When is it time for surgery?

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Jellyhall
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March 16, 2012 at 6:05 am

Post count: 91

#5770

I have cervical spondylosis throughout my neck, with my cord being pushed backwards and compressed at C3/4 and C4/5. There is no Spinal fluid visible either side of my cord. I don’t have high signal on the MRI. There is loss of lordosis of my neck. I have various stabbing and shocking pains, aching and burning, tingling and numbness in my hands,wrists,arms, legs and feet and neck and shoulder pain with headaches. Most of the pains don’t last long, but the headaches can last for days. Sometimes the numbness (in the ring and little finger of my left hand, and the thumb, first and second fingers on my right hand) lasts for several hours.

I have hyper reflexes in both legs. I get stiffening spasms in my legs and inturning right foot in the morning as I start to move as I wake up. Strangely, I particularly notice this as my husband gets up out of bed and makes the bed move. Sometimes this extends to my adbomen causing my back to arch right up off the bed. I also get this stiffening if I get up after sitting for a long time. My muscle strength is pretty good but I am getting slightly clumsy hands and sometimes my legs feel rather jerky when I walk. This is not always apparent and sometimes they feel ok.

I had a decompression and fusion of L4/5 2 years ago for grade 2 spondylolisthesis. I also have 2 dics mildly compressing the cord in my thoracic spine, which cause tightening around my chest and spasms, particularly when I try to twist. I think that this makes it hard to know which levels are causing which symptoms.

How do you know when it is time for surgery? It has been suggested that I have a 2 level ACDF. Weighing up the risks of surgery with the risks of not having surgery, it is so hard to decide. Are there any particular symptoms that would indicate that surgery can’t wait any longer? (I am aware that bowel and bladder incontinence would mean this.)

Donald Corenman, MD, DC
Moderator

March 20, 2012 at 11:17 pm

Post count: 8660

#5795

You have cervical stenosis at C3-5 (see website for further details). The loss of lordosis could be from the degenerative disc disease that always accompanies the bony spurs that compress the spinal cord or from antalgic positioning (neck flexion opens the canal to protect the cord).

The intermittant symptoms in your arms and legs could be from cord compression. Headaches can be created from cord compression but also from degenerative discs and facets.

Hyperreflexia (increased deep tendon reflexes) goes hand and hand with myelopathy from spinal cord compression (see website for myelopathy). Muscle spasms like you are experiencing is also associated with myelopathy. “Clumsy hands” and a feeling of “jerkiness” when walking are hallmarks of myelopathy.

In general, if you have the symptoms described above and you have cord compression in the neck causing myelopathy, you need surgery. Compression of the cord is unforgiving and if there is damage, the cord may not heal after surgery. See your surgeon soon.

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.

Jellyhall
Participant

March 22, 2012 at 11:58 pm

Post count: 91

#5813

Thank you for your reply and expert opinion, which I value.

Is there any way to determine which level is causing my symptoms? I have been told that the tightening and spasms I get around my chest are probably being caused by the 2 thoracic discs which are compressing my spinal cord and nerve roots, particularly to the left, where I get the most pain.

How can we tell if it is my neck or thoracic spine that is causing the symptoms below my chest, particularly the pains and stiffening spasms in my legs?

I am in the UK where things seem to be left longer than in the USA.
I am an otherwise healthy 56 year old woman. (I do take prescribed Vitamin D and Calcium, after my levels were found to be low.)

I have seen 4 neurosurgeons, 2 of which have said that I should have surgery. The other two say not yet, but that we should ‘wait and watch’, (every 6 months) but no real explanation has been given as to what they are waiting for. I suppose that there is some symptom that I don’t have yet.

I don’t want to be in a situation where I have permanent nerve, or worse still, cord damage from waiting too long.

I now have the option of having surgery with one of these neurosurgeons, but do wonder what the reason is for this other surgeon saying that we should wait.

It is so hard to make this decision without fully understanding what is going on.

Donald Corenman, MD, DC
Moderator

March 23, 2012 at 12:41 am

Post count: 8660

#5815

If you have symptoms in your arms (incoordination of the hands, numbness and “a feeling of being off”), these could not be generated by your thoracic spinal cord compression. You need to address your cervical spine very soon with ADCFs. Cord compression is not well tolerated and further damage to the cord does not heal well.

I- to this very day, do not understand why some surgeons will hold off on surgery in the face of cord compression that compromises the integrity of the cord. In my opinion, the only reason to avoid surgery in this case is if surgery would cause greater risks than the risk of cord damage.

It is impossible to know at this point how much thoracic cord compression is causing thoracic myelopathy as your current leg symptoms most likely are also caused by the cord compression in the neck. Without seeing your MRI of the cervical and thoracic spines, my estimated guess would be to have the cervical ADCF now and see what type of relief is gained.

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.

Jellyhall
Participant

March 23, 2012 at 5:03 am

Post count: 91

#5822

I have been told that if I was in an accident or if I had a fall, I could risk bruising my cord because there is no spinal fluid around it to cushion it. This could cause me serious problems.

I work in a school and we have some difficult children who can be unpredictable. I am excused playground duty because of my spine problems.
After cervical fusion surgery, will my neck return to a normal risk level once it is fused?

We are going on holiday over Easter (2nd – 13th April). Also we had planned to go and visit our son in Switzerland at the beginning of June during the school break.
Can surgery safely wait until after this?
How long after ACDF do you think we would be able to travel to Switzerland or go on a restful holiday abroad?

I really appreciate being able to ask you all these questions.
Thank you so much.

Donald Corenman, MD, DC
Moderator

March 23, 2012 at 11:59 pm

Post count: 8660

#5828

My advice to you is based upon only what you have told me so take everything with a grain of salt. You are in some danger with the symptoms and the cord compression that you have described.

The spinal canal enlarges with neck flexion (bending the head forward) and narrows with extension (bending the head backwards). If you have a fall onto the front of your forehead that causes your head to bend backwards, you could injure your spinal cord. This could even happen if you are rear-ended in a motor vehicle accident so you need to take precautions.

The surgery generally makes your neck stable immediately depending upon the type of surgery and the skill of the surgeon. I personally allow patients to travel within one week of surgery (they fly in, stay a week and then depart) but I cannot tell you what your surgeon would suggest.

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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