Neck pain and wrist -forearm pain.

Tagged: Cervical artificial disc replacement failures

Viewing 5 posts - 1 through 5 (of 5 total)

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StephenF
Participant

January 28, 2019 at 7:03 am

Post count: 5

#30075

Thank you for providing this service .

Some quick general questions to help me evaluate my current care.

Has dual level CDR C-5-7 on 0820/18. Symptoms have increased and in some cases become worse. It seems to be a compression issue. Riding in cars for long time or sitting or standing long periods increase pain.

I have seeked a second opinion from another surgeon. He requested and MRI, even though I had a current CT Mylogram . I was told that an MRI is not effective to diagnose with devices installed . Also, CT shows “ possible, probable “ impingment in the areas of CDR. The second surgeon never asked for my pre-surgery MRI. It seems to me the surgeon would need to see a pre-surgery MRI to help evaluate if surgery was done correctly.The second surgeon said he saw nothing on the MRI that looked “ OH WOW”!

I know my symptoms are somewhat baffling, but I question the route of diagnosing the issue. The plan now is to “carpet bomb “ the neck with an epidural to see if my is originating from the neck.

I have had two EMG’s and have seen a surgeon about my hands and wrist.
Second EMG showed very minor carpal , but wrist surgeon said I did not have carpal issues.
My humble theory is that I wasn’t decompressed enough and or the CDR device is not tall enough. Not sure is that can be determined non surgically.

I am contacting you because I met one of your patients and he was over joyed with his result, and he seemed in worse shape than I am now.

Thank you for your time

Stephen

Donald Corenman, MD, DC
Moderator

January 28, 2019 at 3:57 pm

Post count: 8660

#30077

I would agree that an MRI after a cervical artificial disc replacement is not a very revealing study. The MRI (magnetic) reacts to the significant amount of metal and distorts the images. The CT myelogram is the study of choice (performed on a precise machine). EMG studies are generally not revealing if there is no motor weakness.

I would be careful with a “carpet bombing” or the “shotgun approach” to these injections as they are not diagnostic in nature. That is, you cannot discern what the disorder is based upon results. I would consider asking the injectionist if they would do selective nerve root blocks specifically of C5-6 and C6-7 at the same time. If good temporary relief, you might need to convert the ADRs to ACDFs.

See:
https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/
https://neckandback.com/treatments/diagnostic-therapeutic-neck/

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.

StephenF
Participant

January 28, 2019 at 4:43 pm

Post count: 5

#30078

Thank you for taking time to reply.
I can’t tell you why Dr (Indiana Spline Institute) wanted an MRI when I had a current CT. Maybe to look at the rest of my neck ?
Dr (Goodman Campbell Brain and Spine) – who did the CDR – was also baffled . His possible solution was what you have suggested – go with the ACDF. Dr did pull the MRI for me to see- and it’s wasnt revealing , like you said.

Would you ask for a pre- surgery MRI for the purpose of an evaluation?

The approach of the carpet bomb was to see if pain in hands was emanating from the neck or carpal symptoms, “ before I start really sticking you” said Dr ( Indiana Spine Institute. I believe your approach is what the injectionist was trying to tell me today.

Might be time for a consult with you guys also.

I will add that I understand that a second opinion from a surgeon will result in traveling over the same bridges , and Dr seems to have a lot of experience, so I am riding this to see where it goes .

Thank you and have a great day

Donald Corenman, MD, DC
Moderator

January 29, 2019 at 7:58 am

Post count: 8660

#30080

If you are going to “be stuck”, then in my opinion a “one and done” set of injections should be considered. That is, SNRBs at C5-6 and C6-7 at the same time. This would differentiate the neck from the carpel tunnel and at the same time confirm that the C5-7 disc replacements are the problem. This would lead to the ADR revision to an ACDF without the need for yet another injection.

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.

StephenF
Participant

January 29, 2019 at 8:24 am

Post count: 5

#30081

One more reply , I’ve probably used up your generosity in this matter.
Before ADR , I was stuck C6-7 I believe , and it was effective for a total of 4 days . Dr. Eads was hesitant to perform ACDF( wasn’t aware that CDR would be covered under my insurance) because my symptoms were not “ classic “ arm pain ( no bicep pain, more wrist and neck , shoulder , upper back).
He gave me a 50/50 chance that ACDF would fix my issues.
Then there was a significant time of two years between cortisone shot and decision for surgery because of other family issues I put it off.
When reconsidering surgery, insurance coverage had changed and CDR was now an option. Eads agreed to do the surgery, but now wanted to do dual level CDR because of significant disc issues seen on the MRI( updated).

So this is where I am now, under the care of Dr Sasso and his approach to my symptoms . More symptoms , more pain, more effected by compression issues as in riding in a car , or brisk walking or anything with significant impact.

Dr. Eads made a comment that the ADR devices were or can be tough to remove . Is there normally complications for reversing this surgery to ACDF? If this was an issue of an improperly sized device (height) to properly decompress , wouldn’t a properly sized device be an option?

I apologize if this seemed like I was leaking information and maybe chronologically backwards . Not sure what I expected as a response , but I feel like I’ve already learned more from you then my current surgeon. You have been gracious with your time .

Sincerely

Stephen
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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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