MRI Cervical Spine C6-7

Tagged: Cervical ACDF vs. artificial disc vs posterior foraminotomy

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bpipkin
Participant

April 6, 2019 at 3:58 pm

Post count: 4

#30315

Dear Dr. Corenman,

Hoping you can offer some advice.

Symptoms: Shoulder pain and pain down arm over the last four years, off and on. Severity is getting worse. Currently, some numbness in hand, tingling, and arm is very weak. Lots of off/on burning sensations.

MRI results: There is reversal of the normal lordotic curve. Cervical vertebrae maintain their stature and have a normal T1 and T2 appearance. Moderate interspace narrowing at C4-C5, C5-C6 and C6-C7.

C5-C6 level there is some minnor spurring on the RIGHT side. No herniated disc or canal stenosis is present. There is mild bilateral foraminal narrowing.

C6-C7 level, there is a broad-based disc osteophyte complex which is more pronounced on the LEFT side at the entrance to the intervertebral foramen. This causes severe LEFT foraminal narrowing. There is moderate RIGHT foraminal narrowing at this level. No canal stenosis is seen.

C7-T1 level, there is no evidence for a herniated disc or canal stenosis. The intervetebral foramina are not enroached upon.

The issue is with C6-C7. Would ACDF be the best procedure for this or is disc replacement an option? Or perhaps a posterior cervical foraminotomy?

My general MD recommends a prodedure. I am doing PT with no relief, but will continue doing it. I met with one surgeon who does the ACDF. I am 40-years-old and do have degenerative disc disease.

Thank you for your help.

Donald Corenman, MD, DC
Moderator

April 6, 2019 at 4:53 pm

Post count: 8660

#30316

Based upon your information, the C6-7 level looks like it needs to be addressed surgically.You do have a choice regarding an ACDF, maybe an ADR (artificial disc replacement) or a posterior foraminotomy. The x-rays and MRIs would really be helpful to review prior to a decision as there are circumstances that could lead against an ADR or a posterior foraminotomy.

If the disc height loss is 50% or less (than normal), there is a high percentage of neck pain or degenerative facet disease including a slip, this leads away from an ADR as a useful surgery. In addition, an ADR has a wear life and I expect these devices to wear out in 10-20 years needing an eventual fusion.

A posterior foraminotomy has its place in surgery and can be effective but I tend not to use this technique if there is motor weakness. The posterior foraminotomy open the back of the nerve exit zone allowing more room for the nerve root. However, the normal problem causing root compression is uncovertebral joint hypertrophy which is a spur that grows into the nerve hole from the front of the spine. The posterior foraminotomy does not address this spur which is why Peyton Manning’s first two surgeries didn’t work and he finally had to have an ACDF.

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.

bpipkin
Participant

April 6, 2019 at 5:59 pm

Post count: 4

#30317

Thank you. I assume the disc space has collapsed some as the doctor who would do the ACDF said the bone graft would restore height. My fear in fusion is adjacent disc stress and further degeneration. Also I am not sure how lacking the curve in my neck will be impacted by each procedure. My recent injury has lingered for 6 weeks. The burning has subsided but the arm is really weak. I assume my progress will plateau. My neck is very stiff and is now making cracking sounds when I turn my head. Is this something that can be waited out a few more weeks before going under the knife? Disc replacement sounds great but not sure it will last.

Donald Corenman, MD, DC
Moderator

April 7, 2019 at 8:50 am

Post count: 8660

#30323

If your disc height has collapsed, then an ACDF is the correct surgery. I think you can wait 2 more weeks as the cervical nerves have reasonable capacity to recover strength after compression. I have decompressed individuals almost 6 months out with good recovery (although not every one responded).

The cracking is most likely from degenerative facet disease that is present at this level or another one. Cracking sounds without pain are nothing to worry about.

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.

bpipkin
Participant

April 8, 2019 at 4:42 pm

Post count: 4

#30334

Will a disc osteophyte complex go away on its own over time? Do reduced symptoms only mean the nerve isn’t irritated as much while still being pinched? I asked because my symptoms are up and down. I’ve recovered from other herniations but I assume this complex is a different matter? Thank you!

Donald Corenman, MD, DC
Moderator

April 10, 2019 at 7:40 am

Post count: 8660

#30342

Disc osteophyte complex (bone spurs mixed with cartilage) is a permanent condition. Reduced symptoms have to do with reduced root swelling and reduced inflammation. Generally the cause of the osteophyte is some collapse or instability causing bone stress (enthesopathy). This could get better with time meaning the disc can stabilize so the bone spurs will not continue to grow.

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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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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