What type of cervical surgery, or am I jumping the gun?

Tagged: Neck pain and cord compression

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billb
Participant

March 17, 2016 at 11:19 am

Post count: 3

#21567

Hi,

I’m quite active 65 year old guy. Professional voiceover talent, 5 days a week weight training and cardio. Best shape of my life and generally feel great. Have had lumbar issues for years, can live with them, and had neck pain too with first MRI in 2004. The pain can be pretty rough especially early AM and later in the day/night …and sometimes for periods of days and weeks, I have very little pain at all So far, heat packs and some stretching and home traction device have helped. I do have some transient paresthesias in right hand, sometimes left, and left foot, but not usually right. Also had some very fleeting instances of leg weakness, left side…feels like I’m losing power. but it passes in a moment and I’m back walking again. Briskly usually

Couple months back had a few instances of toe catch on left side that made me trip/fall waking up stairs. Primary sent me to neurosurgeon who said it might be L5…had some ENG testing done and he ENG neuro was skeptical. (though he identified peripheral neuropathy which he felt accounted for some of my extemity issues Another NS when hearing about my neck asked for MRIs, thinking maybe that had something to do with the toe issue The MRI s did show a lot of stenosis and so show some encroachment on cord..second doc and NYC consult doc said prob should have surgery to prevent things from getting worse. But of course it’s hard to get my head around surgery when I don’t even have anything that’s really pain (except for neck oain but I’ve had that for years and none of the docs are interested in that) Nobody has a better answer for the toe catch than maybe it’s L5 and can be taken care of with hemilamintomy

One recommended a cervical multilevel (there are issues at most) posterior laminectom,y with fusion; the other a three level ACDF with at least one corpectomy…and said further surgery may be needed later on adjacent disks, which would be posterior.

My head is spinning. ACDF scares me to death because of noted voice issues, and I’m a professional voice artist . But it has faster recovery . The posterior would spare the voice butdeeply involve the neck and upper back muscles.

With the posterior would I be able to get back to my gym workouts????How many months might that take…I’m not a serious lifter but I do lift…for the first time in my life I can do bodyweight pullups… like 12 in a row. For me that’s a major accomplishment. Working out and staying fit is such an important part iof my life. I’m trying to stay on the young side of getting old….

I could definitely use an opinion, because I’m really having a hard time sleeping these days.

Thank you!

Donald Corenman, MD, DC
Moderator

March 19, 2016 at 10:14 am

Post count: 8660

#21623

First you need a diagnosis. Neck pain is caused by degenerative discs, degenerative facets or rarely nerve root compression. Narrowing of the spinal canal (stenosis) and cord compression is generally painless. Cord compression can cause a spinal cord injury with a fall onto the head forcing the head backwards. If you do not engage in sports that potentially can cause a head blow (skiing, biking, contact martial arts), the risk of cord injury is diminished.

A workup might be necessary to determine which levels and structures are painful. Facet blocks might indicate the facets are more painful saving you a surgery (https://neckandback.com/treatments/facet-blocks-and-rhizotomies/).

Toe catch can be due to foot drop-an L4 or L5 nerve injury. See https://neckandback.com/conditions/symptoms-of-lumbar-nerve-injuries/ and https://neckandback.com/conditions/walking-disorders-nerve-joint-injuries-change-gait/. The toe catching could originate from the lumbar spine. A good, careful history and physical examination is much more valuable than any electrical test.

If an ACDF is performed with a left-sided approach, the risk of recurrent laryngeal nerve injury (the nerve that goes to the voice box) is highly diminished. Most neurosurgeon use a right sided approach and most spine surgeons use a left-sided approach. Good to know.

Posterior approaches are good for cord compression and there would have to be a fusion along with the decompression using rods and screws. This could be helpful for your neck pain depending upon how many levels were included.

There are still many unanswered questions that need to be answered before you choose treatment including 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.

billb
Participant

March 19, 2016 at 10:38 am

Post count: 3

#21625

Thanks so much for your reply..a lot to consider for me. I appreciate your input!

Donald Corenman, MD, DC
Moderator

March 19, 2016 at 7:53 pm

Post count: 8660

#21631

Please keep us informed of your eventual treatment.

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.

Donald Corenman, MD, DC
Moderator

March 19, 2016 at 7:53 pm

Post count: 8660

#21632

Please keep us informed of your eventual treatment.

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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