Think C6/7 replacement disc has migrated into spinal canal

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silvermoon
Participant

February 26, 2018 at 1:41 pm

Post count: 3

#27713

Hi everybody, I’m new here and I have a big problem, I’m hoping that discussion will lessen my fears….here goes!
In 2012 I had a three level hybrid neck fusion, C4/5 & C5/6 ACDF and C6/7 disc replacement.
Trouble started two years ago with right sided bad shoulder and arm pain and my orthopaedic consultant gave me a steroid injection – Kenalog + Marcain – in my shoulder for subacromial impingement.
I don’t think the injection worked but I persevered with the pain, which gradually left me last summer to be replaced with back of the neck and head pains last autumn becoming excruciatingly painful after Christmas and to the present day.
All the pain is in my neck and back of the head with sharp pains shooting up into my scalp and around to my temple, not into my arms or hands.

Friday 23/2/2018 I had an MRI scan and I’m shocked to see what looks like the disc replacement pushing into my spinal canal on the axial images. I’ve looked at the sagittal ones too and although I’m no medic I can see from the large black areas around the C6/7 vertebrae including the spinal canal that I’m in big trouble.
Anyone had a removal of the disc?? I’m terrified.
I’ve an appointment with my GP Wednesday 9am and the report of this MRI should have been faxed through to him by then.
I’m asking to see a particular neuro here in the UK as I’ve recently undergone a two stage spinal fusion at L1-2 for stenosis, that’s above a previous long arm L2-S1 reconstruction with rods and screws + rhbmp.
My legs are still weak and although I can walk if I take it slowly I haven’t the strength in my legs to climb stairs without two handrails to haul myself up.
I’m a 68 year old non smoking virtual teetotaller, I’m hopeful that any surgery I might need will be successful.
I’m hoping to hear some good news from any other people here who may have had removal of their adr.
Thankyou for reading my post.

Donald Corenman, MD, DC
Moderator

February 26, 2018 at 3:21 pm

Post count: 8660

#27715

First you have to understand that many of the artificial disc replacements are made of chrome/cobalt metal which causes severe defects in the MRI images. The artifact appears as a large black density surrounding this ADR and can be misinterpreted as a large “hole” around the disc area. The best way to interpret where an ADR is located is with a simple X-ray or if necessary, a CT scan.

Also, since the ADR is placed at C6-7, malplacement symptoms generally would be located into shoulders and arms with coordination symptoms. not the back of the head.

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.

silvermoon
Participant

February 26, 2018 at 3:56 pm

Post count: 3

#27720

Thankyou Dr Corenman.
So the large bulge three quarters of the way across the spinal canal in some of the sagittal images is nothing to worry about then, it certainly looks frightening coupled with all this pain.
I need to know what’s causing the pain, if not migration, what else I wonder?

Donald Corenman, MD, DC
Moderator

February 26, 2018 at 4:12 pm

Post count: 8660

#27721

I can’t tell you that the ADR is not displaced but normally, the MRI images are not the studies you want to consider for disc positioning and it sounds like you are noting metal artifact. I would assume that your upper neck pain and headaches originate from the upper cervical discs and facets.

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.

silvermoon
Participant

February 26, 2018 at 4:19 pm

Post count: 3

#27722

Thankyou for your help, I feel a bit easier after reading your opinion.
I agree I do need different diagnostics but looking at the MRI scans taken two years ago it’s interesting that the spinal canal in the sagittal images isn’t taken up by the black bulges, its virtually clear.
Hopefully I’ll soon get the answers without having to wait too long.
I’ll post again when I do. Once again many thanks for your time.
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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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