[justkat12]

#9441

Depuy hardware (28mm plate) as well as interbody cages with Trinity and DBX bone graft. This is how the OP report reads….

[Donald Corenman, MD, DC]

#9442

You had a fusion with Peek cages and cadaver bone graft (DBX). The fusion rate for this construct is about 85% for a two level fusion. This means that you were in the 15% who did not fuse. I don’t understand why your surgeon has not seen this before as pseudoarthrosis occurs even in the best of hands.

The fracture of the peek cage is a direct indication of lack of fusion. You have had a CT scan which did indicate a pseudoarthrosis. Did the CT indicate the status of the foramen that the C6 or especially the C7 nerve exited?

I don’t think a collar at this time is useful for a patient in your situation. It will not hurt to use a bone growth stimulator. I don’t think too highly of these devices but occasionally they will work.

You might be better off with a revision of your anterior surgery than a posterior fusion. It really depends upon the appearance of the current

I do review images. There is no change at this time but it does take some time for me to review the images. I expect I will eventually have to charge if these requests become too numerous.

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]

#9443

These are the findings verbatim from my 2 CT reports:
3/14/2013
There has been an anterior discectomy and fusion at C5-C6 and C6-C7. The fusion appears solid and complete at the C5-C6 level. There are posterior osteophytes that project off the posterior vertebral body at C5-C6 to project into the epidural space but no encroachment into or involvement of the exit foramen seen.
The C6-C7 interbody fusion plug appears fractured horizontally across its midportion. Clinical significance is uncertain. The cranial and caudal components of that interbody fusion plug are solidly fused to the respective endplates. Posterior osteophytes do minimally project into the epidural tissues. This is best appreciated on the sagittal images. Exit foramen are normal. Spinal canal dimensions and the craniovertebral junction appears normal.
Anterior bone plate from C5 down to C7 is seen. No evidence of fracture of that bone plate. Screws are intact.
Conclusion: Postsurgical changes to C5-C6 and C6-C7. There appears to be a lineal irregular fracture line through the interbody plug but no displacement. Cervical spine otherwise appears generally satisfactory for this postsurgical status.

9/11/2013:
Comparison: with 3/14/2103 CT scan
The CT examiniation demonstrates the patient to be status post anterior cervical plate with screw fixation at the C5 through the C7 levels. Interbody disc spacers are seen at the C5-6 and C6-7 levels. There is a lucency within the midportion of the C6-7 spacer (series 6 image 35). This may represent a fracture and was present on the prior study and appears stable.
There is loss of the normal cervical lordosis which may be secondary to positioning. The vertebral heights and rest of the intervertebral disc spaces are maintained. The atlanto-dens interval is maintained. The osseous structures are intact without fracture.
At C5/6 level, the patient is status post fusion. There is mild osseous ridging. There is no neural foraminal narrowing.
At C6/7 level, the patient is status post fusion. There is mild osseous ridging. There is no neural foraminal narrowing.
Impression: Patient status post ACDF at C5-C7 with interbody disc spaces in place. Stable exam

I would be happy to send you the disc associated with these reports if it would be easier for you to appreciate the fracture. All my Dr. said was that he didn’t think there was a solid fusion at C6-C7 and that it appeared to be a fracture of the bone that was used for the fusion. He told me in so many words that if it wasn’t fused he would have to “bolt me down from the back” in order to achieve stability so that the area could fuse??? That this failure to fuse could very well be the source of my neck/arm pain. Let me know if you want me to send the images and where I should send them to. I sooo appreciate your response to my questions and would be happy to see if my insurance would pay for a second opinion from your office. I think that the “Beech Street” insurance that was listed under your covered plans might be who my plan, issued through the hospital I work for uses for “out of network”. I can check. Again, your professional courtesies are so appreciated!!!

[Donald Corenman, MD, DC]

#9448

This radiologist did not commit regarding the lack of fusion. He stated the “interbody fusion plug appears fractured horizontally across its midportion” and then “the cranial and caudal components of that interbody fusion plug are solidly fused to the respective endplates”. He does not state that there is a solid fusion or bone that grows from endplate to endplate.

He does state that he sees no evidence of foramina stenosis at either operated level. Since this is a CT scan however, only bone can seen so there can be no final determination that the foramen are patent (free and clear of obstruction). An MRI would be helpful to determine that.

At this time, I do review films without charge but that might change in the near future as I have more reviews than I can conscientiously answer in a short period of time.

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]

#9457

Thanks so much for your response. I will gather all of my films and make a disc to ship to your office. I guess the biggest question is, fused or not? I am gathering all of my results to burn to a disc and will send to you. Thanks again for all you have done!!

[Donald Corenman, MD, DC]

#9464

Very good.

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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