Multilevel Fusion with ProDisc-C &Basilar Invagination ?

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musicman45
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June 28, 2012 at 3:41 am

Post count: 2

#6441

Dr. Corenman,

I have cervical damage from C-2 down to T-1. It all started from a car crash,where C-5/C-6 were ruptured,and I had a failed anterior cervical fusion,where my bone graft popped out two weeks after surgery,and the surgeon decided not to put in a new graft bone,stating my body would absorb the bone graft.Basically,I walked around years with no fusion,as no doctor would touch me after seeing the failed surgery.Consequently,the discs above,and below began to degenerate due to pressure,and I now have ruptured disc from C-2 ,down to T-1.I am disabled with pain & numbness in my head,neck,arms,hands,and now have frequent episodes of Basilar Invagination. Doctors in my area suggest a solid fusion all the way up,which will result in a total loss of range of motion,or fusing C-5 to T1 using (rhBMP-2),which I’ve heard many bad things about,as it is not an FDA approved method for cervical fusion.

To the point. I’ve been researching patients who have had ProDisc-C multilevel cervical fusions with good results.I have moderate to severe narrowing of the foramen,spurs,anterior,and posterior herniation from C2- down to T1.I know this can not all be repaired.However,I’m asking if ProDisc at multilevels,and a combination of standard fusion with plates,& screws would be a viable option to get some relief for me ?

As for the bouts of loss of balance,I have read your post on Basilar Invagination,and know that that is a separate procedure.Any help or advise would be greatly appreciated.I have recent MRI’s and reports.

Thank You

Donald Corenman, MD, DC
Moderator

June 28, 2012 at 1:15 pm

Post count: 8660

#6445

You have different pathologies that can cause various disorders. You note a pseudoarthrosis from a prior surgery at C5-6 that you have lived with. You note multiple levels of degenerative disc disease. You note “frequent episodes of Basilar Invagination”.

Basilar invagination is a disorder in which the dens (the head) of the second vertebra pushes against the spinal cord at the foramen magnum (the exit of the cord from the skull). This causes very different symptoms (Arnold Chiari syndrome) than lower cord compression. Do you really have basilar invagination along with everything else?

Fusion of “everything” in the neck is normally ill-advised and only rarely necessary. Prodisc C at multiple levels is rarely necessary and not FDA approved at this point. Insurance companies will not approve multiple levels of artificial disc replacement at this time.

Balance issues could originate from myelopathy secondary to lower cord compression or from inner ear problems as well as from basilar invagination. You might need a second opinion to understand your diagnosis and options.

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.

musicman45
Member

June 29, 2012 at 3:26 am

Post count: 2

#6446

Thank you Dr. Corenman,

To answer your questions,It was suggested by a local neurologist,and neurosurgeon that I could possibly have Basilar Invagination,due to the presence of large spurs,or other unknown bone formation protruding from the top of C-2 detected by the MRI.That along with episodes of losing total balance led them to this conclusion,after checking the inner ear,with negative findings .

The question I can’t seem to get answered is, if any of the compression from the C-5 to T1 could be causing the frequent loss of balance,which usually occurs after upper body, arm activity from lifting,or pushing etc. ? I have a lot of pain at times in the back of my head at the base of the scull around the Sternocleidomastoid,or just the mastoid muscles .Only seems natural that once these muscles get into extreme spasam,that it could possibly have some effect on balance,as the mastoid connects to the scull near the ear ? Just guessing on my part ?

At any rate,thank you very,very much for the info relating to ProDisc,and the lack of Insurance companies willingness to cover such procedures.You’ve been a great help,and I will save my money for the ProDisc surgery !
Thanks Again !

Donald Corenman, MD, DC
Moderator

June 29, 2012 at 4:59 am

Post count: 8660

#6447

Basilar invagination should be obvious on MRI scan. Symptoms are somewhat similar to myelopathy but there are other potential symptoms somewhat different such as headache, dysarthria, among others. Your physical examination should display hyperreflexia, Hoffman’s sign, clonus, imbalance among other signs to confirm irritation to the cord.

Imbalance is generally not specifically related to neck pain. I have patients walk into my office with severe imbalance from cord compression and not even know they have a neck problem. On the other hand, severe degenerative changes of the neck can cause both neck pain and cord compression leading to balance issues.

Hybrid procedures such as an artificial disc at one level with fusion at other levels seems to work well but the time to the disc wearing out is still unknown.

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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