Post Surgical Pain ACDF Spect imaging

Tagged: chest pain, thoracic spine, vertebral tumor

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JBoz
Participant

January 24, 2015 at 11:20 pm

Post count: 51

#12052

Hello Dr. Corenman

I have a question regarding intense uptake at the bodies of C3 and C4. I had ACDF surgery in December of 2012, due to left ventral cord flattening, with possible mass effect on the C4 nerve. I woke up one day with severe left arm pain, chest pain, and neck pain. The above was discovered and surgery was performed after ruling out the heart.

I still have severe neck pain and moderate left arm pain to this day. I have also ruled out the lung, GI, and heart in everyway possible for the chest pain, all the way to an angiogram, bravo endoscopy. The chest pain is a mystery. I have been through two physical therapist for treatment on my neck, the only relief I found was by traction, while they pulled on my neck. This took away the pain. I have also done almost every pain management procedure, including facet injections, epidurals, trigger points, medial branch blocks, and RFA. The medial branch blocks brought me 24 hours of relief, and I was desperate to find some type of relief, so the nerve burning was done. I did not have any success with any of the pain management options.

I have found a new neurosurgeon, and he wants to see me based on recent images on my spine. I’m told they will not see me, unless they feel the problem can be revisited. It has taken me some time to get in with this surgeon, and I will see him in a month.

I did a SPECT scan, single machine with SimonMed. They only had one of these in my area. The surgeon asked for a PET scan, but it was denied. The SPECT scan found the intense activity in the bodies of C3 C4, this is my fusion site, this image is 2 years post opt, there was also physiological radiotracer excretion noted. They ordered three more images after the SPECT.

I had a MRI , that showed moderate left forminal narrowing at the C3 C4 level. The hardware appears to be fine. It’s very strange how radiologists read images. I feel SimonMed over reads their findings. I had these recent images done by the surgeons preferred outpatient image center. These show far less, and there were no comparisons done, as he has all my previous MRI’s and CT’s. Two of each prior to these latest ones.

They did a flexion extension x-ray. This showed a 3mm retrolisthesis on C4 C5 neutral and extension, which reduced on the flexion image, with no evidence of hardware failure.

They did a CT, with no findings at all, also with no comparison. My one year post operative CT shows the following.

Oct 2013 CT Impression
1. Disc replacement surgery C3 C4 appears satisfactory new.
2. Levoscoliosis is mild at C6; spondylosis is mild at C4-C5 C5-C6
3. C3-C4 forminal decompression, New.
4. No frank disc extrusion, central canal stenosis or foraminal throughout the study.

My questions are,

What could intense activity mean two years later at the fusion location? Along with physiological radiotracer excretion?

Does the recent moderate left forminal narrowing ,and the 3mm retrolisthesis constitute any issues regarding continued pain?

I have been dealing with this since August of 2012, and I’m hoping that it can be resolved. This surgeon told me that they would not see me, if they felt I had no need for surgery. I was also told by a very good neurologist, that the uptake needs to be handled. He actually told me that is the issue, and he is under the same umbrella as my upcoming surgeon.

I wish I knew what to expect, and I’m trying to see what they could possibly revisit prior to my visit with them. They won’t tell me anything.

Thank you so very much,

John

Donald Corenman, MD, DC
Moderator

January 25, 2015 at 12:54 am

Post count: 8660

#12058

Chest pain is common if the C4 nerve root is compressed. This nerve travels to the anterior chest wall and if compressed, can cause chest pain. In fact, one of the differential diagnoses of chest pain is C4 radiculopathy (called “cervical angina”).

The two most common problems that a bone scan (SPECT) would demonstrate are pseudoarthrosis (lack of fusion) or infection. You note that you have had at least one CT scan. This would demonstrate this lack of fusion but realize that some radiologists will not comment on this. It requires the eyes of a spine surgeon to determine this possibility.

There are also findings on CT and MRI that could indicate infection. Careful scrutiny will help to identify this disorder. Normally lab tests (CBC, ESR, CRP) can help to rule this in or out but some fungal infections (and TB-rare but not impossible) might also not show up in labs.

The “new” finding of C3-4 foraminal stenosis does not fit with a fully fused surgery. The only way new narrowing can occur is if there is motion of this level. I suspect that the C3-4 level is not fused with a secondary diagnosis of the C4-5 level as a pain generator if the C3-4 level is fused.

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.

JBoz
Participant

January 25, 2015 at 3:56 am

Post count: 51

#12064

Dr. Corenman, you have been so very helpful. I have heard about the cervical angina, but my recent visit with a neurologist indicated the chest pain wasn’t related to my neck, he did not review everything though. I will be going to Barrows for my consultation. I have provided the surgeon all the evidence of my chest pain being ruled out. I may take some time to post all 4 of my image results in the near future… word for word, as you may get a better picture of the issue.

I want to thank you for your response. I cannot tell you how valuable you and your thread have just proven to be.

John

Donald Corenman, MD, DC
Moderator

January 25, 2015 at 4:36 am

Post count: 8660

#12065

Please let us know how this encounter with the new spine surgeon goes.

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.

JBoz
Participant

January 28, 2015 at 12:23 am

Post count: 51

#12096

Dr. Corenman, I will let you know for certain.

What is worse to treat, the possible lack of fusion, or an infection?

It’s all very strange, because there was never a period of relief. I always thought the other issues should have been handled at the time of surgery, and after reading your facts about failed fusions, it could be a one of many things. You really have a neat website here. I wish I would have found it prior to surgery.

Thanks,
John

Donald Corenman, MD, DC
Moderator

January 28, 2015 at 3:55 am

Post count: 8660

#12098

An infection would be unlikely but worse to treat. Hopefully it is a pseudoarthrosis and easy to remedy.

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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