[RandyC]

#24442

Dr. Corenman,

My wife just had spinal surgery on 1/24/17. C3-C7, the first three levels were artificial disc replacements (metal w/plastic cages) the lowest C6/C7 was a fuse. This was caused from repetitive motion, not some type of accident. It is just over one month’s time and she is having a reaction to her metal hardware. She started with blistering and rashes that would come and go. Blurry vision caused from scratched corneas. The Neuro opthamologist determined her optic nerves were fine but she stopped producing tears which was creating a situation of damage to her eyes. Chronic Fatigue (aches/pain) is setting in. She is tired all the time, no energy.

She was tested for metal allergies and as it turns out she is allergic to nickel. The metal installed during the surgery contains nickel. Her surgeon has suggested another option, remove the hardware and replace it with something else that still contains nickel but at a lower percentage. The allergist stated that any nickel, no matter what the percentage will cause the body to react and should not be used.

With that information, the surgeon now has decided to fuse all 4 levels without hardware. After research, we have found this can be done but it is dangerous because the cadaver bone could shift during the healing process. Our question is, have you had or heard of patients with a metal(nickel) allergy that required cervical spine surgery and what is the best and safest alternative for this surgery. We are looking for a second opinion. We live on the East Coast.

Thank you

RandyC

[Donald Corenman, MD, DC]

#24443

It is unusual but certainly possible to have nickel allergy. Obviously, your wife has nickel allergy and is reacting to the nickel in the metal endplates of the artificial discs. Removing them is the correct decision but I have doubts about using allograft and especially the lack of a plate as this will have a much higher chance of pseudoarthrosis (lack of fusion).

In this situation, I would consider her own bone (iliac crest bone graft) as it has the highest chance of fusion but it is not terrible to use allograft. I think the use of a plate is mandatory as the chance of pseudoarthrosis goes way up without the plate.

I have never seen one of my own patients with a nickel allergy but have seen reports about this problem. Interestingly, I had a patient with a very rare titanium allergy (I am writing a report on this rare allergy). I had to remove the plate at 6 weeks and her allergic symptoms disappeared. The nickel allergy and titanium allergy do not cross-react

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.

[RandyC]

#24445

Dr. Corenman,

Thank you for your reply. From the manufacturer of the titanium plates, they do contain some nickel. Do you know of an alternative non metal device to include screw hardware? Finally, if you’re patient had a titanium allergy, and you removed the plates I assumed you performed the type of fusion as you suggested for my wife. What hardware (screws) did you use for the fusion? Not being in the medical field, my knowledge is very limited. Isn’t some type of metal required even in a fusion to hold the bone in place?

Thank you for your time.

RandyC

[Donald Corenman, MD, DC]

#24455

Many titanium plates do not contain nickel. Check with Medtronic to see their plate’s content. All plates generally contain metal. I do believe that there was a company that made a plate out of PEEK (polyether ether ketone-a plastic material) but I don’t know if it is still manufactured and the screws I believe were titanium.

The fusion is generally carried out by bone graft but there are some surgeons who use PEEK cages filled with bone graft. I do believe that there are some metal cages but these are generally not used for fusion in the cervical spine.

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.

[MarieTaylo]

#25562

Dr. Corenman,
Update from Winter 2017:
After meeting with 3 neurosurgeons, I was told that “most likely” an infection may have caused muscle & nerve damage in the cervical spine area. Basically, the shook their heads and expressed sadness about my situation.
(I don’t want sympathy…I want answers!!!)
By March, 2017 I was in debilitating pain. My husband & I met with a new Pain management doctor closer to home. (By March, I couldn’t tolerate more than a 10 minute car ride.)
Currently, I’ve been diagnosed with “intractable pain secondary to failed back surgery Syndrome”.
In Ohio, there is a law that allows Pain Specialist to treat “Intractable Pain” with higher doses of opioid medication than the “DEA/CDC/FDA/’Doctors without a MD’ Guidelines permit.
Currently, it’s been the only effective treatment offered to me.
After trials on various combinations of opioids, I’m currently on a 50 mcg./hr. Fentanyl pain patch and Norco 10 mg. TID prn (I’m taking all 3 doses daily).
Since the pain is down to a slightly more manageable level, I’ve completed 4 months of intensive physical therapy on my neck with in-home PT.
In June, I added daily aerobic exercise and worked up to 40 minutes of stationary biking and 25 minutes of Treadmill walking to my stretching exercises. Recently, I started going swimming twice/weekly, too.
Despite the exercise routine, I have severe pain bending, lifting pulling or any type of jarring movement. Sitting at the dinner table is challenging. So, I’m working to increase my stamina and reverse the severely deconditioned state that comes with prolonged bed-rest. However, simple daily tasks of living are very painful.
I have two more appointments in Cincinnati.
I’m meeting with a General Surgeon this week to evaluate the hideous scar on my neck. Sores have started to appear near the incision. (REVISION???)
The following week, I’m meeting with the Pain Specialist to discuss adjunct procedures (RFA to the cervical spine nerves, Occipital nerve block, trigger point injections, Facet injections, etc.).
“I know the pain medications are only covering up a painful problem.”
I’ve worked very hard and will continue to do exercise therapy until I drop!
Bottom line: I’m still in a lot of pain. I force myself to workout because I have no other options.
3 years of debilitating pain has taken its toll on me. I’m 54 years old, I haven’t been able to work since July, 2014. I rely on my husband for almost everything.
I told my husband that if between the two doctors they are unable to concieve of a plan that would make me less dependent on others; we need to consult with Dr. Corenman.
I don’t know if you can help me but I don’t even have a diagnosis.
Two neurosurgeons said, “We think an infection set into your neck incision.”
Another doctor said, “Your neck is a mess!” Then, he told me to return to the surgeon who created the ‘mess’
Do you feel a trip to Colorado could answer some questions and come up with a treatment plan to increase my ability to function?
Possibly, pain medication isn’t the only answer.
(BTW-I’m fused from C2-T2)
Let me know,
Marie C. T.
SW OHIO

[Donald Corenman, MD, DC]

#25565

Well, it seems you are doing everything in your power to try and gain some semblance of your life back and I’m around of your efforts. “Since the pain is down to a slightly more manageable level, I’ve completed 4 months of intensive physical therapy on my neck with in-home PT”. “walking to my stretching exercises. Recently, I started going swimming twice/weekly, too. Despite the exercise routine, I have severe pain bending, lifting pulling or any type of jarring movement”.

I am unclear why you would have an incision infection so far removed from your surgery. Possibly, you have a very delayed reaction to the suture placed under the skin and you have a suture reaction but this is normally not that delayed.

I do have a program called a long-distance consultation where I have you fill out my new patient consult sheet (5 pages), send all your records, images and consultations and any patient pictures you feel are pertinent. I review all of these documents and discuss all of this personally with you over the phone for 30 minutes. Any new tests that I think are required I ask your family practice physician to order and generally they agree with these tests and order them. Further discussions over the phone after the long-distance consultation are free. This helps if you are going to come out to Colorado as I will know what is necessary and have “covered all the bases” prior to your in-person visit.

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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