Post-operative MRI Report indicates the same thing as Veteran Affairs MRI done 3

Tagged: residual symptoms after ACDF

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wgreenlee
Participant

November 23, 2015 at 9:48 pm

Post count: 53

#20830

Hello Dr. Corenman,

I’m a disabled veteran that had the VA pay for me to have a ACDF Surgery on my C5-6 C6-7. The surgeon that preformed the surgery had a busy morning in surgery and I was the final one on the slate. Anyway, back in 2012 the Department of Veteran Affairs had a MRI done on my cervical area and the impression and notes read as follows:

This is the 2012 VA MRI:
MRI CERVICAL SPINE: ASYMMETIC DISC PROTRUSION IS SEEN TO THE RIGHT C5-6 CORD INDENTATION AND COMPRESSION OF THE RIGHT C6 NERVE ROOT.

This is the post-op report 2015:
The post-operative report indicates that POSTERIOR LONGITUDINAL LIGAMENT WAS OPENED AND BILATERAL FORAMINOTOMIES WERE PREFORMED. AT THIS POINT, THE DURA AND NERVE ROOTS WERE WELL-DECOMPRESSED AT C5-6 C6-7 LEVELS.

This is the MRI REPORT 2015 POST-OPERATIVE SURGERY:
C5-6: PRIOR CERVICAL FUSION. THERE IS RESIDUAL RIGHT PARACENTRAL DISC OSTEOPHYTE WITH MASS EFFECT ON THE VENTRAL RIGHT C6 NERVE ROOT.
C6-7:CERVICAL FUSION. RESIDUAL BROAD-BASED POSTERIOR DISC OSTEOPHYTE ASYMMETRIC TO THE LEFT. THERE IS RESIDUAL LEFT GREATER THAN RIGHT NEURAL STENOSIS.

This is the 2nd MRI REPORT POST-OPERATIVE

IMPRESSIONS:
1. POST-OPERATIVE CHANGES FROM ANTERIOR CERVICAL DISC FUSION OF THE C5 TO C7 DISC LEVELS WITH PERSISENT LEFT FORAMINAL PROTRUDING DISC AT C6-7. RESULTING IN AT LEAST MODERATE LEFT FORAMINAL STENOSIS.

2. RIGHT PARACENTRAL PROTRUDING DISC AT C5-6 CONTACTING AND INDENTING THE RIGHT VENTRAL CORDAND RESULTING IN RIGHT FORAMINAL STENOSIS AS WELL.

3. MILD SPONDYLITIC DISC DISEASE AT C3-4 AND C4-5 WITH SMALL BILATERAL SPURS AT EACH OF THESE LEVEL, PARTICULARLY ON THE RIGHT C3-4.

Well this is what I’m dealing with post-surgery. I’m having issue’s with getting a straight answer and the only thing that has been a definite is that I will have to have a 2nd surgery. The problem that I’m having is that the Department of Veteran Affairs is going to want a reason for a 2nd surgery, and I’m having a problem getting a straight answer. The surgeon looked at the MRI and said everything looks good and stated on the office visit that I said the arm pain is slowly getting better even after looking at the MRI. I have no idea who to speak to since I can’t seem to get a honest answer. Any input would be greatly appreciated.

Thank you,

Bill G.

P.S. The biggest part I can’t and the VA will won’t to know about is why does the MRI from 2012 and both the post-operative reports state the same condition.

Donald Corenman, MD, DC
Moderator

November 24, 2015 at 6:21 am

Post count: 8660

#20831

The questions I have for you are what are your residual symptoms? Did you obtain any relief from surgery? Did your symptoms change in quality or intensity? Do you have a solid fusion (as noted by x-ray or CT scan)?

The surgeon might not have been able to fully decompress the roots. This is unusual but does happen.

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.

wgreenlee
Participant

November 24, 2015 at 7:28 am

Post count: 53

#20834

Hello Dr. Corenman,

It was about 3 weeks after surgery that both arms started having burning and also in both shoulder blades with numbness and tingling in the hands. Also have had headaches come along as well. The intensity level has increased in comparison to before the surgery. The surgeon recently saw me and wanted to do another MRI and X-ray. He also did a reflex test where he used the rubber device and tap right below my knees. The question I might have with the results from that test is that both my feet were on the floor. So I’m not really sure how that works. Still waiting on either the VA to authorize a CT scan (which I don’t think they will approve it). What I can’t figure out is why the MRI results from 2012 and after the surgery are the same. I understand that all surgeries are not going to be successful, but this just seems a little bit odd.

wgreenlee
Participant

November 24, 2015 at 8:53 pm

Post count: 53

#20836

Dr. Corenman,

After the surgery The symptom’s have gotten worse plus headache’s and muscle spasm’s have also started in the left arm. Especially when I lie down to sleep at night. I have a appointment with a neurologist December 2. My PCP has looked over the MRI’s as well and indicated that I need to get back to the neurosurgeon who saw me twice after surgery and then said to try a epidural shot. I never heard back from him after that meeting and since then I had the shot and have seen another neurosurgeon who indicated that he would not have done the surgery to begin with since there wasn’t any cord compression. I’m having mixed opinion’s and thought you might be able to give me a better direction. Thank you for any further input.

Bill

Donald Corenman, MD, DC
Moderator

November 25, 2015 at 5:10 am

Post count: 8660

#20837

You have to compare the symptoms before surgery to the current ones. With the complaint of “bilateral burning symptoms in the shoulders after surgery”, this begs the question if these same symptoms were present before and if so, did the symptoms change. Please be specific. See the section on how to describe symptoms to better define what you are experiencing

I assume “new onset headaches” and muscle spasms in the left arm are new.

You really need the two studies, MRI and CT to help define what the current anatomy is.

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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