Return of neck/sholder pain and new symtoms

Tagged: ACDF and return of symptoms

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RSSMITH
Participant

June 21, 2017 at 8:05 am

Post count: 23

#25257

October 2016 I had a C-3-C-5 disectomy with C-4 corpectomy with expandable cage and plating. Pain and weakness bilaterally in neck, upper traps and deltoids. Doing well after surgery, while in PT blew out c6/7 disc and had posterior foraminotomy March 2017. Now I have had return of pre October surgery symptoms along with muscle twitching in traps and SCM and diffuse swelling over both clavicles. CT/Myelogram performed May 30, Doctor said “all good”, report states at least moderate right side formainal stenosis C4 and C-5 due to hypertrophy and end plate spurring. 3 of the 4 plate screws are well seated, Left C-3 screw tip enters the ventral cortex. Top of plate not flush. No screw retraction noted. I asked Dr. about fusion he said on XRAY it looks like fusion has occurred (did not do flex/ext Xrays). No mention of fusion on CT/Myelogram. They are saying my problems are muscle related and referring to PT for dry needling. Could this all be muscle related or possibly something else? Thanks

Donald Corenman, MD, DC
Moderator

June 22, 2017 at 4:54 am

Post count: 8660

#25263

I have some concern about your fusion status. First, the CT scan is the gold standard for fusion so why your surgeon commented on your fusion status by observing an X-ray not even having flexion and extension views and did not comment on fusion status using your CT myelogram is unusual. There will be a radiological report read by a radiologist that you have a legal right to read and you might find some information there.

You might have symptoms from a lack of fusion (pseudoarthrosis) at C3-5, continued compression of a nerve root, new degenerative changes (C5-6) causing root compression or facet disease. Ask to have your surgeon go image by image over your CT myelogram with you so you can understand what is going on.

I worry about corcectomies with expandable cages as the fusion rate of these devices can be problematic.

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.

RSSMITH
Participant

June 22, 2017 at 7:23 am

Post count: 23

#25266

Thank you so much for your quick response. Meeting with the surgeon will be problematic as he moved to a practice across state 30 days ago with no notice to patients. We are given option to see another neurosurgeon in practice but they are booked out 6-8 weeks. I do have the CT/Myelo report:

Stable straightened cervical alignment status post C-4 corpectomy with C3-C-5 anterior cervical fusion with expandable interbody cage in place. C5 screws are well seated. Tip of left C3 screw extends to ventral cortex. No screw tract loosening identified.

C2-C3 no disc herniation or significant spinal stenosis.

C-3-C4 Status post C4 corpectomy with resection previous left parasagittal osteophyte and resolution of previous mass effect upon the left cord. Progressive interval enlargement of right unicate spur producing at least moderate right foraminal stenosis which has increased since prior. Correlate for potential right C4 radiculopathy.

C4-C5 Progressive right formainal stenosis from enlarging right unicate spur with marginal disc bulge effacing the proximal right foramen and exiting C5 nerve root. Moderate right bony stenosis.

C5-C6 No disc herniation or significat central stenosis. Mild right foraminal narrowing from unicate spur.

C6-C7 Interval left formainotomy with resection previous left formainal disc herniation. No recurrent disc herniation or central stenosis. Unicate spurring without significant foraminal stenosis

C7-T1 no disc herniation or spinal stenonis

Impression:
Stable ACCF C3-C5
Interval left foraminotomy at C6-C7
No new disc herniation
Multilevel bony foraminal stenosis

No mention of fusion status. I also do not understand how I can have moderate formainal stenosis with disc herniation at C-4 and C-5 when that was suppossedly removed during the diseectomy/corpectomy. As stated my NS said this CT/Myelo was “all good”. I dont know if I am comfortable seeing another NS in this practice. We have one orthopedic spine surgeon in town and a University Medical Center about an hour away. I am thinking I need to get a second set of eyes on this scan and reports, do you agree?

Thanks again for your tremendous help!

Donald Corenman, MD, DC
Moderator

June 24, 2017 at 6:31 am

Post count: 8660

#25281

This surgeon’s move to another location far away from his old practice without notice is a major red flag as to the quality of his care. You definitely need a second opinion to shed light on your current symptoms. It is alway difficult to recommend who to see. It depends upon the age, experience, meticulousness and thoughtfulness of the new physician. This is why I generally don’t make referral recommendations here.

You will note the radiologist does not comment on the fusion “Stable ACCF C3-C5”. This just states it appears as before but does not comment on fusion status. The CT/myelogram is what you need reviewed.

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.

RSSMITH
Participant

June 24, 2017 at 11:47 am

Post count: 23

#25285

Thank you so much for your assistance, it has helped confirm that “nagging” feeling that I need to get a second opinion, but was reluctant because I always want to trust my surgeon but I just did not feel good about what I was being told with my symptoms. I really appreciate your assistance!

Donald Corenman, MD, DC
Moderator

June 25, 2017 at 9:59 am

Post count: 8660

#25293

Please keep in touch to let the forum know how you 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.
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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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