Two neck fusions and still having issues

Tagged: non-union of ACDF, pseudoarthrosis of cervical spine

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fmoadab
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May 25, 2016 at 10:11 pm

Post count: 2

#22255

Hi, 53 year old male in good health, I injured myself by picking up a not only heavy but a rather awkward table that was almost 4 feet wide and about 200 pounds which resulted sever herniation of c4-6 which after a good amount of therapy with no positive result, I had fused by a neurosurgeon on nov 2013. Followed by therapy which ended on Dec 28, 2013. Jan 10, 2014 a young man skidded through snow and hit my car on the driver side about 30 mph, resulting my car to be totaled. Pain was back so was I in my surgeons office. Initial x-ray showed nothing out of the ordinary so he sent me to therapy. 6 months of therapy and numerous trigger point injections had done nothing when my pain mgmt md decided it was time for an mri, so off I went and mri showed herniation on c6-7 below my fusion. Since I had lost confident in my surgeon, I went along to see an orthopedic surgeon who suggested to have fusion on c6-7. I went along so on Sep 2014 I had my second fusion. As normal, I was back in therapy and the pain would not go away. Almost 7 months after the second fusion, I decide to get an opinion of another surgeon so I went to Dr. who was brought over to Columbia in NY, with great reputation, I mean you drop his name and all surgeons bow!!! He took one look at my x-ray and said by c6-7 has not fused since not only a plastic piece was used, but he felt that all the hardware should have been removed from previous surgery and one long plate should have been used from c4-7. Of course that shocked me and I ended up having a big argument with the surgeon who performed it, not that he convinced me that I was fused but I decided to take a different approach hoping that I would not have to go though another surgery. Since I had no numbness or tingling, it was a good indication that perhaps my facet joints were causing the problems, so we started with medial block injection starting from c3 down to T1 on both sides and I must say the pain was being eliminated even though the effect was short lived so based on that I decided that RFA would be a good option, therefore we started with RFA from c3 down to T1. Now I just had my last RFA on the left side 2 days ago which happens to be side giving me more pain, surprisingly as to other RFAs which have been eliminating pain in different areas, and I was sure that this would have ended my pain completely on my left side, I am still feeling pain on my left, and therefore, I am starting to think that perhaps Dr. Rew’s diagnosis was correct and I have not been fused non c6-7. I am dying to know if there is a test that can show for sure if the fusion has been success or not without opening me up, and it goes without saying that the surgeon told me when I was confronting him about not being fused, that If I have not been fused by now I would be fused by another year. Well that one additional year is almost over and I am still having pain. I just want to know if there is a test that can show for sure the status of my fusion without relying on anyones opinion. I must say that I do plan to continue the RFAs on my right as I do have pain on the right too, but not as much.I think I have multiple issues which happen to be facet joints and possible failed fusion. Ct scans have all been inconclusive since radiologist can’t tell. Any thoughts or suggestion is deeply appreciated since this has got me frustrated for the past 3 years and it goes without saying that I am a rug dealer and my work is physical which involves lifting and bending and all sorts of activity. I was off work for one week after each surgery and back to regular activity within 45 days, and now that I think about it, I sort of understand why I may not be fused due to the short time I took off work and short time before I resumed my regular activity. Very anxious to hear your opinion. Many thanks, Fred

Donald Corenman, MD, DC
Moderator

May 26, 2016 at 6:17 am

Post count: 8660

#22257

You have already gone through all the procedures that I would recommend for pain relief. It seems that the only one left is addressing the pseudoarthrosis. You can have a pseudoarthrosis block attempted to be performed to help indicate if this is a pain generator. This is a difficult block that depends upon the anatomy of the pseudoarthrosis. If there is a clear non-union line that can be accessed by a needle, numbing agent can be introduced into the non-fusion line and relief is an indicator that this level is a pain generator. Generally however, these blocks are not possible at least 50% of the time.

If you had a PEEK cage used in your fusion (a plastic cage), this has a higher chance of non-union and back to regular activity in 6 weeks is somewhat soon for this type of fusion.

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.

fmoadab
Participant

May 26, 2016 at 2:02 pm

Post count: 2

#22263

Thank you Dr. Corenman. I will suggest the pseudoarthrosis block injection to my pain mgmnt md, but from your explanation I don’t have high hopes that he will be able to perform it. I am curious if you think that a Electrical Bone Growth Stimulator would help my situation and fuse the level if it is not fused and perhaps I can escape a mortifying surgery. Many thanks in advance.

Donald Corenman, MD, DC
Moderator

May 28, 2016 at 1:13 pm

Post count: 8660

#22270

Electrical bone growth stimulators are a reasonable way to treat this non-union. These stimulators are not highly effective and they are expensive but this is a non-surgical way to try and treat this pseudoarthrosis. If you use this device and have success, it would obviate the need for an attempt at a pseudo block.

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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