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  • drdave35
    Post count: 5

    Dear Dr. Corenman,

    I had a two-level ACDF with titanium plating and donor graft bone at C5-6, C6-7 at the end of June, 2012.

    My MRI read as “severe” neuroforaminal encroachment, myelopathy, spinal cord displacement due to osteophytes and disk herniation.

    I just had my seven week post-op follow-up, and my surgeon told me that “You have reached surgical maximum improvement”.

    He is a great surgeon, but it’s been such a short time since surgery, and I still cannot lay flat on a bed or sleep with a pillow, I have to try to sleep in a recliner. I’m having continued numbness in both arms, daily deep neck pain, very bad neck-based headaches, you name it.

    I’m 50, so I didn’t expect to heal in a day, but is it normal to have these conditions at this stage post-operatively?

    Why does my surgeon insist that he does not need a post-operative x-ray (he took one during surgery, but has rejected the idea of any films now to see if I’m fusing) because he states “the titanium plate “Is your fusion”.

    I’m scared, in pain, and don’t know what to do. Please help.

    My surgeon discharged me from his care today and from what I’ve read, this is way too early, and not performing follow-up x-rays is unusual.

    Thank you so much.

    Donald Corenman, MD, DC
    Post count: 8455

    I am truly mystified why you have been released from care after seven weeks post ACDF with allograft (donor bone).

    First, your diagnosis of myelopathy means that you have spinal cord dysfunction. That, in itself will require a longer rehabilitation through physical therapy which could be months.

    The second reason to continue under care is that allograft (donor bone) takes between three months to nine months to incorporate. Your surgeon needs to make sure that you do not develop a non-union (pseudoarthrosis).

    The titanium plate is not “your fusion” but stabilizes the grafts so that they have a better chance of fusion. There still is a 10% chance of non-union, even with the plate.

    I think you need to have a talk with your surgeon to see why he has taken this course of action.

    Dr. Corenman

    Post count: 5

    Thank you, doctor, for confirming my concerns. It is reassuring to know that I have not been “self-diagnosing” the need for x-ray, continued follow-up with my surgeon, and P/T.

    I did ask him specifically about these issues, and he looked me straight in the eye and told me I did not need them, and the pain and problems I am having are “usual post-operative sensations”.

    Coming from a physician’s family, I am concerned that a renowned surgeon would be so casual in his approach…but he is world-famous and extremely well respected in his field, and I have professionally sent patients his way for 15 years.

    I guess this is just a matter of finding another physician to follow-up my care with. Again, I am scared and confused, as there was/is no “bad blood” or any other issue underlying this discharge from care.

    My surgeon simply seems to feel his outcomes are superior and that the plate is the answer to all my woes.

    I will attempt to locate another spine specialist in this area who will follow me, or perhaps ask my internal medicine specialist if he could order the P/T and x-rays, etc. Do you agree with this approach?
    (I understand this is for educational purposes, only)

    Thank you again for your reassurance that I need continued care.

    P.S. – I have already undergone trigger point injections (marcaine only) for the severe neck and shoulder muscle spasms I have been experiencing since surgery.

    I have been diagnosed as vitamin “D” deficient/insufficient, so I began taking D3 5,000 IU prior to surgery, and spend time in the sun, and take calcium in order to maximize the fusion potential.

    I am still shocked that my surgeon, knowing all this, discharged me…I feel “abandoned”.

    On the plus side, he did a great job with the closure, so at least the external scar will be minimized!

    God Bless.

    Post count: 5

    P.P.S. – I am not a physician, my nick-name came about years ago when I was an anatomy/physiology tutor in college. Just so you know!

    Donald Corenman, MD, DC
    Post count: 8455

    In my opinion, hubris should not have a place in medicine.

    I can tell you my protocol if that might help you. A collar stays on for about 5-7 days simply to protect the incision and telegraph to others that the patient need special attention. Patients can perform isometric exercise in the collar (see video of “around the world”).

    After the collar is off, patients can start to perform “yes and no” (see video). They can drive after passing the “driving test after neck surgery” (see website).

    I start patients on therapy after six weeks and that continues for six to twelve weeks depending upon strength, pain, function and range of motion.

    X-rays are generally taken at six weeks, twelve weeks and six months.

    Hope this helps.

    Dr. Corenman

    Post count: 5

    Thank you, Dr. Corenman, again.

    Your reassurance has made a big difference in the way I have mentally approached this whole issue.

    I am a grown man, not prone to being either scared or confused, respectively, however, when someone has removed key components of my spine, placed a plate, six screws, multiple layers of sutures, etc.. in my neck…well, it is disconcerting to say the least.

    The promises that were made regarding pain relief and recovery of function have not yet materialized with the exception of relief of the mid-back (between the shoulder blades) along with a return of some of the strength in my right arm.

    Of course, I have constant headaches, numb upper extremities (down neural pathways to my hands and fingers), and I was told at my “last” follow-up on Friday that “You waited too long to have the surgery”.

    Basically, now I feel it’s a matter of having had the ACDF in order to save myself from future deterioration of function, rather than attempting to bring back what has already been lost.

    The scary part is that now, on top of all my prior symptoms, I do have neck pain from the surgery, that “lump in the throat” I heard so much about, along with an inability to hold my head upright for more than about 10 minutes without getting deep stabbing pain in the lower part of my posterior neck (presumably where a disk was removed).

    I believe I will follow-up with a neurologist and perhaps an orthopedist, as well, given the fact my symptoms were not relieved to the extent I thought they would be.

    Again, it was technically an excellent surgery based on what I saw on the one x-ray which was taken in the operating room (demonstrating the alignment of the screws and plate), but all the same, I feel as if I’ve been “turfed” in order to preserve this physician’s “track record of excellence”. In other words, my recover does not fit his notion of he feels I should be progressing, so get me out of his practice before I make his “numbers look bad”.

    I was never placed in a collar post-operatively except for “comfort”, and was discouraged from using it after week 1. I have been doing the exercises recommended, but I seem to hit a hard painful limit, especially on the left, which shoots pain up into the side of my head and across my left temple.

    Any time I try to look upward, there is a stabbing pain in my posterior lower neck, and muscle spasms thereafter. Same for if my head is tilted more than a few degrees left or right, or if I sleep on anything but the recliner. Any pillow under my head makes me feel as if pressure is being applied to the middle of my neck, and I get deep throbbing pain in my neck, and a bilateral deep “nerve-like” headache.

    I realize you are not treating me, and I am sorry for rambling on, but you are the first and only spine specialist with whom I have been able to “talk”, rather than to listen.

    My surgeon even went so far as to tell me at my first post-op visit, when I told him my left and right arms continued to be numb, that “you should not tell me about your left side. Let’s concentrate on the right, because that’s where the surgery was”.

    Dumbfounded is not an expression I frequently use, however…that, I am.

    Thank you so very much for your website, videos and reassurance. If you would like, I will keep you posted as to my progress once I become established with a different surgeon or neurologist.


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