[Donald Corenman, MD, DC]

#21995

Neurosurgeons generally have been trained on CT-myelograms so I understand why he wants this test. If this is what he needs, then you should accommodate him.

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.

[Rozy56]

#22001

What are the pros/cons of a 2 level ACDF vs 2 level artificial disc?

[Donald Corenman, MD, DC]

#22009

There are some interesting similarities and some obvious differences between an ADR (artificial disc replacement) vs. an ACDF (anterior cervical decompression and fusion.

First, the ADR can only be used in certain situations. Contraindications include collapse of the disc height (there must be at least 50% of the disc remaining) so conditions like IDR (isolated disc resorption) would not be conducive for an ADR. Another contraindication is a degenerative spondylolisthesis. This means a slip forward of the vertebra above on the one below. The only way this slip can happen is with damaged facets and normal facets are needed to allow safe implantation of the ADR. The last contraindication is with bony stenosis causing myelopathy. In my book, with cord damage already apparent, you want to fuse this level as an ADR allows motion and motion is what injured the cord in the first place (along with compression).

When ADRs were developed, these devices were thought to prevent or limit adjacent segment disease (ASD) or the breaking down of levels above and below. Unfortunately, this is not the case. I believe that the genetics of the individual is the main factor in ASD.

Additionally, ADRs will eventually “wear out” just like hip and knee replacements. This means that the implanted ADR will need to be replaced with a fusion (ACDF) eventually. This might be 12-20 years.

Now, the ADR does allow movement so preserved motion is a benefit. The most obvious place an ADR would be indicated is in a relatively normal disc that suffers a disc hernation. This disc has not had enough time to degenerate to make an ADR unfeasible. The motion is preserved and the herniation is removed with an ADR.

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.

[Rozy56]

#22021

Thank you for that explanation with my facet disease, osteophites and collapsed discs, it is clearly contraindicated it is scary that one spinal surgeon wanted to do two consecutive artificial discs. I followed my instinct that they were of questionable ethics. I am scheduled for a 2 level ACDF.my neurological symptoms are slowly worsening. I am still functioning nut I am seeing the progressive slow decline. The surgeon came highly recconendrd by 2 doctors. He is a board certified spinal surgeon who is also fellowship trained in neurosurgery(Cleaveland Clinic and Biometric Orthipedics from a top rated NY orthopedic

hospital.

[Donald Corenman, MD, DC]

#22023

Please keep us informed of your progress.

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.

[Rozy56]

#22088

My 2 level ACDF was done on Wednesday. After I went home, my neck started to swell. By Friday, it had become enormous. I emailed my surgeon a picture of my neck and he told me to come to the ER. When he saw the neck swelling, he was afraid that it would compromise my airway. He had called ahead to the hospita and I was fast tracked. While waiting for the spine surgeon to arrive,an ENT had scoped me and did a swallow study which were normal. Both the spine doctot and ENT drained and cleaned out the neck. The eusophagus was examined by the ENT and looked fine. The doctors think that I developed an enormous hematoma which had just started to become infected. When I got to the ER, I was running a temperature and my neck was warm and red. Infectious disease has me on UV antibiotics while the culture is growing out. So far, After 2 1/2 days, the culture continues to be negative. The despite negative findings for the eusophagus, the ENT has me NPO and receiving bonus feeds as a precaution. I am frustrated as the tube is very uncomfortable and there is no evidence that the eusophagus had ever been compromised. The spine surgeon came by yesterday. He said that there were so many massive spurs that it looked like a mountain range. In all of his years of doing this kind of surgery, mine was one of the worse he has seen. He said that it usually takes a few minutes to smooth out the surface where the plate will go. It took an hour to smooth mine out. The bone were so thick that he had to drill some of the areas. I will be in the hospital through Tuesday Wednesday.

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