Laminectomy concerns?

Tagged: Phrenic nerve injury

Viewing 4 posts - 1 through 4 (of 4 total)

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shipper
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July 24, 2015 at 10:11 am

Post count: 2

#20086

I had a laminectomy at c3-4 and c4-5 about 1.5 years ago. Six months ago I started noticing a clicking or popping noise when I turned my head or looked up. A couple of months later I began having a tingling on the left side of my face which has worsened to numbness and tingling on both sides and back of my head with some tingling down both arms to the top of both hands. Is it reasonable to suspect new problems at c1-2-3 or is it more likely that the pins and screws of the laminectomy are causing the problem. I get some relief wearing a soft collar and using Naproxen Sodium at the max dosage. I had Phrenic nerve damage resulting in a disabled diaphragm so I have no motivation to return to my Neurosurgeon which limits my options for advice. Thank you for sponsoring this forum and any comments you might make.

Donald Corenman, MD, DC
Moderator

July 26, 2015 at 10:08 am

Post count: 8660

#20092

First, you did not only have a laminectomy but had a laminectomy and fusion. Using “pins and screws” means you had a fusion along with the laminectomy. “Hardware” is used to immobilize the vertebra to allow for a fusion. I assume you had cervical stenosis (narrowing of the spinal canal causing cord compression) along with instability which led to your initial surgery.

Your current symptoms could be do to cervical instability at the levels above or below, cervical degenerative spondylolisthesis (facet disease causes “popping and clicking”) or a pseudoarthrosis (lack of fusion) of the previous surgery.

You need a consultation with an experienced spine surgeon to determine what your current symptoms are due to. I am sorry to hear your initial surgery caused phrenic nerve injury (reduced diaphragm strength and difficulty breathing due to lack of connection between the diaphragm and the brain).

Could you please give us a small history of your phrenic nerve injury and how you have compensated for this injury?

Thank You

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.

shipper
Participant

July 31, 2015 at 10:03 pm

Post count: 2

#20105

I noticed shortness of breath immediately after the surgery, but it was 3 months before my pulmonary physician ordered an x-ray with sniff. I use an Advair Diskus and have learned how to lay in bed at night which was my most difficult position. I am 75 and, although in reasonable condition, not extremely active so I’ve learned to adjust to my shortened breathing. About 15 years ago I had a cervical fusion at c5-6 and c6-7 with cadaver bone and a plate (because it was an old injury) and 6 screws. I now have 12 screws, a plate and some pins which will probably hinder me from boarding an airplane. I’m beginning to feel like an old car that’s been wired together to keep running-I’m a good example of your CNS type of patient.

I have wondered if my earlier fusion with the plate caused my problems above c5,and if my laminectomy caused this recent tingling problem which I suspect is above c3. Yes, I do have cervical stenosis, but I had assumed that the screws and pins were to spread the vertebra to relieve the stenosis. I knew that I had had two posterior fusions, but didn’t associate all the hardware to the fusions. My earlier fusions were anterior which I assume must be an entirely different procedure.

I don’t know how to approach this latest problem because more surgery might put me on a ventilator for the rest of my time on earth. Would you feel that an anterior surgery would be less likely to cause Phrenic nerve damage, which could effect my remaining working diaphragm, if my problem is now at the c2-3 level?

I have made an appointment with a Neurosurgeon in another area, but it seems most doctors don’t want to get involved with someone else’s work. It seems it’s all a crap shoot to find the right doctor, but I guess that’s true of most of life’s situations.

PS: I did purchase and use an expensive neck device that was supposed to aid in bone fusion during recovery. It reminded me of the voodoo gimmicks on TV, but perhaps I’m just being cynical. ;)

Thanks again for any further comments!

Donald Corenman, MD, DC
Moderator

August 1, 2015 at 8:34 am

Post count: 8660

#20106

Fusion below can increase stress on levels above but generally, there is little motion of the surgical levels so the difference is much smaller.

You still continue with issues. I will assume that the levels at C3-5 are fused posteriorly (but that is a dangerous assumption). If C2-3 is causing difficulty, it can be addressed from the front (an ACDF-generally a safe surgery). You must first make sure that this level is causing you enough symptoms to require surgery. This can generally be done with a TFESI (see website) and a pain diary. I would make sure that these symptoms are not generated by the levels below.

It seems you have adapted to the phrenic nerve injury. Sleeping is more difficult as the lungs when you sit up are “stretched” by gravity making them more compliant (easier to fill up). When you lie down, gravity is not as helpful and there is more work required to expand the lungs (breathe).

Good luck.

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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