Trying to understand my post op problems and work-up

Tagged: Myelopathy and further progression post-surgery

Viewing 6 posts - 1 through 6 (of 6 total)

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amandabu
Participant

June 24, 2021 at 6:05 am

Post count: 6

#34158

Hello,
I had a C5 corpectomy with C4-C6 arthrodesis in 9/18 for cervical kyphosis with radiculopathy and myelopathy. These were all upper body symptoms. Right after surgery I developed leg weakness to the point of needing a walker and my arms were still very weak and pain still went down my right arm as before. They did an extensive work up with EMG’s, CT Myelogram, cervical facet injection, . . . I was unable to have an mri due to having a medical device for my bladder for interstitial cystitis. I. Saw a neurologist who looked at my past history from 20 years ago where I had some trauma with losing family members and diagnosed me with functional movement disorder. I got a second neurologist to do another EMG/NCS and he found an abnormality in the NCs showing radiculopathy and suggested I could have cervical myelopathy but would need an mri. I had to wait about 6 -8 months for a new lead wire to come out that was mri compatible so I could have another surgery to have it replaced. Then I could have an mri.
In the mean time I was diagnosed with this functional movement disorder. I mean no disrespect to anyone who has it, I was going to just go on and work hard and try to get better, but I was given the impression that “this was all in my head”. I was treated with a lot of disrespect by PT/OT and physicians from other disciplines because of this diagnosis.
I decided to go to the Cleveland clinic for another opinion after getting the mri compatible device. The mri and the Cleveland clinic diagnosed me with cervical myelopathy, pseudoarthrosis, cervical kyphosis below my surgery, congenital spinal stenosis, and cervical cord compression. I underwent a posterior cervical fusion from C4-C7 with rods and pins and laminectomies as C6 and C7. Needless to say I had a rough go of it. I was in rehab there for a month. I am still using a walker and the surgery was in 10/2020. I am Back to square 1 because the neurosurgeon believes I should be much better by now. I am not. I can barely hold my head up after walking 200 ft. I have nerve pain down both arms if I move my arms in a certain direction. I feel like I am walking in quick sand. mRI shows fusion is starting and good placement of hardware. A neurologist cannot find anything on exam, but did bloodwork. The only thing that came back low positive was an RNP antibody index. The ANA was negative as well as the rest of the ENP panel. He has now diagnosed me with functional neurological disorder. I’m devastated. In your opinion, can you think of anything else that would cause my symptoms? I have trouble raising my arms, my hips are week, I can walk now about 235 feet and then I have to sit down and I can barely hold my head up. This is after months of physical and occupational therapy including 2 inpatient stays in rehab. I am trying really hard. I want to get better!

Donald Corenman, MD, DC
Moderator

June 24, 2021 at 6:17 pm

Post count: 8660

#34159

Apparently, you had a significant flair-up or further cord injury after your first surgery. That can happen during surgery as the cord is under significant compression with stenosis and motion or work around the cord can further injure it. This is why you had new symptoms in your legs.

I am unclear what a “functional movement disorder” is as functional means adaptive or “learned”. Are they saying for have problems with your gait or upper extremity motion not due to a neurological disorder?

You then needed further surgery (“I underwent a posterior cervical fusion from C4-C7 with rods and pins and laminectomies as C6 and C7”) due to possible incomplete decompression and pseudoarthrosis. This surgery was at the old levels (c4-6) adding one additional level (C6-7).

After surgery, your symptoms don’t sound like they improved much (“I am still using a walker and the surgery was in 10/2020….I can barely hold my head up after walking 200 ft. I have nerve pain down both arms if I move my arms in a certain direction”). Inability to hold your head up could be from alignment or fusion issues post-surgery or from a neuromuscular issue causing weakness in your neck muscles.

Do you have current MRI and CT scans of your neck?

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.

amandabu
Participant

June 24, 2021 at 8:52 pm

Post count: 6

#34160

Hi Dr Corenman,

I may have used the incorrect terminology, I was diagnosed with Functional neurological disorder after the first surgery and now again. Another name for this disorder that has been used in the past is conversion disorder. The neurologist cannot find a neurological reason for my symptoms on exam nor on mri. I was under the impression that a person could still have cervical myelopathy even after their spine had been surgically corrected??
I have pasted a copy of my latest mri below. The neurologist has ordered an mri of my brain to verify I don’t have MS. I was checked for that after my first surgery as well, but he wanted to confirm that it is still negative. I will have the mri in a couple of weeks.

MRI CERVICAL SPINE WITHOUT CONTRAST,

04/10/2021 at 1348 hours.

HISTORY: Spinal stenosis, cervical region.

TECHNIQUE: Multiplanar multisequence imaging was obtained of the cervical spine on a 1.5 Tesla magnet. Images were obtained without IV gadolinium.

