Status post ACDF C-5-C7 1 year

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justkat12
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September 20, 2013 at 4:03 am

Post count: 10

#9421

Just have a question about a fracture of an interbody fusion plug. I am status post ACDF of c5-c7 on September 4,2012.

I have continued to have pain in the back of my neck and radiculopathy of the right arm and also have pain in the right scapular region. I had an Emg nerve conduction test which showed some nerve root damage at c7. Both CT scans, one done in March 2013 and one done Sept 11, 2013 show a lucency at c6-c7 which both radiologist describe as a fracture of the interbody fusion plug. I used cadaver bone for my procedure. I am still in significant pain on a daily basis. I am a nurse and find it difficult to make it through a 12 hour shift without the wish to “take my head off and put it on the desk next to me” to relieve the pressure and pain. I could live with the pain and tingling in my arm, I surmise I shall never be completely pain free, but at the age of 44, I don’t want to live the rest of my life with this neck pain. The c5-c6 level has fused with no difficulty. What would be the normal recommendation to fix this problem for someone who has pain that affects my ADL’s daily, not to mention the lack of sleep?

If I did not provide enough information, please let me know. Just struggling to find another opinion as the neurosurgeons in my area (Orlando, FL) seem to be having a problem with scheduling an appointment for someone who has already undergone surgery elsewhere. As a healthcare provider myself, I am just desperate for answers to a solution for my ongoing pain.

On another note, as far as medication goes….these are what I have tried and currently take: For sleep at night, I take 5mg of Ambien, 5 mg of flexeril, and 1 hydrocodone (5/325). This allows me between 4 and 6 hours of sleep before I wake up again with neck pain. During the day and on nights that I work I take mostly advil or tylenol with the occasional Ultram if I really need it. These somewhat keep the neck pain in check, but does nothing for the nerve pain. I am a 5’4″ female that weighs 123 and have also tried Lyrica and neurontin for the nerve pain, but already having low blood pressure, both of these meds make me dizzy and blur my vision.

Otherwise, I am a perfectly healthy lady. NO other health conditions whatsoever. This injury was the result of a low impact collision (not my fault) that resulted in herniated and ruptured disc at the levels fused. Otherwise my spine is also normal per the radiologist reports.

Thanking you in advance for any advice you can offer.

Kimberly P.

justkat12
Participant

September 22, 2013 at 10:46 pm

Post count: 10

#9431

I did forget to mention that my flexion and extension x-rays according to my Orthopedic do not show movement? He didn’t take any measurements of any kind that I could see? Would the fracture that is showing up in the CT exams of the interbody fusion plug impede a solid fusion? What are the chances that this is the causative agent that is responsible for my neck pain?

Donald Corenman, MD, DC
Moderator

September 22, 2013 at 11:20 pm

Post count: 8660

#9434

Fracture of the interbody fusion device generally but not always signal a pseudoarthrosis (lack of fusion). Was this device made of bone or of PEEK (a plastic spacer)?

The fact that there is no motion on flexion and extension X-rays does not necessarily mean that this level has gone on to fuse. There might be some tail tale signs on the motion X-rays that were missed but these signs might not have been present.

With continued neck pain one year after a neck fusion especially with a fractured interbody device, in my opinion a CT scan is called for. I generally like the 64 slice scanners and prefer the 128 slice scanners as the images are much more defined and diagnostic. An MRI might also be needed as these two tests are complimentary.

The continued arm pain could be from a new spur that formed from the pseudoarthrosis or from an incomplete decompression. These symptoms could also be from chronic radiculopathy (the nerve is decompressed but did not heal-see “Nerve injuries and recovery” and the sections under nerve healing and chronic radiculopathy).

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.

justkat12
Participant

September 22, 2013 at 11:46 pm

Post count: 10

#9435

What else on the CT scan should I look for? I have had 2 CT scans, one in March 2013 and one last week. Both show the interbody fusion plug fracture. My orthopedic said that the c5-c6 level fused, but that the c6-c7 most likely had not.
What would cause the cadaver bone to fracture? could it possible have been a “bad” piece of bone to begin with? My orthopedic said he has never seen this before???
Would this be a reason to go back in and have a posterior revision?
What is your position on bone growth stimulators?? The current recommendation from my orthopedic is to go back into my hard collar for another 8 weeks and wear the bone growth stimulator 24/7. I am already a year + post op. My thought is that if the fracture has not healed in the amount of time (6 months) from one CT to the other, this is simply going to prolong the inevitable.
Is there any risk to the stability of my neck if I don’t go back and have a posterior revision. I am scared to death of another neck surgery. I hear that the recovery from the posterior approach is harder than the anterior approach. I must admit, I don’t handle the pain very well :(

justkat12
Participant

September 22, 2013 at 11:47 pm

Post count: 10

#9436

It was a PEEK…..

justkat12
Participant

September 22, 2013 at 11:51 pm

Post count: 10

#9438

If you do 2nd opinions from across the USA, I would be more than happy to send you all of my films. I have had an MRI post fusion, but I believe that was back in October, or 1 month post op, because I was still complaining of significant R arm radiculopathy and neck pain. I have also had an EMG study done. I have copies of all test done and the discs as well from the MRI’s and CT exams. I could also provide you with a copy of my OP report.
Thank you so much for all your help thus far. I have to agree with the other posters on this forum. You are a godsend for giving of your time to answer all of these questions!!! You are appreciated!! :)
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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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