Ligamentum Flavum Infolding

Tagged: New C6-7 herniation below a 3 month old ACDF at C5-6

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Heathry76
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August 31, 2019 at 7:43 pm

Post count: 16

#31003

Dr. Corenman,
I had a 1 level ACDF in January 2019. All was wonderful after and I resumed my normal life after being cleared to do so. I was pain free and happy as can be. Then after doing quite a bit of running I started having an issue. I developed triceps weakness that was pretty bad with muscle atrophy. I had many of these flare ups and bounced back and resumed things with my routine. Then I had a bad flare up back in July that I have yet to recover from completely. It was different. I had sharp pain in my upper thoracic area and muscle spasms down my entire back; slight weakness in my legs and pins and needles in my feet. So, I had an MRI of my entire spine to see what was up. Funny, not much was up that was new. The only new finding was progressive adjacent segment disease at c6/7 which partially effaced the ventral subarachnoid space with an infolded ligamentum flavum, mild foriminal narrowing.

I had an EMG and it showed mild old C7 radiculopathy with chronic reinnervation. That was conducted before my big flare up. The big flare up massively effected my lats, triceps and right pec major as far as weakness. I’ve now gained back most of the strength from the big flare up.

I saw a neurologist who thought I had myelopathy because I had Hoffman’s bilaterally and other reflex abnormalities. After the MRI she was like you don’t have myelopathy. This is wonderful of course but could there be something going on with this ligamentum flavum that’s dynamic?

I still am dealing with this weird leg stuff when I bend my neck, plus still have a sharp pain in my neck, to high t spine down the center line, plus spasms that prevent me from really bending my neck that are pretty much constant, leg stiffness. Gait is normal. It seems my body is trying to protect the area by tightening.

Curious what you think about an infolded ligamentum flavum. This is brand new to me.

Heathry76
Participant

August 31, 2019 at 8:20 pm

Post count: 16

#31004

Also, I do have a t7/8 disc extrusion which results in contact and indentation of the thoracic spinal cord without underlying signal change. My thoracic spine does cause me pain problems when doing any exercises that twist and bend. I had a flare up of this area also over the summer from doing core work. I also have a perineural cyst on the right T7 nerve root.

This is not new. I had this since 2017. It seems like neck movement causes the leg stuff I have going however I was told it can’t be doing that.

Either way, I’m curious if you’ve heard anything like this happening. It’s weird.

Thanks

Donald Corenman, MD, DC
Moderator

September 2, 2019 at 7:00 am

Post count: 8660

#31010

Your one level ACDF was at C6-7 or C5-6?

It is not uncommon to have an ACDF and go on to a failed fusion (pseudoarthrosis) over a 4-6 month period where symptoms again can recur. Did you have a new MRI or CT scan after surgery to look at fusion status or current compression?

Your T7-8 HNP or perineural cyst at that level would not affect arm strength or symptoms in the arms.

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.

Heathry76
Participant

September 2, 2019 at 7:21 am

Post count: 16

#31013

My ACDF was C5/6 and recent MRI discovered new disc herniation at level below the fusion at C6/7 with ligamentum flavum infolding resulting in mild central stenosis. The called this progressive adjacent segment disease. The symptoms I had this time are new. Triceps weakness now not biceps. The fusion status wasn’t mentioned in the MRI report. I was discharged from care with my surgeon back in May 2019 with a “stable fusion”. I’d assume not all the way fused but healing was going in the right direction I guess. Now I just feel as though I have to be careful or I’ll flare up again, with triceps stuff. It’s deems rather sensitive to flare ups if I stretch to much or do anything where it fatigues. Anyway, it stinks but hopefully it will pass in time. Would my MRI show failed fusion?

Donald Corenman, MD, DC
Moderator

September 2, 2019 at 10:11 am

Post count: 8660

#31014

I have no doubts that you had degenerative changes present at C6-7 before your C5-6 ACDF but these changes were asymptomatic. The new disc herniation at C6-7 was probably not present before your C5-6 surgery but you had annular tears, possibly even through and through without a herniation before. Since this is a new level, I would suspect your fusion status at C5-6 is OK.

If you have triceps weakness, this means you have substantial nerve root compression at C6-7. You might consider an epidural steroid injection but if this weakness continues for 3-5 months, you should consider addressing this root compression surgically.

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.

Heathry76
Participant

September 2, 2019 at 11:05 am

Post count: 16

#31019

Last EMG showed chronic reinnervation of C7. However it keeps bouncing back and forth so each EMG I get could reveal different stages of C7 nerve issues. Could C7 affect the latisimus dorsi? My lats are twitching and atrophied slightly bilaterally. With the triceps weakness comes lat weakness. Anyway, I’m sensing another surgery is in my future, near future, but I’m really trying to find any way to avoid it. My new symptoms happened so fast after the surgery I’d worry about that pattern just continuing if I had another one. Pain is definitely not my issue this time. Just weakness and fasciculations, some numbness here and there.
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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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