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in reply to: Artificial Disc Replacement #4443
If you have a herniated disc causing nerve root compression and the disc space height is relatively normal, you would most likely be a good candidate for an artificial disc replacement. However, if the nerve compression is from a bone spur off the uncovertebral joint and that spur is due to a collapse of the disc, then an artificial disc may be questionable. I do like artificial discs for the neck but we still don’t know the longevity of these implants, so keep that in mind. There is nothing wrong with another ACDF if that is what is indicated.
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.The symptoms after an ACDF- either single or multiple levels vary depending upon the technique. Any surgeons that surgically distracts the disc level back to its original non-degenerative height will cause a stretch of the posterior ligaments that have for many years been shortened and contracted. This will cause posterior neck discomfort for anywhere from 2 days to three weeks. Also, the collar rests the weight of the head on the shoulders. The point of contact with the collar can cause irritation.
Ask your surgeon if you can come out of the collar for an hour twice a day. Also- ask if you can do the exercises found on neckandback.com under “pre and post op” then”post-operative rehabilitation” then “neck exercises” and finally “around the worlds” and “yes nos”. Some surgeons are reluctant to start exercises so soon so don’t be disappointed if he or she keeps you in the collar. Finally, a muscle relaxant works well to relieve some of the ache and spasm.
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.in reply to: Foot numbness due to bulging disc in lower back #4438I can probably help with the diagnosis and point to treatment but there is a problem with pro bono work in surgery. For a deserving individual, I will sometimes work for free and pay the salary of my physicians assistant and my own nurses on my dime. However, when someone undergoes surgery- the individuals and corporations involved are not just my responsibility. The hospital charges for the operating room use (somewhere about $100.00/ minute- they have to pay nurses, supplies, equipment, electricity, drugs and even mortgage on the space). The anesthesiologist has to get paid, the spinal cord monitoring company and the cell saver representative have payment requirements. Finally, the spinal companies would need to donate up to $20,000.00 in free implants to see a pro bono surgery come to fruition. It can be done but getting everyone and not just me on board takes an act of God sometimes.
In regards to your sister, her inability to feel her feet may not be directly related to her back. Compression of the spinal nerves normally does not cause bilateral numbness of the feet (although that can rarely happen). Typically, peripheral neuropathy causes bilateral numbness of the feet and that is sickness of the nerves in the legs and not of the back. Bluish feet are not related to the spine but to blood circulation problems from the arteries or the veins. She may need to see a neurologist for an EMG of her legs to determine the source of the numbness.
Let me know what goes on.
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.If you are a planning treatment of your neck or back condition, below are the best questions to ask when interviewing a spine surgeon.
1. What is your infection rate? And along the same lines, what is the hospital’s infection rate?
2. With whom do you operate? Do you have a resident, fellow, co-surgeon, or physician assistant? Specifically, what is this individual’s role in the surgery? Will you be in the surgery the entire time, and if not, what parts of the procedure will you not be present?
3. I am sure that you have had some complications or at the very least some unsatisfactory outcomes over the course of your career – how do you handle such outcomes?
4. Do you utilize intraoperative neuromonitoring? Do you utilize Stealth Navigation technology and an O-arm when placing instrumentation?
5. Would you be willing to allow me to speak with 3 consecutive patients who have had a similar surgery, perhaps from a specific period of time?
6. Will you be going out of town or unavailable for any reason within several weeks of my surgery? If so, what surgeon do you have covering your patients if there should be a delayed complication requiring a spine surgeon’s expertise?
7. How many times have you performed this procedure?
8. How many years have you been practicing spine surgery?
9. Do you collect data for research and/or to track your patient outcomes, complications, etc..?
10. Do you work with specific anesthesiologists? In the anesthesia group contracted with the hospital, would you be able to recommend one over another, or is it possible for me to research the anesthesia providers and request a specific one?
11. What is your fusion rate for lumbar surgeries?
12. What is your take on bone Morphogenic protein for fusions in the cervical and lumbar spines.
13. What do you think about artificial discs? In the neck? In the lower back?
14. How do you determine if a spine surgeon is any good?
15. What is the difference between a spine surgeon and a neurosurgeon for the spine?
16. What are the questions I should ask the surgeon before getting spine surgery?
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.in reply to: Does Disc Fusion Require a Neck Brace in All Cases #4434An ACDF at C4-5 can be performed with the graft being allograft (cadaver bone), autograft (your own bone) or a plastic cage with shavings and BMP (bone morphogenic protein). Each method has its own type of healing potential and stability. In all cases, if a plate is used in the front of the neck, the plate will confer immediate stability (as long as the carpentry of the graft and the surgical bed are well done). If the graft fits perfectly and the plate is applied correctly, there really is no need for a collar at all. I do use a collar for my patients for the first week just to remind them they had surgery and to comfort the achy muscles.
If more than one level is done, the plate would simply be longer in length. The recovery period would be about the same and the need for the collar is still questionable.
I have a different algorithm than some surgeons for post operative recovery and have my patients engage in immediate post operative exercises.This may not be how your surgeon operates so I don’t recommend doing this unless you get your surgeon’s approval. If you are interested- please go to my web site (neckandback.com) and look under the header “Pre & Post OP”, the subheading “Post Operative Rehabilitation” and finally “Neck Exercises”. I immediately have my patients start “Around the Worlds” and after one week, “Yes and Nos”. Do not do “Neck Situps” until you neck is fully healed.
Good luck!
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.in reply to: Do My MRI Results Warrant Spine Surgery #4433Reading an MRI through the eyes of a Radiologist always makes me nervous but I will let you know what I think. Is your only symptom “electrical jolts” down the spine which has significantly improved over the last few months? You do not complain of arm pain or weakness in your left arm, balance problems or problems with fine motor skills (handwriting and zipping a zipper). If this is correct- you most likely had a new onset herniated disc at C6-7 that originally compressed your cord but now is both shrinking down and your cord has accommodated. I can’t tell you the risk of future problems without knowing specific details.
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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