Neck Pain with little Radiculopathy and Strange MRI Report

Tagged: CFS leak, coral graft, PAIN, pseudo-arthrosis

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creimer
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November 26, 2016 at 10:13 am

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#23490

My history: 19 years ago October 2016: C5-6 & C6-7 fusion… with a graft material that was neither approved by FDA nor Health Canada (coral) and it failed. 10 days later they re-did the surgery by removing the grafts (“millions of pieces, particle by particle with a tweezer and hard to see because of all the blood vessels”, my neuro-surgeon’s words to me) and used my own hip bone for the second operation. No plates or pins or devices were implanted in either surgery. Over time, I have had pain in the neck but never enough to really ask for further majorintervention and only rarely do I get radiculopathy. Had a few MRIs over the course of 19 years. Each one shows progressive cervical degeneration (moderate to severe). FAST FORWARD to April 2016, the pain in my neck and terrible stiffness would not go away. It slowly got worse over time, chronic. July 2016 started to take tylenol, ibuprofen, aleve,… they worked for a short period of time. Some radiculopathy into fingers but only a day here or there. Some pain in left cheek and temple (thought it might be a second issue, like teeth, but endodontist pretty much ruled that out.) October 2016: Finally, asked family physician for prescription meds… have been on moderate to high dose of Lyrica which helps a lot, but I am a bit dozy. OF NOTE, my family doctor got a simple xray done in Oct 2016, the report notes ONE FUSION at C5-6 !! This led me to investigate previous MRI reports and the last one says that “apparently there were two fusions reported but this MR Scan only shows one at C5-6”. SO THEN, I found two CDs in my drawer of former MRIs I had, one in 2008 and one in 2014. I looked at them and with my layperson eyes, indeed see only one fusion in both MRI scans. I AM GUESSING THAT THE HIP BONE GRAFT AT C6-7 FAILED BEFORE 2008 OR THE SURGEONS DECIDED TO ONLY REPLACE THE ONE AT C5-6 AND THE CORAL DETERIORATED OR FAILED OVER TIME, MAKING IT LOOK LIKE THERE IS A DISC THERE. (or the C6-7 hip bone graft failed at some point) WHAT MY LAYPERSON EYES SEE IS A POSSIBLE DISC THAT LOOKS DEGENERATED OR SIMPLY A BUNCH OF OSTEOPHYTES, IN SOME VIEWS IT LOOKS LIKE A REGULAR DISC, MABYE A BIT WORN… IN ANY CASE, I SOON LEARNED THE WORD PSEUDO-ARTHROSIS. I should add that there was a 2 year waiting list for the neurosurgeon I wanted to see (one of the surgeons who did or assisted at my second surgery) and the one available much earlier is a Parkinson’s expert. I have a March 2017 appointment with my (very, very good) neurologist whom I have seen for other (related?) visual vertigo (or sometimes called visual-vestibular mismatch) a couple of years ago, which has almost resolved, and so I got my driver’s permitback. Even my neurologist in March 2017, Im guessing, won’t be able to get me to see an expert neuro-surgeon, I am guessing, very soon because my neck issue won’t be seen as “urgent, urgent” and the Lyrica is kinda dealing with my symptoms.. My questions are: Is there anything serious going on that would require me to have urgent care? Is it okay to be on Lyrica the rest of my life? I have one last question … I used to think (3 years ago?) that I had a CFS leak as I could “feel” and “hear” some drainage going on in my neck but I came to believe it may just have been throat related, and it is gone. What does a patient with a CFS leak in the neck report? Any other thoughts? I am 59 years of age.

Donald Corenman, MD, DC
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November 27, 2016 at 11:20 am

Post count: 8660

#23491

I am a little confused. You refer to “19 years ago” and then reference a surgery date (October 2016) that was one month ago. I’ll assume that surgery was long enough ago to discover the failure of the coral graft and have a subsequent revision of the failed ACDF with you hip graft-even if there was no plate applied. I am surprised that coral was used as the graft material for the first surgery as this material has no ability to tolerate load and will fragment “into a 1000 pieces”. The appropriate response to this failure is a revision with your own bone which you did have performed.

Without the use of a plate, the chance of a solid fusion drops and the more common level that does not go on fuse is typically the lowest fusion level (in your case C6-7). The C6-7 level will look very degenerative with a long-time pseudoarthrosis (disc narrowing and bone spurs). You will not have a persistent CSF leak in your neck. If you did have one from either of the two surgeries, you would have a pseudomeningeocele which is a small self-contained pocket of CSF. I my entire career, I have seen only two CSF leaks from cervical surgeries (out of about 6000).

Your problem is not an emergency so if you showed up at an ER, they would not put you in the from of the line. You probably need a revision of the C6-7 level.

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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