[westie California]

#34502

I did have ACDF’s. ACDF’s at C3,C4, C5, C6 and C7. In addition a partial corpectomy was performed at T1.

[Donald Corenman, MD, DC]

#34504

If you have solid ACDFs at those levels, the only way to proceed is to perform a corpectomy which is way too much surgery for the potential outcome. You might be a candidate for peripheral nerve stimulation. If you want, call my 888 number and I can give you a doctors name.

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]

#34518

Good afternoon Dr. Corenman,

Thanks so much! I found a place only 20 minutes from my home that preforms peripheral nerve stimulation procedures, however the wait is approximately two months if your a candidate, after doctor reviews your paperwork.

In the meantime, I’ve been researching, reviewing my medical records, and looking over my notes. There’s two pieces of information that still get’s my attention, time after time, 1) MRI 5 years after 5 level laminectomy states “Hypertrophic changes are noted at each level deforming anterior margin of thecal sac” and 2) CT scan performed 6 years post laminectomy states ” C3-4: Bilateral uncovertebral spurring and bilateral facet arthropathy, mildly progressive since 5/19/2018. There is associated mild right and moderate to severe left foraminal narrowing”, “C4-5, C5-6, C6-7, C7-T1: Postsurgical changes. Spondylitic ridging and uncovertebral spurring at C4-5, C5-6 and C6-7, mildly progressive since 5/19/2018. There is associated foraminal narrowing, mild on the right at C4-5 and C5-6, mild on the left at C6-7”.

I am still dwelling on these because in my gut something just doesn’t seem right. My understanding is with a solid 360 fusion one should not have progressive “Spondylitic ridging and uncovertebral spurring”. I’m also perplexed on “C3-4 progressive bilateral facet arthropathy and Hypertrophic changes noted at each level deforming anterior margin of thecal sac”. My questions are:

1. Is there a possibility that there’s still some kind of micromotion going on from above information, multiple CT Scans show fusion?

2. Can facet arthropathy at C3-4 cause foraminal stenosis? I read online a case where a patient had severe trapezius spams with neck and arm pain that was caused by C-4 nerve compression. Can a facetectomies and or foraminotomies be performed to help with above?

3. Selective nerve root blocks were performed back in May with improvement. You mentioned that injection confirms that level is a pain generator, however it doesn’t tell you if nerve is permanently damaged. So I was thinking of getting another spine surgeon to take a look while I wait for peripheral nerve stimulation decision to be made. Is this a case you would be interested in reviewing?

[westie California]

#34522

Hello Dr. Corenman,

I spoke to my neurosurgeon and he mentioned what can be done is to add instrumentation from C5, so that there will be instrumentation from C5 to T3. He would add bone graft to help make things more solid. What he explained is, after laminectomies (C3-C7), medial facetectomies (C5-C7) and foraminotomies (C5-C7), it can weaken spine and cause instability. The ACDF’s (C3-C7) and partial Corpectomy (C7-T1) are solid and nothing needs to done from an anterior spine perspective.

What’s your thoughts on this, I want to make sure I ask around before committing? Are all instability issues usually seen on scan’s i.e. flexion\ extension or are some based on clinician’s judgement? Thanks again

[Donald Corenman, MD, DC]

#34523

“My understanding is with a solid 360 fusion one should not have progressive “Spondylitic ridging and uncovertebral spurring”. You are correct. If there is a solid fusion, there should be no advancement of bone spur formation. It might be a possibility that the radiologist is looking at different cuts and interpreting differently.

“Is there a possibility that there’s still some kind of micromotion going on from above information, multiple CT Scans show fusion”? There is is very slight chance that there is a fusion but not as stiff causing some increased stress and bone formation but this is very unlikely.

“Can facet arthropathy at C3-4 cause foraminal stenosis? I read online a case where a patient had severe trapezius spams with neck and arm pain that was caused by C-4 nerve compression. Can a facetectomies and or foraminotomies be performed to help with above”? Facet arthritis can cause root compression but remember that you had an ACDF at C3-4 that was deemed solid so advancing arthritis is much less likely.

“Is this a case you would be interested in reviewing”? I would be happy to perform a long-distance consultation for you but you seen to have all the information and I’m not sure I could contribute more enlightened information.

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.

[Donald Corenman, MD, DC]

#34524

“My understanding is with a solid 360 fusion one should not have progressive “Spondylitic ridging and uncovertebral spurring”. You are correct. If there is a solid fusion, there should be no advancement of bone spur formation. It might be a possibility that the radiologist is looking at different cuts and interpreting differently.

“Is there a possibility that there’s still some kind of micromotion going on from above information, multiple CT Scans show fusion”? There is is very slight chance that there is a fusion but not as stiff causing some increased stress and bone formation but this is very unlikely.

“Can facet arthropathy at C3-4 cause foraminal stenosis? I read online a case where a patient had severe trapezius spams with neck and arm pain that was caused by C-4 nerve compression. Can a facetectomies and or foraminotomies be performed to help with above”? Facet arthritis can cause root compression but remember that you had an ACDF at C3-4 that was deemed solid so advancing arthritis is much less likely.

“Is this a case you would be interested in reviewing”? I would be happy to perform a long-distance consultation for you but you seen to have all the information and I’m not sure I could contribute more enlightened information.

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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