Unknown reason for failed surgery ADR

Tagged: artificial cervical disc replacement with increased pain post-operatively

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Mary
Participant

February 17, 2018 at 7:00 pm

Post count: 4

#27592

Hello Dr Corenman,
My son at 21 years old
had a c4/5 artificial disc replacement.
He is 23 years old now and is very much in worse pain than before surgery and is classified as chronic pain now.
I have taken him to 3 second and third opinions and all say needs fusion, even though the disc looks Normal and perfect in scans. It’s a prestige Lp disc. He’s so young and does not want that done due to the domino affect. He has anxiety from the bad experience he had from the surgery. And has nightmares. He’s terrified to have surgery again.
I am desperate to find what is the cause for his pain. No one can tell us exactly.
He is still taking pain medication and still in pain.
He describes the disc in his neck as feeling it all the time and has limited movement. And full pain, burning back of his neck. He can’t sit, stand, walk or do anything for a long time. He had to leave university as he can’t study and keep his neck looking down. And can’t work from the constant intense pain.
I hope you can help him
We are desperate for answers.

Thank you

Kind regards,
Mary
Sydney, Australia

Donald Corenman, MD, DC
Moderator

February 17, 2018 at 9:56 pm

Post count: 8660

#27593

First-what was the initial reason for the ADR? Was it radiculopathy (herniated disc with compression of the exiting nerve root)? Was it neck pain that did not radiate into the shoulders? What was the indication for surgery?

What does the disc look like alignment-wise and motion on flexion-extension films? Is his pain the same pain that he had before the replacement but more intense or is it different pain than before 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.

Mary
Participant

February 18, 2018 at 5:21 am

Post count: 4

#27605

We don’t know how this disc happened. He was complaing from neck pain for 1 year before our Dr sent him to get a MRI scan, when he started to get numbness.
That’s when it showed he presented with right brachialgia secondary to c4/5 paracentral disc prolapse.
Neck pain first started then, yes it was numbness and nerve pain in his right arm, which became very weak.
The x rays where the disc is looks fine Drs said. It’s bizarre why he is in so much pain.
He said to me, he feels worse than before surgery.
Surgery only helped the nerve and numbness pain.
He regrets the surgery.
He says his pain is a bit of both
Same pain but different not bulging disc pain but feels like the disc pain.
I have photos of the x rays
I tried to email but didn’t work

Donald Corenman, MD, DC
Moderator

February 18, 2018 at 6:37 am

Post count: 8660

#27612

OK. He had a disc herniation and needed a decompression surgery. An artificial disc (ADR) is not a bad way to go in these circumstances. The problem with theses ADRs (if they are aligned correctly and of the right height when initially implanted) is that an ADR might allow increased motion of painful facet. If your son has neck pain as his major complaint and the arm pain/numbness is much better after surgery, he might have facet syndrome. The next step is to get facet blocks of the painful level and look for temporary relief. He then might be a candidate for an ablation of the facet nerve. See https://neckandback.com/treatments/facet-blocks-and-rhizotomies-neck/ and https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-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.

Mary
Participant

February 18, 2018 at 8:23 am

Post count: 4

#27619

Thank you Dr, yes but unfortunately this all was looked into. Our Dr said the same thing, that the pain is coming from his facet joints and scans show no problem with his facet joints. Yet the Dr still went ahead and said he should try the blocks to see where the pain is coming from. Once again unfortunately for my son, it didn’t help the pain at all. Then our Dr suggested to have the rhizotomy.
For some reasons my son experienced more pain after that procedure was done. It’s like a big mystery. No one knows what is the exact cause and where this pain is coming from.
He was in more pain after that this procedure.
He feels his neck pain is mechanical pain.
Turning his neck to the right and left is very limited.
Constant dull pain and burning at the back of his neck. Wakes up every day with a stiff neck and needs a long time to actually get moving out up out of bed. He says he feels like his in a 80 year old body. Always in pain.
Feeling helpless, don’t understand why no one can help him and give us answers.

Donald Corenman, MD, DC
Moderator

February 18, 2018 at 12:46 pm

Post count: 8660

#27624

I am unclear as to the results of the facet blocks. Did your son get significant relief from the first three hours? This is the diagnostic time interval (see pain diary-https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/). If he could say he felt great for this small time period, then the facet can be implicated as one of the pain generators. If not, then the facet is probably not the pain generator.

You could try a discal block. This is an anesthetic injection into the disc space of the ADR. Sometimes, the anesthetic will work on the surrounding movable tissues and yield 3 hours of relief. If so, the ADR would need to be replaced with a 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.
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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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