Symptoms Post ACDF and PCDF

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mvenkata
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September 30, 2012 at 12:38 am

Post count: 3

#7044

Hi Doc,
Thank you for taking your time reading through this. I am 36 yrs. old and in Dec 2010, I had two surgeries within 2 days to alleviate severe cervical stenosis. ACDF 2 levels from C3-C5 and PCDF from C3-C5.
I had a severe radiating pain running through my shoulder to my left arm with severe head pain before my surgery which had lead me to the doctor’s office visit.
There have been many ups and downs since then and now almost 21 months from my surgeries, I am often experiencing these symptoms which I had also discussed (MRIs and x-rays) with my doctor three times and I was told that the surgery has alleviated the pressure from the nerves and these symptoms might be related to something else. I can also see that the severe myelopathy (stenosis) is taken care off and the nerve shoots have good room to branch. I also tried physical therapy and it made my pain worse and caused more knots on my neck muscles.

My Symptoms: Numbness in my right hand from time to time in the ulnar area. Stiffness/Neck pain and upper back pain on my right shoulder and Torticollis on the right side of the body.

I have also noticed that this happens if I stressed myself a little more the previous day. Also whenever I experience these symptoms, the torticollis seems much more prominent which also leads me to think that my sleeping position or the torticollis is pinching some nerve and causing the pain.
I did have one shoulder above the other since I remember, but my neck was always straight. Now after the surgery, it looks tilted and only if I keep my shoulder straight then the neck aligns straight.
I want to get my life back and start exercising but given this above symptoms, I feel that I will cause more damage without knowing the reason for the stress and fixing the same in the first place.

Donald Corenman, MD, DC
Moderator

September 30, 2012 at 6:59 pm

Post count: 8660

#7048

Cervical stenosis (narrowing of the central canal which compresses the spinal cord) causes a condition called myelopathy. Myelopathy does not include neck pain as a symptom by itself as the spinal cord does not have any pain nerve ending in its substance.

Neck pain is normally generated by the discs, facets and nerves but not by compression of the cord. You report “head pain” which I think you mean back of the skull headaches. If that is the case, this type of pain is typically generated by the facets at C2-3 and C3-4 (rarely by the C1-2 facets). If you have had a fusion of the C3-4 level and it is solid (lack of fusion can also cause these symptoms), then the base of skull pain could be from C2-3. Facet blocks (see website) can help to diagnose this condition.

Shoulder pain radiating into the left arm sound to be a radiculopathy (see website- compression of a nerve root). If the pain radiates down below your elbow, that could originate from the C6 or C7 nerves. If the pain does not radiate below the elbow, then the C5 nerve could be involved as well as C6 or C7.

Torticollis, I assume you to mean that you have neck pain that stiffens your neck. If this is the case, this neck pain can originate from degenerative disc disease or facet disease in the lower portion of your neck (assuming that your fusion of C3-5 is solid). A new MRI and physical examination can go a long way to help sort out your disorder.

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.

mvenkata
Member

September 30, 2012 at 9:51 pm

Post count: 3

#7052

Hello Doc,

Thanks for replying to my post. I might not have come across correctly in the original post. My symptoms prior the surgery are not there anymore.
I have a recent MRI and many x-rays after the surgery and all shows good fusion and no myelopathy or stenosis. C3 to C5 are completely fused.

What i experience now is numbness in my right hand from time to time in the ulnar area. Stiffness/Neck pain and upper back pain on my right shoulder(which is mostly muscle knots as i can feel them too) and Torticollis on the right side of the body(The left shoulder goes much higher, but my neck looks short on the right side).

My doctor has mentioned that this is musculoskeletal and not nerve related but also cautioned me to against adjustments(worrying that it might reverse the work from surgery) from a chiropractor. He told me that i might get some relief from massages. I have been in physical therapy last year , but the pain and numbness did not go till i stopped. Once I stress, they return back. I have also had a discussion with a chiropractor who feels that he can alleviate the pain and do corrections. He has done this to his mother-in-law after her ACDF.

Doctor, I know that you have also practiced both studies and can better relate to my question on the safeness on visiting a chiropractor.

Donald Corenman, MD, DC
Moderator

September 30, 2012 at 11:33 pm

Post count: 8660

#7054

I do not have any issues with my patients having chiropractic adjustments after a neck fusion that has become solid (as long as there are no other areas that demonstrate instability).

Numbness in the ulnar side of the hand could originate from new or residual cervical radiculopathy, thoracic outlet syndrome, ulnar nerve compression at the cubital tunnel (elbow) or compression at the tunnel of Guyon (wrist). A physical examination and occasionally an EMG test can determine this source of numbness.

Malalignment of the neck (torticollis) can be caused by scoliosis in the thoracic spine, antalgia (painful posturing), asymmetric degeneration of the cervical discs or malalignment from surgery. An X-ray and a physical examination will uncover the source of this problem.

Pain in the neck can be caused by the discs, facets and occasionally nerves. Many of my patients can get adjustments after ACDF surgery but that is determined on a case by case basis and it also depends upon the skill of the chiropractor.

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.

mvenkata
Member

October 1, 2012 at 12:21 am

Post count: 3

#7056

Thanks a lot for the reply. I really appreciate your insight.I live in Denver-DTC and I would definitely like to visit you in person to get evaluated. I will call your office on Monday to schedule an appointment. I will get all the MRI’s CTs and x-ray which i also have in discs during the visit. Thanks again for taking your time in replying to my questions.

Donald Corenman, MD, DC
Moderator

October 1, 2012 at 8:37 am

Post count: 8660

#7062

A pleasure. Please call the office directly at (970) 476-1100.

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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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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