[Donald Corenman, MD, DC]

#8320

Ask your surgeon all the questions we have discussed regarding the fusion status of the levels above, the possibility of nerve or cord compression of the levels below and the status of your lumbar spine.

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]

#8381

Thank you Dr Corenman for being available to discuss things with and giving your opinion. I am so grateful for your generous giving of your time.

I saw my surgeon yesterday and he is sending me for a full spine MRI with contrast on Friday morning. He is concerned that I may still have cord compression, or my numerous symptoms could be coming from nerve root compression at different levels of my spine. He was confident that I am fused.

He did warn me before my surgery that he may need to do another one from the back afterwards. We talked about this and I asked what he had meant by that. Did he mean the two levels that he fused or the levels below that where there was also lots of degeneration? He said, all of them!! It would not be a fusion. He said that the two levels below where he fused look like they have self fused and that he would just need to remove bone and ligament that was compressing the spinal cord (and I think the nerve roots) from the back. He said that if I had been younger he would have fused all 4 levels at the same time when he did the original surgery. I just feel that things all sound worse than I realised and today I have a sense of doom!

I have heard differing views of surgery from the back to get pressure off the nerves and cord. Some say it is worse than an anterior surgery and others say that it is not so bad. Will it be like a first surgery on my neck as I have not had a posterior surgery before? I am hoping that it won’t be necessary but can’t help but think about the possibility that I will need it.

I am also being referred to an ENT consultant to try to find out why I can no longer sing in tune.

[Donald Corenman, MD, DC]

#8382

I am as confused as you as to your surgeon’s plan. A posterior approach could mean central decompression (laminectomy or laminoplasty), posterior foraminotomy or fusion with or without instrumentation. I do not understand why the surgeon would need to remove bone from the back of the canal at the levels where he performed anterior fusion. There are rare times that an anterior surgery is not effective enough to decompress the spinal cord but that would be an unusual circumstance.

To reply that if your were “younger”, he would have fused all four levels is also confusing. The older a patient is, the more levels they can tolerate with fusion.

Your inability to “sing in tune” could be from injury to your superior laryngeal nerve. This nerve “tightens” the vocal cords to allow different pitches. Ask your surgeon about this.

Have your surgeon explain why he intends to perform surgery and at what levels. Look for understanding of the pathology seen on MRI or CT scan and how surgery will modify this pathology to your benefit.

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]

#8386

I may have got the wrong idea about removing bone. At the moment there isn’t a plan to do surgery, just to have a full spine MRI scan with contrast to see what is going on to cause my numerous remaining symptoms. He said they could be coming from compression to the cord (or remaining symptoms from that) or to the nerve roots. I assumed that this would include bone and ligament, but perhaps I was wrong.

I remembered that before my surgery he had said that he may need to do another surgery from the back afterwards and so I asked what he had meant by that, and which levels he had been thinking of. He told me that things had been very tight in there, both on the MRI and when he saw inside. He didn’t name the procedure that he would do. I do know that I have a congenitally narrow canal. I think that before surgery he felt he may still need to get more pressure off the cord and nerve roots from the back afterwards. He referred to the EMG testing that showed ‘chronic neurogenic changes’ to the muscles in both arms. These are the deltoid, biceps and triceps muscles which I believe are fed from nerves below my ACDF at C3/4/5. I asked him if he would do a fusion and he said that he didn’t think it would be needed because the C3/4/5 levels were now fused and the two levels below that look like they are self fused. I do have lots of degeneration and osteophytes at all levels.

Before my surgery he had said that he would only fuse the two worst levels because if he did more than that there was a higher chance of not having a successful surgery.

He did explain that the nerve (laryngeal, I assume) may have been injured or stretched during the surgery (his incision is on the right side) which could be why I have lost my singing voice.

Once we have the new MRI scans I am sure that we will talk again and I will make sure that I understand what he intends to do, and make sure that I get a procedure name. He is generally good at writing down what he intends to do.

Thank you Dr Corenman for your help

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