Two level ACDF 1 year Melopathy

Tagged: ACDF Myelopathy

Viewing 5 posts - 1 through 5 (of 5 total)

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corrochan
Participant

February 10, 2016 at 2:41 am

Post count: 4

#21296

Dr.Corenman

First many thanks from the UK for your great site and the advice already provided to many of us who suffer spinal issues.
Could you please see included.Many thanks in advance.
Oct 14/ ACDF C5 C6/ C6 C7 no plate or hardware introvertebral prosthesis only.
Treatment for cord compression Myelopathy.
3 mths review some improvement strength in hands improved and walking, but pronounced pain right dorsus making gripping painful and difficult.
Recommendation physio and 5 days Vallium.

No further action or review at 6 mths as was lost in the system which happens with the NHS.
Managed to get a further review December 15 results as below.
During this year increase myelopathy in both hands and disturbed gait and heavy legs making me reduced my work by 50%
Surgery site healed well no extreme pain due to scar or swallowing problems healed very well.
But intense continuing pain in the left trap area 24/7 making neck turning slow and difficult.
Movement now at 80-90% but increased pain when extending neck and full rotation.

MRI result Dec 15

Two level ACDF C5 C6 /C6 C7 No significant improvement to rule out residual compression.
Findings: The vertebral canal dimensions at these levels have improved; although moderate canal narrowing with cord flattening persists at lower level. A more conspicuous rim of CSF of signal is shown surrounding the cord.
On the axial imaging there is a suspicion of signal cord alteration at C6/C7, which predates the surgery.
The left C5 C6 C7 neural exit foramina remain severely narrowed with less marked osteophytic narrowing demonstrated left C8 and right C5 foramina.
At C4/5 there is mild osteophytic vertebral canal narrowing The vertebral alignment and bone marrow signal are preserved.
Non compressive disc bulges are shown in the thoracic spine.

Donald Corenman, MD, DC
Moderator

February 10, 2016 at 5:08 am

Post count: 8660

#21301

The surgery at C5-7 was warranted and did decompress the cord somewhat but there is still residual cord compression (“moderate canal narrowing with cord flattening persists at lower level”). The better news is that there seems to be some CSF now around the cord where there was none before (“A more conspicuous rim of CSF of signal is shown surrounding the cord”). This is somewhat confusing as if there is more CSF around the cord, the “flattening” should not be present.

You did have a cord injury due to the chronic compression (“On the axial imaging there is a suspicion of signal cord alteration at C6/C7, which predates the surgery”). This might help to indicate why the myelopathy has progressed but normally after surgery-myelopathy improves, so this is somewhat confusing also.

You still have significant foraminal compression (the area where the nerve root exits the spinal canal), especially at C5-7 on the left (“the left C5 C6 C7 neural exit foramina remain severely narrowed”) which would explain your continued left shoulder pain (“intense continuing pain in the left trap area 24/7 making neck turning slow and difficult”).

I hope the NHS allows second opinions as I think you need a new set of eyes to assess you and help you with the remaining pathology that was not addressed at the first surgery. Find a surgeon who is meticulous, really wants to help his or her patients and won’t take no for an answer.

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.

corrochan
Participant

February 10, 2016 at 5:50 am

Post count: 4

#21304

Dr. Corenman

I am so grateful for your quick response, I was beginning to question whether I am imagining the pain I am suffering.

As background I am a male 55yr old who was previously a Rugby and Judo player,but know I feel constantly drained. I take from your reply that the procedure carried out was not definitive and that there are area yet to be addressed.
By just stating the chord is clear is not a through appreciation of my condition and that the pain I am know suffering has a correlation. With the NHS here in the UK you are in the main dependant on a singular consultation/consultant.
As I understand the position I have a congenitally narrow Spinal canal,my consultant has grudgingly allowed a nerve conduction test,which I am not sure what benefit this will be and a further lower MRI to see if Thoracic or Lumber issues are the reasoning for my pain.Nothing was mentioned regarding that in 2014 facet joint and ligamentum flavum hypertrophy with a loss of cervical lordosis.
Would I be right to when next I get a chance to see my consultant normally months later, insist that my cervical neck has not been definitively treated and that there still exists procedure (not sure which) to improve my outcome
Once again may express my thanks for your kindness and professional expertise in explaining something I had hoped would have been passed on to me by my consultant,who is new to my case, I have had the luck,at least I thought I was to be treated in a dedicated Neurological Hospital here in London. The average waiting times here in the UK are 3-4mths to see a Consultant 6-12 weeks to have an MRI.
Best of luck to all fellow sufferers,Society still underestimates how debilitating spinal issue can be.

I hope this will be helpful for other members and visitors of your very helpful and informative forum.

Thank you once again.

Donald Corenman, MD, DC
Moderator

February 10, 2016 at 7:32 pm

Post count: 8660

#21316

The EMG will not be helpful for cord injury (myelopathy) but might shed some light on your shoulder and arm pain although a precise physical examination will yield much more information than an EMG will.

Also, you should make sure that you have a solid fusion and have not developed a pseudoarthrosis (lack of fusion) of the surgical levels. This can be diagnosed sometimes with an in-office X-ray (including flexion/extension) and if any questions, a CT scan of the 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.

corrochan
Participant

February 11, 2016 at 5:05 am

Post count: 4

#21321

Many thanks I shall certainly try to get a CT scan, and hopefully convince this Consultant that I still have unresolved issues.
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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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