestie2023
Participant

March 4, 2023 at 3:24 pm

Post count: 3

#35499

I should add that the updated imaging said moderate foraminal stenosis due to unconvertable hypertrophy…isn’t that bone spurs? After the c4/5 acdf, the chest pain let go and improved over the next 6 weeks or so. But within a couple of months neck pain returned…I just started eating advil and icing again and didn’t pick up anything heavy…It didn’t dawn on me that it was the same neck muscles and shoulder blades getting tighter that it all came from the same level that I had surgery for to begin with. I plan on explaining this in more detail at my injection appointment

Donald Corenman, MD, DC
Moderator

March 4, 2023 at 3:36 pm

Post count: 8660

#35500

Neck pain origin is more difficult to determine than shoulder/arm pain is. The pain can originate from many different levels and selective blocks are one way to determine origin of the pain. See:
https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/ and
https://neckandback.com/treatments/diagnostic-therapeutic-neck/

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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