Risks of ACDF?

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Jellyhall
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May 29, 2012 at 12:02 am

Post count: 90

#6272

I recently saw my neurosurgeon to discuss a 2 level ACDF on C3/4 and C4/5.

When explaining the risks of this surgery, there was something that he mentioned that I haven’t heard of before. He told me that after a spinal cord has been compressed for a while, sometimes after the compression is removed, the cord can’t cope with the extra flow of blood and paralysis or extreme weakness can happen.

Could you please explain this to me and also, is it likely to be a temporary thing, or could it be permanent?

Is a problem with swallowing more likely at these higher levels than lower down in the neck?

What are the other risks that you tell your patients about?
Do you give them what the chance of each problem is?

Donald Corenman, MD, DC
Moderator

May 29, 2012 at 12:44 am

Post count: 8660

#6274

Please see the risks section of the website to understand more about the general risks of ACDF.

As far as cord injury after decompression from vascular injury, this would be highly unusual. First, there has to be significant cord compression and not just nerve root compression. Then, the decompression of the cord has to be performed precisely. Injury could occur from aberrant placement of a small tool while decompressing the cord (very rare). This would not be a vascular injury but a mechanical one.

After this decompression, there is some revascularization of the cord. This can change the blood flow pattern in the cord as the cord has adapted to the previous compression. It is theoretical that this revascularization phenomenon could cause cord dysfunction and injury.

Dysphagia (difficulty swallowing) after ACDF is not uncommon but typically disappears after 2-6 weeks.

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.

Jellyhall
Participant

May 29, 2012 at 2:10 am

Post count: 90

#6275

Thank you for your reply Dr Corenman,
I have looked at the risks section of your website in the past. I will take another closer look.
I believe that I do have significant cord compression in my neck, in addition to nerve root compression. I have numerous symptoms in my neck and shoulders, but also in my arms, wrists and hands. I also have symptoms in my legs and feet and get daily involuntary stiffening spasms which cause both my legs and feet to stiffen and sometimes the muscles around my abdomen also stiffen causing my back to arch up off the bed.
I am being tested for MS and some other neurological conditions to make sure that all my symptoms are coming from my cord compression. I have had a brain MRI scan and various blood tests. I am waiting to hear from the neurologist to see if he wants to do more testing, or if he has reached his diagnosis.
I have no spinal cord fluid on either side of my cord and my cord is being indented. However, there is no visible high signal on my MRI scan. I have been ‘watched’ for the last 18 months, but now surgery is being suggested by a second opinion neurosurgeon. The first neurosurgeon referred me to a neurologist to rule out MS.
I believe that once we are sure what is causing my numerous symptoms, we will schedule surgery. I hope that we have not increased the chance of post surgical complications by waiting for so long. I do not want to be in a worse position after surgery than I am now.

Donald Corenman, MD, DC
Moderator

May 29, 2012 at 8:28 am

Post count: 8660

#6277

I am glad that your surgeon is looking into more than myelopathy. Symptoms of MS can mimic myelopathy including the physical examination signs. Do you have signs like Hoffman’s sign, hyperreflexia, Lhermitte’s sign, as well as Rhomberg’s sign (imbalance) and weird pins and needles sensations? I would assume that you know what those signs are as you seem well informed but I can explain them if you need.

Surgery for cord compression without signal changes within the substance of the cord is generally better news than if those signals were present. I assume you are also getting an MRI of the brain to rule out MS.

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.

Jellyhall
Participant

May 30, 2012 at 2:03 am

Post count: 90

#6281

Yes the brain MRI scan was to check for MS. I don’t have the results of that yet. I have had several MRI scans of my spine at all levels, including my thoracic that showed 2 herniated discs, one slightly indenting the cord. I have already had a fusion of my L4/5 for isthmic spondylolisthesis. No-one mentioned any lesions on these scans, only osteophytes, hypertrophic facets and disc problems. My neck from C3 to C7 is very degenerated with disc herniations and osteodiscal ridges, but it is C3/4 and C4/5 that are concerning them, as there is significant cord compression.
I do have hyperreflexia in my arms and legs but no Hoffman’s. I have unequivocal Babinski as there is no movement of my toes apart from a very slight flaring of my 2nd to 5th toes. I don’t have Lhermitte’s sign although I do get occasional shooting electric shocks out of the blue. I had no Rhomberg’s sign although I do sometimes feel off balance, especially if I turn. I do get frequent pins and needles, stabbing and burning in my arms and legs especially my hands and wrists and my feet and ankles. I don’t appear to have Clonus. I get twitching, fluttering and cramping, particularly in my legs and feet, but also have twitching in my right arm. I get a feeling of a mobile phone on vibrate in my right leg which is also starting to appear in my left arm, and a frequent feeling of having cold water splashed on my arms, legs and abdomen.
The symptoms that bother me the most are the frequent headaches and these stiffening spasms in both legs and sometimes around my abdomen as I wake in the morning or when getting up after sitting for a long time. My right foot turns inwards strongly with my big toe sticking up when I have these spasms. Then the first steps of walking are very stiff, but I loosen up as I get moving.

I am very interested to hear what you think of all this.

Donald Corenman, MD, DC
Moderator

May 30, 2012 at 4:12 am

Post count: 8660

#6282

Your symptoms could be from a demyelinating disorder or from myelopathy. Most individuals with your intensity of symptoms and stenosis have cord signal changes but not all. If the brain MRI is normal, then more likely than not, these symptoms would be from the cord compression. Nonetheless, there are other neurological disorders that can cause these symptoms. A thorough neurologist can help to differentiate this.

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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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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