Neck and Shoulder Pain

Tagged: ADR (artificial disc replacement) vs Fusion, Neck pain, RFA, X-raysh

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BRONCOFAN1
Participant

June 30, 2017 at 9:34 am

Post count: 42

#25357

Hi Dr. Corenman,

I have been having significant neck and shoulder pain for the last 5 months which came on suddenly without injury. The pain is a gnawing pain just above C7 at the back of the neck, along with burning pains on both sides of the neck out toward the shoulders. It seems to be recurrent, with periods where it improves a bit followed by relapses. Initially I had deep pain between the shoulder blades and significant pain at the lateral portion of the shoulder along with neck stiffness – the stiffness seems to have faded somewhat. I have tried medrol dose packs and physical therapy without success – neck exercise and running significantly irritate the condition, while lying down seems to relieve it. I have also more recently developed very occasional shooting pains in my arms that seems to correspond mostly to the C6 nerve path (near wrist on thumb side, outside forearm, outside of upper arm). Two ESIs gave me a week or so of relief from the the burning pain. My MRI shows a diffuse bulging disc a C5/C6 with posterior predominance, 4MM in AP dimension and an annular bulge at C6/c7, also posterior predominance measuring 4 MM in AP dimension. There are also a few places with mild uncovertebral hypertrophy. EMG shows Incr insertion activity, > 12 ms Dur and +1 poly on both left and right biceps and Brachiradialis, Incr Ins Activity and +1 PSW on the left triceps, and all cervical paraspinals Incr Insertion activity and +3 poly. Flex/Ex Xray does not show instability. My neurosurgeon recommends a two level disc replacement with Mobi-C at C5/C6 and C6/C7.

I suppose the main question I have is whether this is a normal presentation – the MRI does not show any neural impingement, but it seems like the nerve is irritated with the dynamics of daily activities. I am really just trying to get comfortable that the disc replacement has high odds of relieving these symptoms. Thanks for your wonderful website and forum.

Best,
Kevin

Donald Corenman, MD, DC
Moderator

July 2, 2017 at 6:39 am

Post count: 8660

#25371

Your symptoms do match with cervical radiculopathy. I am unclear as to your comment that “the MRI does not show any neural impingement” as a “diffuse bulging disc a C5/C6 with posterior predominance, 4MM in AP dimension and an annular bulge at C6/c7, also posterior predominance measuring 4 MM in AP dimension” would cause neural foramen compression (unless this spur/bulge does not enter the foramen.

Your relief of neck and arm pain form the epidurals is also evidence that these levels are the pain generators. Did you keep a pain diary after the injections (https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/)?

I cannot comment on the indications for two artificial discs (ADR) vs. the need for ACDFs (anterior decompression and fusion) as there is not enough information to determine if you are a candidate for ADR vs. ACDF. If your neck pain is greater than your arm pain, generally an ACDF is preferred over ADR. IF any level has discal collapse (greater than 50% loss of normal disc height), you would not be a candidate for ADR. If you have had facet blocks with greater than 50% relief of your neck pain, an ADR would not be indicated.

Do understand that I like ADRs for some patients but as a simple mechanical device, the ADR will eventually wear out and need to be replaced with an ACDF eventually.

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.

BRONCOFAN1
Participant

July 2, 2017 at 7:14 am

Post count: 42

#25373

Hi Dr. Corenman,

Thanks so much! On the MRI, the report did not indicate a nerve compression (I’ve seen that on some reports), but it makes sense that these bulges narrow the foramen and it certainly seems they are causing at least intermittent compression.

I have not had facet blocks, but I have full range of motion in my neck without
generating additional pain and only minor loss of disc height. The neck pain that I have is a gnawing pain at the back of the neck that is intermittent and relieved by muscle relaxants (I assume it is due to paraspinal spasms). I am 39 years old without a history of neck pain until now. Is it safe to assume that the facets are not the pain generator or would you suggest facet blocks to be sure?

Thanks!
Kevin

BRONCOFAN1
Participant

July 2, 2017 at 7:29 am

Post count: 42

#25374

Dr. Corenman,

A quick clarification, I have full range of neck motion without generating immediate pain. PT neck exercises and running both cause an increase in the burning pain from the side of the neck out toward the shoulders but this begins 30-60 minutes after the activity is completed.

Thanks again!
Kevin

Donald Corenman, MD, DC
Moderator

July 2, 2017 at 10:06 am

Post count: 8660

#25375

Generally, it is the radiologist’s job to note foraminal stenosis but there are some reports where I have see mis-dictations.

Delayed onset of pain is not typical for nerve generated pain. You might consult an injectionist or a spine surgeon to see if you are a facet block candidate.

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.

BRONCOFAN1
Participant

July 3, 2017 at 7:39 pm

Post count: 42

#25390

Hi Dr. Corenman,

I took another look at my MRI, and it does state that at c5/c6 there is no neural foraminal stenosis despite the diffuse bulging disc… and c6/c7 mild left neural foramina stenosis related to uncovertebral hypertrophy along with the annular bulge. However, both the EMG and my symptoms seem to indicate a bilateral C6 nerve root irritation at a minimum. In your experience, does the irritation / compression sometimes happen dynamically in a way that a static MRI doesn’t capture?

My experience has been strange all the way around… Spurling test is negative and I am not able to recreate the pain with any particular neck position.

I will look into having the facet blocks done to see if that is the pain generator – wouldn’t it be unusual for the facet joint inflammation to cause radiculopathy though?

Thanks!
Kevin
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Donald Corenman, MD, DC

Average rating:

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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