Six years post C4-C6 ACDF

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riclach
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July 11, 2024 at 2:25 pm

Post count: 21

#36260

Hello Dr. Corenman:

I had my ACDF C4-C6 fusion on July of 2018.
I still have problems.
I had 2 cervical epidurals for radicular pain at the beginning of the year and the relief lasted 6 months.
The nerve pain is back now with a vengeance with paresthesia.
It radiates from my right side down my right arm and right index and middle finger.
My latest MRI shows C6-7: Uncovertebral spurring and facet arthropathy causing moderate bilateral neural foraminal stenosis, so I believe it would correspond with the pain I am having.
I’m trying to get another epidural scheduled.

*** This was the MRI before the surgery in April of 2018 –

OSSEOUS STRUCTURES: Levoncovex cervical curve with a Cobb angle measuring less than 10 degrees. No spondylolisthesis. No bone marrow edema. The cervical spinal canal is congenitally narrow due to short pedicles

FACET JOINTS: Scattered mild and mild to moderate facet arthropathy

C2-C3: Normal disc. No spinal stenosis or neural compression

C3-C4 Normal disc. Mild narrowing of the central spinal canal with an AP sac diameter of 9.5 mm. Uncovertebral hypertrophy contributes to moderate to severe right and mild left neurforaminal narrowing

C4-C5 Small to moderate sized diffuse disc osteophyte complex contacts and moderately contours the ventral spinal cord and causes moderate narrowing of the central spinal canal with an AP sac diameter of 7.5 mm. Uncovertebral hypertrophy contributes to moderate to severe bilateral neural foramina narrowing.

C5-C6 Small diffuse disc osteophyte complex contacts and mildly to moderately contours the central spinal cord and causes moderate to severe central canal stenosis with an AP sac diameter of 7 mm. Unconvertebral hypertrophy contributes to severe right and moderate to severe left neuroforaminal narrowing

C6-C7 Normal disc. Mild narrowing of the central spinal canal with an AP sac diameter of 10.4 mm. Uncovertebral hypertrophy contributes to moderate to severe bilateral neural foramina narrowing

CORD/DURAL SAC: Normal

PARASPINOUS SOFT TISSUES: Normal

IMPRESSION:

1.Multilevel spondylotic changes of the cervical spine
2.Multilevel severe and moderate to severe neuroforaminal narrowing
3.Moderate to severe central canal stenosis at C5-C6

*** THIS IS THE REPORT FROM THE MRI I HAD IN NOVEMBER 2021 –

The cal sac measures 1.1 cm throughout the cervical spine, except for
at C3-C4 which measures 0.9 cm.
EXAM: MRI CERVICAL SPINE WITHOUT CONTRAST
INDICATION: Neck and shoulder pain.
COMPARISON: None.
TECHNIQUE: Multiplanar, multisequence imaging of the cervical spine
without contrast.

FINDINGS:

ALIGNMENT: Appropriate cervical lordosis without significant
spondylolisthesis.

VERTEBRAL COLUMN: Anterior cervical disk fusion spanning C4-C6. With
susceptibility artifact limits evaluation of the vertebral bodies and
intervertebral disks. No abnormal marrow signal of the C2-C3 vertebral
body. No abnormal bone marrow signal of the visualized T1-T3 vertebral
bodies. No abnormal STIR signal of the facet joints.

SPINAL CORD: No mass, signal abnormality or intradural lesions visualized.
DISC LEVELS:

C2-3: No spinal canal stenosis. No significant facet arthropathy. No
neural foraminal stenosis.

C3-4: Left central and right central disk extrusion, left greater than
right superimposed on congenital narrowing of the spinal canal resulting
in moderate-severe spinal canal stenosis. No abnormal cord signal.
Bilateral uncovertebral joint hypertrophy and facet arthropathy resulting
in moderate bilateral neuroforaminal stenosis, left greater than right.

C4-5: Postsurgical ACDF. No focal disk herniation. Congenital spinal canal
stenosis. Neural foramina are patent.

C5-6: Post surgical ACDF. No focal disk herniation. Congenital spinal
canal stenosis. Neural foramina are patent.

C6-7: No focal disk herniation. Mild congenital spinal canal stenosis.
Moderate left with mild right neural foraminal stenosis.

C7-T1: No focal disk herniation, spinal canal or neural foraminal
stenosis.

PARAVERTEBRAL SPACE: No mass or edema.
CRANIOVERTEBRAL JUNCTION: No significant cerebellar tonsillar ectopia.
Foramen magnum appears adequately patent.
POSTERIOR FOSSA: No mass in the visualized portions.

IMPRESSION:
1. Cervical fusion spanning C4-C6 with cervical spondylosis, superimposed
on congenital narrowing of the cervical spinal canal resulting in moderate
to severe spinal canal stenosis at C3-C4, as detailed above.
2. Moderate bilateral neural foraminal stenosis at C3-C4.

*** THIS IS THE REPORT FROM THE MRI I HAD IN DECEMBER OF 2023 –

EXAM: MR CERVICAL SPINE WITH AND WITHOUT CONTRAST
INDICATION: Neck pain
COMPARISON: MRI cervical spine 11/8/2021
TECHNIQUE: Multiplanar, multisequence imaging of the cervical spine before and after the intravenous administration of 12 mL of Dotarem.

FINDINGS:
ALIGNMENT: Straightening of usual cervical lordosis without significant spondylolisthesis.
VERTEBRAL COLUMN: C4-C6 anterior cervical diskectomy and fusion. Susceptibility artifact limits evaluation of marrow at these levels. No infiltrative marrow signal abnormality in the visualized vertebrae. Multilevel disk degeneration with loss of intervertebral disk height at C3-C4.
SPINAL CORD: No mass, signal abnormality or intradural lesions visualized.
DISK LEVELS: Thecal sac measures 1.1 cm in AP dimension at all levels except at C3-C4 level where it measures 0.9 cm, stable.

C2-3: No spinal canal stenosis. Neural foramina are patent. No significant facet arthropathy.

C3-4: Disk osteophyte complex causes stable moderate to severe spinal canal stenosis. Uncovertebral spurring and facet arthropathy with moderate to severe bilateral neural foraminal stenosis.

C4-5: Postsurgical level. No significant spinal canal or neural foraminal stenosis.

C5-6: Postsurgical level. No significant spinal canal or neural foraminal stenosis.

C6-7: No spinal canal stenosis. Uncovertebral spurring and facet arthropathy causing moderate bilateral neural foraminal stenosis

C7-T1: No spinal canal stenosis. Facet arthropathy with mild to moderate right neural foraminal stenosis..
PARAVERTEBRAL SPACE: No mass or edema.

CRANIOVERTEBRAL JUNCTION: No significant cerebellar tonsillar ectopia. Foramen magnum appears adequately patent.
POSTERIOR FOSSA: No mass in the visualized portions.
IMPRESSION:

1. C4-C6 ACDF.
2. Congenitally narrow spinal canal measuring 1.1 cm in AP dimension with superimposed degenerative changes most prominent at C3-C4 level where thecal sac AP dimension is 0.9 cm, stable.
3. Multilevel neural foraminal narrowing. Please see level by level details above.

****************************************************

I moved to Florida in September of 2019 and I have been very active working in my yard.
A lot of gardening and landscaping.
I do at home stretches and exercises and see a massage therapist.

Dr. Corenman, what do you think of my current condition?
Should I be alarmed that I now have moderate to severe spinal canal stenosis at C3-C4?

Do I need to consider more surgery?

Thank you so much!!!

Claudia
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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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