Chronic neck pain

Tagged: Neck pain

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mocka300
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June 17, 2022 at 12:47 pm

Post count: 10

#35130

Hello, I have chronic neck, hand, arm, feet, and leg pain; shooting, burning, zapping, and pins and needles It started out as neck pain that worsened after a car accident. I had a complete workup from a Rheumatologist, Neurologist, Orthopedic, and Neurosurgeon. My Rheumatologist diagnosed me with Fibromyalgia. I have been convinced that the pain is coming from my neck. My MRI showed that I had a central herniation abutting the spinal cord. Latter the pains became more often and more intense after I worked in my sister’s bathroom installing tile. I had another MRI done and it showed that the herniation was worse and that it was indenting the spinal cord. I went to pain management and had cortisone shots and facet joint shots. It seemed like the cortisone shot helped a little. I also went through numerous rounds of PT. My symptoms worsen when I am sitting a certain way bending my neck and on the computer. I ended up having ACDF at the C5/6 level. After surgery, my feet were worse. They were tingling and numbness constantly for several weeks. Now it’s on and off throughout the day but all my pain and symptoms are worse since surgery. Some of the pain is very sharp. I also had zapping down my spine but that has subsided. I get headaches as well. I had the Orthopedic Surgeon order an MRI several months after my surgery but he said I needed to followup with the my Neurosurgeon sense he did the decompression part of the surgery. After seeing him, he had me get a nerve conduction test that came back fine. The appointment ended with doctors can’t fix everything and that everything looked good and I have to learn to live with the pain. I think it’s possible I have Fibromyalgia as well, but I don’t know. Here is the last MRI report. I am wondering if I should get a CT scan or not.

Status post ACDF at C5-C6 since prior study of 9/18/2021. Some residual encroachment upon the right ventral aspect of the spinal canal cannot be ruled out, but is accentuated by blooming artifact from metallic hardware. Consider CT evaluation for more accurate depiction of osseous structures and metallic elements.
2. Mild central disc protrusion at C4-5, unchanged from prior examination.

mocka300
Participant

June 17, 2022 at 1:02 pm

Post count: 10

#35131

This is the full MRI report.
EXAM: MRI CERVICAL SPINE WITHOUT CONTRAST
HISTORY: 55 year old female states neck, right shoulder and arm pain for several years, increased February 2022.
Widespread pain and pins and needles. History of cervical fusion surgery October 20, 2021. TECHNIQUE: Using a 1.5 Tesla magnet, multiplanar T1 and T2 weighted images were acquired. COMPARISON: Preoperative examination of 9/18/2021
FINDINGS:
General Observations: Since the previous examination, an anterior cervical discectomy and fusion has been performed at the C5-6 level. Two screws are present in each vertebral body, slightly eccentric towards the right.
The C1-2 through C3-4 levels are unremarkable.
At C4-5, there is mild central disc protrusion abutting the spinal cord without displacement or compression. The neural foramina are patent. No change from prior.
At C5-6, the two fusion screws appear to extend to the right posterior margin of the vertebral body, and there appears to be some residual endplate hypertrophy indenting the thecal sac and abutting the cord. This is not as pronounced as the disc protrusion noted previously, is accentuated by the blooming artifact caused by metallic hardware. There is no cord edema or myelomalacia. There is no definite foraminal stenosis.
At C6-7 and C7-T1, there is no disc bulge or herniation. Uncovertebral and facet joints are normal. No central canal or foraminal stenosis.
Spinal cord: No cord edema or myelomalacia. Paravertebral/Prevertebral soft tissues: Unremarkable.
IMPRESSION:
1. Status post ACDF at C5-C6 since prior study of 9/18/2021. Some residual encroachment upon the right ventral aspect of the spinal canal cannot be ruled out, but is accentuated by blooming artifact from metallic hardware. Consider CT evaluation for more accurate depiction of osseous structures and metallic elements.
2. Mild central disc protrusion at C4-5, unchanged from prior examination.

Donald Corenman, MD, DC
Moderator

June 17, 2022 at 1:52 pm

Post count: 8660

#35132

You note after the C5-6 ACDF; “After surgery, my feet were worse. They were tingling and numbness constantly for several weeks. Now it’s on and off throughout the day but all my pain and symptoms are worse since surgery. Some of the pain is very sharp. I also had zapping down my spine but that has subsided”. All of your symptoms are non-specific so further description could be helpful. I’ll include a hyperlink noting how to give a good history at the bottom. Normally, myelopathy (problems due to compression of the spinal cord) causes incoordination and paresthesias in the feet but not pain.

The radiologist notes; “appears to be some residual endplate hypertrophy indenting the thecal sac and abutting the cord. This is not as pronounced as the disc protrusion noted previously, is accentuated by the blooming artifact caused by metallic hardware. There is no cord edema or myelomalacia”. This means there is some smaller residual abutment of the cord, but not as bad as before surgery. However, you could have developed a pseudoarthrosis (non-fusion) of the C5-6 level which could leave you with greater neck pain than before. A fine-cut CT scan would be quite helpful to evaluate the fusion, residual compression and will get rid of the “blooming artifact” noted to obscure the image.

https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/

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.

mocka300
Participant

July 11, 2022 at 7:18 am

Post count: 10

#35138

Dr. Corenman, I want to thank you for your reply. I found it to be very helpful.I am working on putting together a better description of my pain/symptoms using the guidelines from the link you provided. In the mean time, my primary ordered the CT scan, which I am having done today. I will give an update soon.

mocka300
Participant

July 13, 2022 at 8:51 am

Post count: 10

#35139

Hi Dr. Corenman,

Here are my CT results from 7/11/22. I had my ACDF on October 20, 2021. Is “significant partial osseous incorporation” considered normal at the stage of healing? I am still waiting to hear back from my primary doctor on these results.

HISTORY: 55 year old female. Radiculopathy, cervical region.

TECHNIQUE: Spiral CT was performed, and multiplanar images were created. One or more of the following dose reduction techniques were used: automated exposure control, adjustment of the mA and/or kV according to patient size, use of iterative reconstruction technique.

COMPARISON: Cervical spine CT from 04/20/2021

FINDINGS:
ACDF C5-C6 with intact orthopedic hardware in place. Interbody fusion at this level with significant partial osseous incorporation. The vertebral bodies have a normal appearance and the bony alignment is normal. No abnormalities are seen at the craniocervical junction or the C1-C2 level. No fracture, dislocation, lytic or blastic lesion is seen.

IMPRESSION:
ACDF C5-C6 with intact orthopedic hardware in place. Interbody fusion at this level with significant partial osseous incorporation.

Donald Corenman, MD, DC
Moderator

July 13, 2022 at 10:11 am

Post count: 8660

#35140

To my mind, “significant partial osseous incorporation” is most likely a solid fusion meaning a successful immobilization of this level. This would mean that local neck pain generation should not be possible at C5-6. It is interesting to note that he does not comment on the decompression of the spinal canal or nerve roots at C5-6 or at any other level.

This means that either you have pain generation at another level, you still have compression at this level or you have a chronic nerve injury that continues to cause pain even though it has been decompressed. The only way to find this out is to undergo diagnostic testing with facet blocks and nerve root blocks. See here:
https://neckandback.com/treatments/diagnostic-therapeutic-neck/
https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/
https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/
https://neckandback.com/treatments/facet-blocks-and-rhizotomies-neck/

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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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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