Nerve pain 30 times worse within 2 days after c5-7 Fusion

Tagged: ACDF caused need for additional surgery within days.

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

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miker319
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October 14, 2018 at 10:21 pm

Post count: 2

#29686

Dr. Corenman,
I had C5-7 Fused ACDF in February of this year. When I was discharged within a couple of day (even with oral pain meds) I was having severe nerve pain it is not an exaggeration to say it was at least 30 times worse than what I had before surgery. The pain was in my left side form my finger tips to my neck. I went back to the ER and they administered IV pain meds which helped some. My surgeon upped my oral pain meds oxycodone and gabapentin. I went home and as soon as the iv deladid wore off I was in just as bad of pain as before. I called the surgeon and was advised to go to the ER. same basic story this time as well except he made an appoint for me as soon as I was discharged to see a pain management person. I did see the pain management doctor and was given an oral delodid he stated that that was as strong as it gets. I went home that night as the iv pain meds again wore off I was somewhat relieved to know I had this powerful oral pain med I took the pain meds as prescribed. The pain gradually came back to its full strength by 10:00 pm that night. I again called my surgeon crying this time he told me he would call right back, he did and stated that he had a room reserved at the hospital for me as we needed to get to the bottom of this extreme nerve pain. I arrived and was sent to get MRI’s and xray’s the next morning there were 4 additional doctors from Barrows neurological to assis my surgeon. they introduced there self and stated they were here to help get to the bottom of this and stated “I should not be in pain and that this is very unusual’. At 10:00 am they all came back into my room stating that they Think they have identified the issue. It would require going in through my upper back on the left side and relieving the nerve a much more invasive surgery which they did 2 hours later. The pain seemed to be gone although I was now on oxycodone 35mg 6 times a day and 8mg tinazadine 4 times a day as well as 3600mg of gabapentin a day. 7 months later I finally stopped the oxy codone after a taperdown and cold turkey stop. 5 weeks without any pain meds and my pain in my neck and back is progressively getting worse as well I am experiencing nerve pain to the point of a 5 to 6 at times. I am very worried at this time if there is an issue with the fusion or am I looking at a lifetime of pain management or an additional surgery. Have you ever seen or had something similar with any patients of yours or others you know of?

windee
Participant

October 16, 2018 at 11:04 am

Post count: 3

#29688

Hi, I am so sorry you have been going through this horrible pain when you were already in so much pain you consented to a major surgery in order to relieve it and only to come out way worse!! I had Acdf fusion to C-6,7 in 2010 and was so much worse with nerve pain after that in desperation I had the C-5,6 fusion in 2011 because my surgeon didn’t know why I was having so much pain and there was a small herniation at that level and that was all he could come up with for the reason of my pain. Well it only made things worse and after a year of such severe pain and no fusion at either level I had to have a posterior fusion through the back of my neck at C-5-7 with bone harvested from my hip 2 years later. Although this eventually did lead to fusion at the two levels the nerve pain was seriously 20 times worse than before and the trauma from all these surgeries with only worsening conditions was really getting to me. I finally had some answers after a CT scan showed 2 of the pedicle screws were mal-postioned in my epidural space causing constant irritation to my nerves. I had the posterior hardware removed and I had immediate relief from the nerve pain. I still have a ton of other issues and I think a lot has to do with the anterior hardware from the first 2 attempts at fusion was not removed which I firmly believe it needs to be for even more relief, but I do think some people like myself have an adverse reaction to hardware in their bodies and even if the hardware appears to be in good position and elicits good nerve function during surgery, just a small bit of movement and it could make the difference of no nerve pain to constant nerve irritation after the surgery. If you have fused at those levels and as scary as it might sound you may consider getting your hardware removed. After fusion occurs at the levels needed there is usually no need for the hardware to stay in there unless you are not experiencing any pain at all then you wouldn’t want to have another surgery. But with worsening nerve pain after surgery and with no let up I really wish I wouldv’e had my anterior hardware removed too before it encased in my bone as it is much easier to remove early on and I think I would be in a much more pain free situation now. I truly hope you will finally get some relief and maybe Dr. Corenman will have some answers for you. Don’t give up, there is a reason for your pain getting worse not better, and you should not have to live in worse pain than when you were before surgery. Hang in there.

Donald Corenman, MD, DC
Moderator

October 17, 2018 at 12:23 am

Post count: 8660

#29689

It is distinctly unusual to have increased pain in a nerve distribution after an ACDF. The normal spot-operative response is significant decreased pain. Increased pain can be from nerve stretch (making the neck much longer using larger grafts), from foraminotomies in which the tool used to open the foramen inadvertently compresses the root causing direct injury, screw misplacement causing hardware impingement or a small fragment of bone or cartilage which “breaks off” and wedges into the foramen. This is all assuming that the diagnosis of nerve root compression was correct in the first place.

It sounds like you need a new CT scan and a new MRI of the neck along with flexion/extension X-rays. Then you need a meticulous physical examination and assessment of all these findings to figure out what went wrong. You might also need diagnostic nerve root blocks.

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.

miker319
Participant

October 17, 2018 at 10:33 am

Post count: 2

#29698

Thank you for your reply,
To help add clarity to this the nerve they were trying to relieve based on pictures of what they did was swollen to three times the size of the one closest to it and this is after the ACDF surgery. It looked as if your finger would if you wrapped a rubber band around it with the nerve bulging out around the passage. This surgery was from a car accident that extruded my discs out and had pushed my spinal cord to the other side of the canal I don’t believe it was compressing it but clearly was against it. Lastly do you have any recommendations for the best place to have this type of diagnostic procedures done at in the Phoenix AZ area.

Thanks Mike

Donald Corenman, MD, DC
Moderator

October 27, 2018 at 8:47 am

Post count: 8660

#29723

A swollen nerve root is an indication of significant problems with the nerve itself. Make sure the nerve is actually swollen “three times its normal size” as a dis herniation lodged right next to the nerve can mimic a swollen root. Gadolinium (dye used with an MRI to distinguish swelling vs herniation) can be useful for distinguishing this disorder. Unfortunately, I don’t have any specific recommendations in the Phoenix area.

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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