COMPARISON: MRI cervical spine dated 9/11/2020, cervical spine radiographs dated 3/9/2020, and CT myelogram, cervical spine dated 10/28/2019.

FINDINGS: Postsurgical changes of prior anterior cervical spine fusion are redemonstrated from C4 through C6, with a ventral surgical plate, vertebral body screws, prior corpectomy at C5, and vertically oriented strut graft from C4-C5 through C5-C6.
Additional postsurgical changes of prior posterior decompression and fusion are demonstrated from C4 through C7, with pedicle/facet screws connected by vertical rods, new compared to the prior exams. The surgical hardware would be better assessed on the
prior CT/x-ray exams. Susceptibility artifact related to the metallic surgical hardware degrades images and limits evaluation of the surrounding structures.

There is persistent straightening of the normal cervical lordosis. No new abnormalities of sagittal alignment are identified. The vertebral body heights are maintained. The marrow signal is notable for mild endplate degenerative signal changes that
are most prominent at C6-C7 outside of the postsurgical levels.

The cervical cord has a normal caliber. There are no areas of abnormal cord signal. No masses or fluid collections are seen in the spinal canal or paravertebral soft tissues. The craniocervical junction is unremarkable.

Multilevel degenerative changes are identified with diffuse degenerative disc desiccation and disc space narrowing, most prominent at C6-C7 outside of the postsurgical levels, where there is moderate loss of intervertebral disc height (slightly more
pronounced ventrally).

C2-C3: Negative

C3-C4: Negative

C4-C5: This is a postsurgical level. Evaluation on the axial images of limited due to the susceptibility artifact related to adjacent surgical hardware. No definite high-grade spinal canal or neural foraminal stenosis is identified.

C5-C6: This is a postsurgical level. Evaluation on the axial images of limited due to the susceptibility artifact related to adjacent surgical hardware. No definite high-grade spinal canal or neural foraminal stenosis is identified.

C6-C7: This is a postsurgical level. Evaluation on the axial images of limited due to the susceptibility artifact related to adjacent surgical hardware. No definite high-grade spinal canal or neural foraminal stenosis is identified.

C7-T1: Evaluation on the axial images of limited due to the susceptibility artifact related to adjacent surgical hardware. No definite high-grade spinal canal or neural foraminal stenosis is identified.

IMPRESSION:
1. Postsurgical changes of prior anterior cervical spine fusion are redemonstrated from C4 through C6, with interval posterior decompression and fusion from C4 through C7. Susceptibility artifact related to the surgical hardware degrades images and
significantly limits evaluation of the surrounding structures.
2. Mild multilevel degenerative changes of the cervical spine, without definite evidence of significant spinal canal or neural foraminal stenosis.

Thank you for your reply. I just can’t seem to believe that my symptoms would be all in my head. It doesn’t make sense to me.

Donald Corenman, MD, DC
Moderator

June 25, 2021 at 11:24 am

Post count: 8660

#34161

“I was under the impression that a person could still have cervical myelopathy even after their spine had been surgically corrected?”. That is correct. A cord injury can be lasting and continuous. Surgery is designed to prevent further progression but may not reduce current symptoms.

The radiologist notes “The cervical cord has a normal caliber. There are no areas of abnormal cord signal. No masses or fluid collections are seen in the spinal canal or paravertebral soft tissues”. This means that the cord has no signs of injury (high signal indicating a scar or myelomalacia indicating a loss of cord mass). This is good news. This doesn’t mean you didn’t injure your cord as microscopic injury may not show up on MRIs but gross injury did not occur.

What does your examination demonstrate? Do you have hyper-reflexia, clonus or a Hoffman’s sign? What does your walking ability look like?

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.

amandabu
Participant

June 25, 2021 at 2:01 pm

Post count: 6

#34162

I still have hyper-reflexia. I do not have Hoffman’s sign. I do not believe I had clonus. I had a “prominent titubation”, “Trace Tromner”, “gait is slow, tremulous distal and proximal activation of legs”

The neurologist told me I had an Essential tremor?? It showed in my hands, tongue and head.

I do have muscle spasms/cramps in my neck, shoulders, shoulder blades, diaphragm area and outer hips as well.

I hope I answered your questions correctly. I couldn’t copy and paste his visit note.

Thank you!

Donald Corenman, MD, DC
Moderator

June 26, 2021 at 6:21 am

Post count: 8660

#34163

Signs of cord dysfunction include hyperreflexia but there is hyperreflexia in the “normal” population as well. No clonus or Hoffman’s is a good indication that the cord is “more normal” than not.

Essential tremors are typical and should not be related to your cord dysfunction.

Cramping has so many causes that I would have to write 2 pages just to introduce the potential causes (of which myelopathy is only one of these).

If you still have arm paresthesias, an EMG might help to point to root irritation but with an MRI that indicates no root compression, the potential solutions do not include surgery.

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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