[Donald Corenman, MD, DC]

#7751

The interbody grafts used should be made of allograft (cadaver) bone. Are you sure these were made of titanium? The X-ray would show a thick “very white” spacer in the disc space if these were made of titanium instead of bone (which should look similar to the density of the vertebral bodies next to them).

It would be unusual to use titanium implants for fusion. It also would be unusual not to use graft bone (or your own bone) to fill these cages. I would think that these are allograft Cespace struts in which case there would be no need for fillers.

Using a plate in front is typical but not absolutely necessary.

The fusion of allograft spacers or struts takes between 3-4 months before solid incorporation occurs. Serial X-rays including flexion/extension will determine if these grafts have incorporated. If there is any question, a CT scan can be used.

Not every surgeon uses physical therapy to rehab a patient but you might ask if he or she would write out a script for you.

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]

#7753

Hi Dr Corenman,

I am almost certain that the surgeon explained that he would use two titanium cages. (I have a document detailing the implants used and it states Cespace titanium cages. One is slightly larger than the other.) I asked about bone graft and plate and he said he wouldn’t use them. He explained that the teeth on the cage would hold it in place and that he would prepare my vertebrae so that they bled and my bone would grow through the holes in the cages. He said that the cage has a special coating that encourages bone growth. (I think he said that it is similar to that used for hip replacements. From research I have done, I think this is Plasmapore.)

On an x-ray, you can see two very white spacers between the vertebrae. He said that his colleagues use the same method, and I have a friend who had the same surgery by another surgeon.

Do you think that fusion with these titanium cages will take longer than with allograft spacers?

As I am in the UK, I will have to pay for any physiotherapy I have. I am happy to do that to help my return to as much movement as possible.

[Donald Corenman, MD, DC]

#7759

Placement of titanium cages without bone graft within the cages means a longer time to fusion. Allograft as I noted takes about 3-4 months to heal. These spaces should take longer than that.

Did the surgeon give you guidelines for what activities you can do at this point and how to modify them for the near future? If your surgeon does not advocate therapy, I do not want to step on his or her toes to disrupt the healing plan.

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]

#8309

Hi Dr Corenman,
I got the ok to do physiotherapy, and having been having weekly sessions where he works on the muscles of my neck and thoracic spine to get them to relax off. Each week they are tight again. Things seemed to get worse when I went back to work.

I wasn’t really given restrictions of what I shouldn’t do after surgery. My surgeon did tell me before surgery that the rules would be similar to after my lumbar surgery. I did find after surgery that my neck movement was better than expected even while still in hospital. Things are pretty much back to how they were before surgery now as far as mobility is concerned.

I have now weaned off the neurontin completely because I wanted to feel how I was without masking any symptoms. I am still getting pains and tingles in both hands and arms and feet and legs. Also I get pain on the top of my thighs, particularly the left one. I am still getting the tight band around my abdomen, especially on the left side.

I have experienced far fewer headaches since my surgery.
I wonder if the other symptoms that I am still getting could be from other levels of my spine. I do know that I had problems with my neck below the C3/4/5 that were fused. An EMG showed bilateral neurogenic changes in my deltoid, triceps and biceps.

I don’t know if you remember viewing my MRI of the whole of my spine. My surgeon did warn me that I may need further surgery from the back at a later date. I am not sure if he meant that would be on C3/4/5 or on the other levels below that where there were problems. When we spoke, you agreed that there were other problems.

I do worry that I am having problems with my lumbar spine again. (My L4/5 was fused 3 years ago, but there were problems with discs above and below before that, although not bad enough to require surgery. (One doctor did say I may need to have more than one level fused or an implant (Wallis Ligament) put in at a second level, but my surgeon felt only the one level was necessary.)
When I woke from my neck fusion I was in a lot of pain from my lumbar spine. These pains on the top of both thighs was not there 6 months ago.

I am interested to hear what you think of my remaining symptoms, and if you still have my MRI scans.

It is still only 5 months since my ACDF so hopefully there is still time to get further relief from the surgery. I just hope that these problems are not coming from other problems in my spine.

[Donald Corenman, MD, DC]

#8312

Five months after an ACDF surgery is plenty of time to allow a full fusion of these levels. One of my suspicions is that you might not have a solid fusion due to titanium cages and no bone graft used. At this point, I think a CT scan might be in order to look at fusion status and also look at the lower levels for bony nerve or cord compression.

You underwent an EMG which demonstrated “changes” in the deltoid triceps and biceps. This concerns me in that EMGs reveal motor nerve compression significant enough to disrupt the transmission of signals to the muscles involved. Normally EMGs are quiet even in the face of significant pain (sensory nerves are compressed but motor nerves, being “tougher” are unaffected).

Degenerative changes preexisting above and below your prior lumbar fusion could now be symptomatic and cause both lower back pain as well as leg symptoms.

I don’t believe that my nurses keep the films that I had previously reviewed but you can call the office at (970) 476-1100 or (888) 888-5310 to check.

Another visit to your surgeon is in order.

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]

#8315

Thank you Dr Corenman for your reply.
I think most of the things that you say are pretty much what I was concerned about.

I have been getting a lot of neck pain from very small movements and even when I use my arms. I had wondered if it could be caused by my neck not being fused. I get pain in my hands and arms everyday although not all the time. This is aching, burning, stabbing type pain and even my wrists feel like they are sprained if I try to pick up anything heavy or even sometimes if I just place my hands on my hips.

I still get the stiffening spasms when getting up out of bed in the morning and up out of a chair if I have been sitting for long. I get cramping, stabbing and numbness in my toes and occasional sciatica. I am still getting the feeling that I have a mobile phone inside my right leg on vibrate, and get this every day, but not continuously, when I am sitting or even lying. I used to think it must be because there was pressure on a nerve, but when I am lying down nothing is pressing on my leg. I have even felt it when standing up.

I think I have been trying to ignore my symptoms in the hope that they are not serious. They make me wince with the pain, but because they don’t generally last for very long, I am coping without much use of pain meds since weaning off the Neurontin/Gabapentin. I do sometimes wake with numb fingertips that does last for several hours and they start to tingle and prick for a few hours as the feeling starts to come back.

It is interesting what you say about the EMG results being a concern as they indicate that there is motor nerve compression which must be significant to disrupt the signals to the muscles. I hadn’t realised this. I had the EMG tests to rule out MS because I had so many symptoms.

There is a part of me that doesn’t want to acknowledge that all this is still going on. I think I have been hoping that it will all resolve itself, and told myself that if there were problems continuing then eventually they would get so bad that there would be no doubt about it. I feel like I sound like a stuck record and seem to always be complaining of my symptoms!

I do have an appointment with my surgeon next month. I was so hoping when it was arranged before Christmas, that it was going to be a positive appointment with my symptoms much better.

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