Plated C5-T1, obvious non-union C7-T1 w/excessive segment motion X-ray

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waderoberts
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June 8, 2014 at 4:13 am

Post count: 17

#10969

DOI was 12/17/1994. 1st MRI 12/1996. 1st c-spine surgery 11/12/1997 with a revision on 11/21/2000. Have been living with considerable neck and arm pain since DOI. Currently have neck and upper back pain, left shoulder and arm pain, with pins and needle sensations in the long and ring finger of my left hand and headaches. Much worse with use of neck outside neutral head position, though I have a fairly full range of motion of my arms, with the exception of a tendency towards left shoulder girdle when symptoms are at their worst. Neck pain and left sided chronic radiculopathy are alleviated somewhat by vegan diet, avoidance of maneuvers outside of a neutral head position, anti-inflammatory medications and Tadalafil on a daily basis. Radiculopathy and neck pain worsened by strenuous activity, especially those requiring head movements outside neutral position and impact both arms and hands when symptoms are at their worst. Am 55 years old and considering another surgery to correct the obvious issues with the last. Would very much like your opinion regarding my current condition and restrictions you would recommend in the interim.

waderoberts
Member

June 8, 2014 at 5:08 am

Post count: 17

#10970

My apology for linking the images. Anonymity isn’t an issue for me.

Donald Corenman, MD, DC
Moderator

June 8, 2014 at 10:57 pm

Post count: 8660

#10980

I can’t allow you to post your images on the forum as this will identify who you are and this is forum is anonymous.

The pseudoarthrosis (lack of fusion) could be your primary pain generator but you also have symptoms of radiculopathy (“left shoulder and arm pain, with pins and needle sensations in the long and ring finger of my left hand”).

I would assume that these arm symptoms became much improved after your surgery and have recently returned. This normally occurs in the face of pseudoarthrosis due to the motion of the unfused level. Motion will cause spur formation which in turn can grow these spurs into the foramen (the hole the nerve exits).

If you had these symptoms both before and after the surgery with little improvement, there are two explanations. One is that these nerves were already injured prior to the surgery due to the constant compression they endured (see chronic radiculopathy on the website), The other is that the surgical decompression was incomplete and the nerves were still compressed after surgery.

Repair of a pseudoarthrosis is not uncommon. If there are significant spurs remaining, typically the repair is performed from the front to redecompress the nerves. If the nerve exit holes are not compressed (due to a well performed previous operation), then the repair can be performed from the back of the 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.

waderoberts
Member

June 9, 2014 at 3:44 am

Post count: 17

#10985

Again I apologize for linking images with personal identifiers and specific information. I will pursue an e-consult for a more detailed discussion of my personal circumstances and prognosis for surgical revision.

I agree totally regarding an anterior approach for any potential revision, as there is considerable anterior spurring of my cervical and upper thoracic spine due to the excessive segment motion at the C7-T1 level, particularly the base of T1 below the plate from contact with T2.

I declined a recommendation in 2004 for foraminotomies and fusion performed from the back of the neck. Since I’ve had anterior approaches both left and right sided, the surgeon felt that scar tissue and other hazards from the previous surgery prevented him from having confidence in making another anterior approach.

As for the radiculopathy, it was only after my second surgery that I had any right sided symptoms, though they resolved somewhat as time passed and only the left-sided symptoms remained relatively consistent, though bearable as compared to the neck pain.

Regarding the two explanations for the lack of resolution of radicular symptoms post surgery, I am confident that it was a matter of incomplete decompression.

As stated previously, I get considerable relief from radicular symptoms by making improvements in diet and lifestyle that help to reduce blood pressure and taking medications and supplements that increase circulation generally.

As for activity restrictions I would like to hear your thoughts regarding recommendations both for one with a successful multilevel fusion from C5-T1 and what additional restrictions you would recommend for one with an obvious non-union with excessive segment motion (instability) at the C7-T1 level.

It is certainly the cause of much “mechanical” neck pain.

Thank you for this forum and the educational insight provided on this website. It is beyond commendable the you devote the extra time necessary to provide people with this valuable resource.

waderoberts
Member

June 9, 2014 at 11:47 am

Post count: 17

#10994

I’d seriously appreciate your opinion regarding activity restrictions and limitations for a properly fused C5-T1 spine and one plated from C5-T1 with a non-union of the C7 and T1 vertebra and excessive motion segment movement behind the plate?

Thank You in Advance
Sincerely,
Wade Roberts

Donald Corenman, MD, DC
Moderator

June 9, 2014 at 9:01 pm

Post count: 8660

#11001

First- don’t worry too much regarding another anterior approach. I have operated on patients with five previous anterior surgeries and there is generally no great drama with another approach. If you are really worried, you can have an ENT surgeon assist the spine or neurosurgeon with the approach portion of the surgery. You do need to have a consult with an ENT surgeon or anesthesiologist if you have had approaches on both sides to check for vocal cord function.

For activity after a C5-T1 fusion, I would restrict impact activities like running or tennis. It is not that you cannot perform impact activities but with three levels already needing surgical attention, you have a genetic propensity for degeneration and impact will wear out levels faster.

Swimming, cycling, hiking, skiing (in general) and such are all low impact activities that you can gain aerobic and strength fitness. You can use devices like the elliptical stationary bike. You can even lift weights but don’t go for power (squats and cleans). You will need some ergonomics for work and play (computer screen at the right level and a stem on your bike that elevates and is shorter).

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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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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