Surgery or Wait

Tagged: necksurgery cervical stenosis surgery or wait

Viewing 4 posts - 1 through 4 (of 4 total)

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kbrisbois
Participant

October 5, 2016 at 4:04 pm

Post count: 2

#23143

Hi! I’m a healthy 41 yo female w 4+ year history of neck/arm/hand pain progressively worsening. Arm and hand tingling/numbness as well as foot tingling/numbness. Neck pain is mild and constant, but flares with activity. Arm and hand pain flares with activity. Extremity tingling/numbness occurs daily even with getting out of bed, walking, using elliptical or stretching. Used to be very active – cross fit, kickboxing, HIIT, cardio, strength training, hiking, etc. Now days I can’t do more than one work out per week without pain flare up that sometimes lasts for days. Arm/hand and leg weakness after certain physical activities or after long day at office.

Saw a 2nd neurosurgeon recently after seeing one a year before who recommended PT, traction, massage, acupuncture, which I did and use a home traction device as needed. This neurosurgeon said assuming my symptoms are showing early signs of myelopathy he proposed posterior laminectomy at C4-5 and partial at C5-6 pending referral to neurologist for differential for MS and to concur. Saw neurologist who opted to order better contrast cervical MRI instead and ruled out MS and ordered me to go back to neurosurgeon (scheduled for mid Oct). New MRI shows:

C2-3: Min posterior disc osteophyte complex. No significant spinal canal or neural foraminal narrowing.
C3-4: Mild posterior disc osteophyte complex. Mild bilateral neural foraminal narrowing.
C4-5: Focal central disc protrusion indents anterior cervical cord. Moderate spinal canal narrowing. Moderate right and mild left neural foraminal narrowing.
C5-6: Moderate posterior disc osteophyte complex effaces the ventral thecal sac and displaces the cervical cord. Moderate to severe spinal canal narrowing. Moderate bilateral neural foraminal narrowing.
C6-7: Moderate posterior disc osteophyte complex effaces the ventral thecal sac and displaces the cervical cord. Moderate spinal canal narrowing. Moderate bilateral neural foraminal narrowing.
C7-T1: Normal for age.

*Radiologist verbally informed me that C4-5 spinal canal is 7(mm). He did not tell me what C5-6 was.

Lumbar MRI discovered moderate disc bulge that may be responsible for my leg/foot issues.

This recent neurosurgeon told me if my symptoms are truly coming from my neck, he does not think I should wait a year for surgery. I always thought surgery was reserved for those in extreme pain or with significant cord compression or full fledged myelopathy symptoms. Is there any indication for surgery at this stage in your opinion? I have casually spoken to another neurosurgeon (friend of family) who said he didn’t think there was any rush.

Donald Corenman, MD, DC
Moderator

October 8, 2016 at 9:15 pm

Post count: 8660

#23158

Neck pain can be generated by facets, discs and nerve compression. Arm pain generally is caused by nerve root compression (with many other less common but possible disorders). Imbalance and incoordination can be caused by cord compression (among other disorders).”Extremity tingling/numbness” can be caused by cord compression as well as nerve root compression. You have all of these symptoms and I would call them impairing as you have stopped all your sports except for maybe one time a week and you “pay for it” after this activity. I would say you could be a surgical candidate if the disorder(s) is correctly diagnosed.

You do have CNS (crappy neck syndrome) as you have multiple levels of degeneration. If your central canal measures 7mm at C4-5, you could have symptoms of myelopathy from this level. See the section on cervical myelopathy on the website. The other levels are also narrowed (“C5-6: Moderate posterior disc osteophyte complex effaces the ventral thecal sac and displaces the cervical cord. Moderate to severe spinal canal narrowing”) and (“C6-7: Moderate posterior disc osteophyte complex effaces the ventral thecal sac and displaces the cervical cord. Moderate spinal canal narrowing”).

Is there a rush to surgery. Probably not. The question is how progressive the symptoms are, how severe the symptoms are now and what activities you participate in that could put your cord in jeopardy? You have significant narrowing of the canal. If you had a fall onto your face causing the neck to “jerk” backwards, this could pinch the cord and cause a central cord syndrome. See this section on the website too. If you don’t participate in activities that could cause this motion, the need for surgery is lessened.

Surgery is performed for three measures; to provide pain relief for degenerative discs, facets or instability, to decompress nerves that are causing arm pain or weakness or to protect the spinal cord. It sounds like you have at least two of the three. Don’t rush-but look into surgery to see what the specialists have to say.

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.

kbrisbois
Participant

October 10, 2016 at 9:58 am

Post count: 2

#23175

Thank you Dr. Corenman. I appreciate your time and feedback! Neck surgery is scary to me and I’m trying to get as much information as possible at this point. I’ve been grappling with trying to modify my lifestyle at the age of 41 while living in an ‘outdoorsy’ little town in the Pacific Northwest where I love to be active – and my quality of life has diminished. Many people have said I need to accept my limitations and just stop doing the things I love and ‘take it down a notch’ instead of taking on the risk of surgery where I may end up with more problems afterwards. Other people say that if my condition is not going to get better and possibly get worse AND surgery can fix the problem now and get me back to the active lifestyle I enjoyed, then why wait? I’m a bit apprehensive, but as I’m sitting at work this morning after handling a few large files and both hands are tingling acutely, I agree I’ll get as much information about the surgery being proposed as I can at my follow up appt w/ the neurosurgeon at UWMC next week. Thanks again!

Donald Corenman, MD, DC
Moderator

October 11, 2016 at 6:46 am

Post count: 8660

#23180

I think if surgery can get you back to your previous level and you miss those activities, you should consider surgery. In addition, you have some risk with your neck and surgery can significantly reduce your risk. Make sure you are comfortable with your surgeon. Don’t be afraid to ask some challenging questions.

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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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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