Post ACDF and now Pseudoarthrosis, Possible Revision

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jefish
Participant

January 31, 2015 at 1:38 am

Post count: 7

#12125

I am writing you on behalf of my wife. We live in SC. I have family that lives in Castle Rock, CO. I would like to have a phone consultation with you Dr. Corenman about her condition if you do those. Two days ago (January 28, 2015) she had MRI with/without contrast and a flexion X-ray. It revealed a pseudoarthrosis from her ACDF surgery according to her surgeon. She had ACDF surgery (C4-C6) on September 20, 2013. She did well for three months and then for the last 12 months gotten progressively worse. She has really bad neck pain and her left arm has gotten weaker. She has pain from her neck to her elbow. She has very little bicep strength in her left arm. She is now experiencing pain on her right side (from neck to shoulder) that she has not had before pre / post surgery. The only relieve she has gotten from severe arm / shoulder / neck pain is from facet joint injections (C4-C6) on both sides. It helped the arm pain but the deep aching neck pain remained. Her surgeon is recommending Posterior fusion and foraminotecmy on left side of C6 and possible C5 nerve root. I question him about her having pseudoarthrosis 6 months ago when she was having so many problems. Back then He had her have a CT scan and said she was fusing but not fused completely. He showed us the movement (pseudoarthrosis) on the Xray from still position to flexed. Below are links to her images for you to review for your opinion if you will. Your website would not allow me to post URL’s so just place the addresses below into the address bar of your browser to see the images. Thank you for your time Dr. Corenman.

moodoweb.com/flexed.jpg

moodoweb.com/straight.jpg

moodoweb.com/mri.jpg

Donald Corenman, MD, DC
Moderator

February 1, 2015 at 1:14 am

Post count: 8660

#12128

Pseudoarthrosis is not uncommon after ACDF surgery, especially if PEEK cages are used. I can understand the reluctance of the surgeon to declare a non-fusion. A posterior fusion and decompression is not a bad idea. There are occasions that I feel a redo anterior decompression and fusion would be a better idea. It really depends upon the images, symptoms and examination.

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.

jefish
Participant

February 21, 2015 at 5:52 am

Post count: 7

#12289

Hello Dr. Corenman,

Since my last post my wife and I have gotten a second opinion for what is wrong with her and it was completely different than what her original surgeon said. I would like to know your opinion based on what this newest surgeon suggests. This Neurosurgeon has a reputation as one of the best in SC. He told us that my wife had multiple problems and they in his opinion should all be addressed. He said that she had pseudarthrosis from her past surgery and that the hardware was loose (from the movement in the straight and flexed imaging). He said she had severe compression on the nerve roots at both C5 & C6. He also stated that she had a reverse curvature or lordosis of her neck. He proposed fixing all of those things. I asked him were those PEEK cages the last surgeon used and he said Yes. His recommendation is to go back in Anteriorly and remove the loose hardware and decompress the nerve roots. He then said he would like to “rebuild” her neck to help give her a more natural curvature. He said he would do that by taking some of her bone and mix it with cadavar bone, etc. to form her neck at the levels of her surgery and a little above. He was extremely confident this would do the job. He told us if the hardware was not removed it would not fuse. What advice can you give from this new information? Thank you so much for your time Dr. Corenman. It is greatly appreciated!

Donald Corenman, MD, DC
Moderator

February 21, 2015 at 12:19 pm

Post count: 8660

#12290

It sounds like this surgeon has good judgement. Removing the PEEK non-fused cages along with the non-fused instrumentation and replacing them with allograft and autograft is reasonable thinking. While he is there, realigning the neck back to a more normal alignment would also be a good move. You might have found a good reconstruction surgeon.

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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