JAMA paper re prior cholecystectomy, C5 art disc and poss 6-7 pseudo

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John Cspine
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June 20, 2014 at 4:33 am

Post count: 1

#11072

Hello fellow neck surgery survivors, pain-putter-upper-withers, and knowledgable pros..

Little less than five years ago, (shortest story I can make it, I promise) right arm rad. led to a C5-6 Prestige artificial disc, then about 2 years after that even worse symptoms in the left arm led to a subsequent fusion in C6-7. (Sprinkle in many confusing the issues and symptoms (6) sinus surgeries culminating in all the fanciest surgeries, then lastly a total frontal obliteration last year.)

Ok..some smashing occipital headaches, then with obvious axial neck pain and headache unresponsive to anything but Norco (not to mention that at just turning 50 (also non smoker) I was just banned by the gastro doc from using ibuprofen because my stomach has gastritis) and I’m once again getting MRI’s and a new CT of my cspine. Broken and backing out screw in the inferior portion of the artificial disc, and possible pseudarthrosis in the level below, my doc is round tabling it with his colleagues to come up with a plan for me. Meanwhile, get my vitamin D run in Feb. Was 14 (lower than 20 is deficiency, between 21 and 29 is insufficiency)..I have always taken the GNC men’s with extra D3, so then took extra on top of that 2-4000 units every day until May and retested, only came up to 23. Now on 50,000 IU prescription D2 once per week. Ran across an interesting paper in JAMA about prior cholecystectomy being a predictor of low vitamin d in spinal patients, and I just so happen to have had mine out in 97, wondering if this was a factor.

One specific question I have is…can a broken screw fragment be removed from C5, or is the vertebrae too small to go digging it out? (Or not possible to answer without specifics..) Are there no tools like in a machine shop called “easy outs” that remove these items? My doc implied it would probably not be possible to get the fragment out. Options would include removing the floating “manhole cover” and screw that is currently backing out about 1.2mm and of course determining if the fusion below is fused or not, or removing the disc and fusing all the levels etc etc, many options so that’s why he is round tabling it. Am I likely looking at a fusion now from C5-C7 as the best course of action to solve this?

Also, I am entering forums like this one drawing attention to the possible link between having your gall bladder out, vitamin d levels, and possible failed fusions…what do you think? I’m thinking that if a patient says that they have had their gall bladders out and are about to have a spinal fusion, it might be money well spent to run a vitamin d baseline..

And, is it possible to determine a pseudarthrosis by seeing movement in the spinous processes in the flexion and extension plain films? I’m looking back at mine from 2012 and 13 and it looks like there is motion happening as the spinous processes are closer in one, then much further apart in the other. Thanks!

Donald Corenman, MD, DC
Moderator

June 20, 2014 at 11:07 pm

Post count: 8660

#11078

It sounds like you have a failure of the Prestige artificial disc at C5-6. One of the fixating screws has sheared off. This level will need to be fused. If the broken screw is embedded into the bone, there is no need to retrieve it unless it is protruding from the surface of the bone.

If a portion of the screw is protruding, then it generally is an easy matter to remove it. If it is embedded under the surface of the bone, there is no need to remove it and an attempt could cause more bone destruction than is necessary.

When surgery is contemplated, I would consider a CT scan to make sure that C6-7 is fused. If not, then revision of both levels is called for.

I am unclear as to the effect of removing the gall bladder and its relationship to lower levels of Vit D. The liver hydroxylases Vit D to a usable form (the kidneys also are involved in this process). I do not have the knowledge of how the gall bladder removal could be involved.

Vitamin D levels should not be involved to any great extent regarding ACDF fusion rates unless the patient has Rickets.

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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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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