Increasing Numbness Following C6/C7 Laminoforaminotomy

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ak31153
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March 23, 2013 at 8:58 am

Post count: 6

#8230

Hello Dr. Corenman,

First of all, thank you for this wonderful service. As I researched leading up to my surgery, your website and forum answered many of my questions. As you can see in my subject line, I recently (1week ago) had a minimally invasive, microscopic laminoforaminotomy at C6/C7 to relieve left tricep/pectoralis weakness, and constant numbness in middle, and index finger, and half of thumb. Additioanlly, fasciculations through tricep, pectoralis and lat muscle. Prior to surgery, I had an MRI which noted:

C6-7: normal disc height with left uncovertebral joint disc osteophyte/extrusion. There is impingement of the left C7 nerve root. Vertebral canal and right neural foremen are patent.
C5-6: small anterior traction osteophyte. Normal disc height without stenosis.

Now that I have had the surgery, I continue to have numbness in the same area of my hand and I have not noticed any improvement in strength in the triceps, etc. Is it unrealistic to think that I would have relief of my symptoms by now? I had been experiencing the neurological and motor issues for approximately 8 weeks prior to surgery. Also, forgot to mention, two weeks after MRI I had a myelogram with CT pictures, which showed essentially the same thing as the MRI. The numbness was worse upon waking up post-op, but has improved since then. Thank you so much!

ak31153
Member

March 23, 2013 at 9:05 am

Post count: 6

#8231

Also, failed to mention that my surgeon told me post-op that the nerve root was “tented,” by the herniation, but he chose not to remove the herniation, as it would have required too much manipulation of the nerve. Will this extruded portion of disc, which I was told is small, but positioned perfectly to impinge the nerve root, eventually be reabsorbed? Also, is it common to leave the herniated portion of disc in order to not further irritate the nerve?

Donald Corenman, MD, DC
Moderator

March 23, 2013 at 7:54 pm

Post count: 8660

#8234

A laminoforaminotomy (posterior foraminotomy) can be a good surgery for the right condition. A cervical nerve root that is trapped by a disc hernation can be decompressed by this procedure without the need for a fusion. The herniation has to be accessible by this approach meaning that if the herniation also extends under the spinal cord, in my opinion, there would be too much manipulation of the cord to allow access the hernation to allow a safe decompression.

This procedure works less well if the compression is caused by a bone spur which is a common finding. See the section under “cervical-radiculopathy” to understand the difference. Accessing and removing the bone spur from the back of the spine (which is the laminoforaminotomy approach) is very difficult and requires significant manipulation of the nerve root. This can leave more numbness and pins/needles after the surgery than before.

I assume the surgeon found this bone spur compressing the nerve root and decided after some attempts that it was better to leave this spur than to try and remove it but possibly injuring the nerve more. This was a good decision on his or her part. There are times that a successful surgery cannot be completed without further danger to the root.

The most appropriate treatment if the symptoms have not improved (especially with continued weakness) is to consider an ACDF surgery (anterior cervical decompression and fusion). This procedure will remove the bone spur and free up the nerve root allowing the best chance for nerve root recovery.

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.

ak31153
Member

March 23, 2013 at 8:30 pm

Post count: 6

#8235

Dr. Corenman,

Thank you for the quick response, it is much appreciated! My surgeon told me that the material compressing the nerve was an extrusion from the disc, and that when he was operating, removing the extrusion would have been unnecessarily risky. Additionally, he mentioned that the extruded portion of disc could possibly reduce in size over time as it is reabsorbed by the body. Have you seen patients experience this before? Also, am I being overly ambitious expecting a complete relief of numbness by the 10-day post-op mark? Again, thank you for this wonderful service, and I hope you have been able to get some good skiing in this season! I used to snowboard at Keystone/Vail every weekend when I was attending CU-Boulder!

Donald Corenman, MD, DC
Moderator

March 24, 2013 at 8:43 pm

Post count: 8660

#8239

The surgeon was probably correct in abandoning the surgery if he or she thought that removing the fragment was more dangerous to the spinal cord or nerve root. He or she is also correct that the fragment might shrink down over time but that is not guaranteed and in fact, if the symptoms continue-especially weakness, the ACDF surgery needs to be given hard consideration.

It is true that it might take some time to recover from the surgery but with no real change in symptoms after this surgery, it is not uncommon to repeat the MRI to see what the condition of the nerve root is and what residual compression remains.

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.

ak31153
Member

April 25, 2013 at 11:14 pm

Post count: 6

#8506

Dr. Corenman,
Dr. Corenman,

I posted this in a different topic, but for some reason it didn’t stick.

I am now 6-weeks post-op, and as I mentioned previously, immediately after surgery, my numbness and weakness increased, which lasted about two weeks. At that point, the numbness started to dissipate, and the weakness started to improve, and today, 6 weeks post-op, the numbness is only noticeable in the tip of my left index finger, and I feel weakness is slowly improving. However, I have noticed that I still get some electrical “shock” sensations in my left hand, where the numbness used to be if I position my neck certain ways. For example, if I pull my head back like I’m trying to make a double-chin, or if I tilt my head back too far to drink water. This doesn’t hurt, but it feels like a sharp zap. My concern is that the nerve root is still being impinged, despite the fact that I had surgery. I am curious to get your thoughts, as I don’t have an appointment with my NS for another two months. Thanks!
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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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