Post ACDF pain

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riclach
Participant

August 7, 2018 at 10:15 am

Post count: 21

#28900

Dear Dr. Corenman, I had my C4 to C6 ACDF surgery one week ago. The neurosurgeon placed a peek cage filled with the remains of my bone spurs. He also placed a titanium plate. The surgery went well, but the pain I am feeling it’s unbearable. I have incredible trapezius and arm spasms with twitching. I also experience nerve pain and dizziness and I have not been able to sit up since 4 days. I have a catheter. I have tried Flexeril, Valium, Percocet to no avail. 25 hours ago the doctor gave me a 12 mcg Fentanyl patch and it has made no difference. I have now applied another patch upon his recommendation. Would Gabapentin or Lyrica help? I have a IFC unit. Would it help if I placed it on my arms?
Thank you so very much!!!
Claudia

Donald Corenman, MD, DC
Moderator

August 7, 2018 at 6:02 pm

Post count: 8660

#28902

I am unclear why you have your severe symptoms after the ACDF at C4-6. If the disc spaces were distracted, typically you would note posterior neck and some trap pain. I cannot explain the arm spasms. After surgery when you developed these symptoms, did you have a thorough physical examination and if so, were all your upper extremity muscles groups tested and if so, were they all strong? Do you have some new onset weakness? Did the symptoms occur immediately after you woke up or did they develop some time afterwards?

Did you have new X-rays to look at the surgical construct?

What does your surgeon have to say about these symptoms?

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.

riclach
Participant

August 7, 2018 at 6:39 pm

Post count: 21

#28904

Yes, all the tests were performed and came back normal, x-rays included.
I don’t have new onset weakness but have pain and spasms in my left bicep which I didn’t have before.
The symptoms got worse after 2 days. Prior to surgery, I only had arm pain on my right bicep but it’s now worsen. I also get twitches on my right side but not the left.
Massaging the biceps makes it feel better.
On a good note, my right hand grip is a lot stronger than it was before my surgery.
Also, the itching on the bottom of my scalp has gone away.
After writing you my initial post I was able to sit up in bed.
I got extremely dizzy but forced myself to sit for 5 minutes.
Within the next hour, I forced myself to sit up again and this time I was able to stand up and even walk and finally wash my hair after a week. Of course this was all done with the help of my husband.
I am now sitting in the recliner and I don’t have any dizziness.

When should posterior neck and trap pain be expected to subside?
Do you think it’s okay for me to use my tens/IFC unit on my arms?
It’s best I don’t use that on my traps though, right?

Thank you as always. You are an amazing doctor to take your valuable time to write to us.

riclach
Participant

August 7, 2018 at 7:20 pm

Post count: 21

#28905

Just wanted to correct that the pain is in my biceps and triceps.

riclach
Participant

August 7, 2018 at 8:22 pm

Post count: 21

#28906

I was able to pull the x-ray reports. My surgery was on July 31.

July 31, 2018
XR C Spine Routine Series
Cervical spine, AP, bilateral oblique and lateral views:
HISTORY: Post op follow up
FINDINGS:
Anterior fusion of the cervical spine from C4 through C6. Plate hardware and interbody position. A drain is identified.
There is normal alignment of the cervical vertebral bodies. Vertebral body height is maintained and no fracture or suspicious bony lesion is seen.
The atlantoaxial joint is normal. IMPRESSION:
Fusion of the cervical spine.

August 2, 2018
XR C Spine Routine Series
XR C Spine Routine Series COMPARISON: 7/31/2018 radiographs Views: 6
IMPRESSION:
C4-C6 ACDF. A surgical drain is in place. The left posterior oblique view demonstrates mild C3-C4, mild C4-C5, severe C5-C6, and moderate C6-C7 right neural foraminal narrowing.
The right posterior oblique demonstrates mild C4-C5, moderate C5-C6, and moderate C6-C7 left neural foraminal narrowing.
The ACDF hardware is engaged and intact. No acute fracture or subluxation.

riclach
Participant

August 8, 2018 at 7:49 pm

Post count: 21

#28922

Oh, and I still have numbness in my right thumb and index finger.
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Donald Corenman, MD, DC

Average rating:

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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