Posterior laminectomy with fusion

Viewing 2 posts - 1 through 2 (of 2 total)

Author

Posts
66N Hokie
Participant

February 25, 2020 at 7:31 am

Post count: 2

#32135

Dr. Corenman,

Thank you for your reply to my post to your former patient, debbyrp. As mentioned in my post, I am scheduled to have a posterior laminectomy with fusion to treat canal stenosis resulting from degenerative anterolisthesis at C7-T1. The doctor plans to fuse from C6 to T2. I also have spondylosis/arthrosis at other levels resulting in canal and neural foraminal narrowing. I have some neck stiffness, but very little pain. I first became aware of problems with my neck approximately 10 years ago when I developed muscle weakness in my right arm, primarily affecting the triceps muscle. I had an MRI done at that time and discussed treatment options with doctors in Charlotte, NC and Iceland where I am currently living. We decided not to have surgery as I did not have any pain and the neurological deficit was considered to be very minor (I only noticed the muscle weakness in the gym when I isolated my arms). The situation has been stable since then and I have continued to be very active skiing, biking, playing tennis and lifting weights. I decided to have another MRI late last year in connection with my annual physical to see if anything had changed. The results of that MRI are below.

Impression: 1. Interval progression of diffuse spondylosis and facet arthrosis with apparent degenerative anterolisthesis at C7-T1 resulting in severe canal stenosis and bilateral neural foraminal narrowing. Clinical correlation for myelopathic symptoms recommended. 2. Uncovertebral and facet arthrosis at other levels resulting in canal and neural foraminal narrowing as delineated above.

Interpretation: There has been interval progression of the anterolisthesis at the cervicothoracic junction. This previously measured approximately 1-2 mm and presently measures approximately 5 mm secondary to apparent hypertrophic facet arthrosis at C7-T1 with
subchondral cystic changes and reactive marrow signal. No fracture evident. Multilevel cervical spondylosis has progressed with uncovertebral arthrosis as well, and discogenic endplate changes are noted primarily at C5-6 and C6-7. The imaged spinal cord
and posterior fossa structures maintain normal signal morphology. Paravertebral soft tissues are unremarkable.

C2-3: No significant central canal or foraminal stenosis.

C3-4: Hypertrophic facet arthrosis on the right. Uncovertebral arthrosis noted as well, disc osteophyte complex combine to cause right greater than left neural foraminal narrowing. No significant canal stenosis.

C4-5: Hypertrophic facet arthrosis on the right. Mild right neural foraminal narrowing from spondylotic ridging and facet arthrosis. Reactive marrow signal seen adjacent to the right C4-5 facet joint.

C5-6: Moderate canal stenosis from broad-based disc bulge and spondylotic ridging with uncovertebral arthrosis resulting in right greater than left neural foraminal narrowing. Mild facet arthrosis primarily on the right.

C6-7: Mild/moderate canal stenosis from right paracentral disc bulge and spondylotic ridging. Mild facet arthrosis on the right. No focal HNP or MR evidence of myelomalacia.

C7-T1: Severe canal stenosis present with AP diameter spinal canal measures approximately 7 mm on sagittal T2-weighted image 9. Bilateral neural foraminal narrowing noted which appears to be due, in part, to the anterolisthesis. No definite MR evidence
of myelomalacia.

I would appreciate your thoughts about the appropriateness of the posterior laminectomy with fusion, along with any restrictions on activities after the surgery. Although the doctor doesn’t expect to fuse up to C5, he believes there is limited movement at this level. I am a very good skier and typically ski 15-20 days per season, mostly in Summit County (the direct flight from Iceland to Denver makes it surprisingly accessible!). I have a mountain bike and a road bike, but have mostly been riding on the road or dedicated paths in Iceland (not downhill mountain biking, which I wouldn’t expect to do after the surgery).

Thank you for hosting this forum and for any feedback you can provide on my particular case.

P.S. I can send you a couple of screenshots of my cervical spine, but don’t see where I can attach a file.

Donald Corenman, MD, DC
Moderator

March 2, 2020 at 2:39 pm

Post count: 8660

#32197

“C7-T1: Severe canal stenosis… Bilateral neural foraminal narrowing”. This level needs to be addressed.
“C6-7: Mild/moderate canal stenosis from right paracentral disc bulge and spondylotic ridging”. “C5-6: Moderate canal stenosis from broad-based disc bulge and spondylotic ridging with uncovertebral arthrosis resulting in right greater than left neural foraminal narrowing”. This level associated with “discogenic endplate changes are noted primarily at C5-6 and C6-7” makes me worry about severe degenerative disc changes and localized neck pain at both levels.

You then have to worry about C4-5 (“C4-5: Hypertrophic facet arthrosis on the right. Mild right neural foraminal narrowing from spondylotic ridging and facet arthrosis. Reactive marrow signal seen adjacent to the right C4-5 facet joint” and even C3-4 is not great (“C3-4: Hypertrophic facet arthrosis on the right. Uncovertebral arthrosis noted as well, disc osteophyte complex combine to cause right greater than left neural foraminal narrowing”).

It really depends upon your symptoms but if the stenosis is not too bad at C5-7 and your symptoms don’t focus on neck pain, you might be better off with an ACDF at C7-T1 and leave everything else alone for now.

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.
Author

Posts

Viewing 2 posts - 1 through 2 (of 2 total)

You must be logged in to reply to this topic.

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel