[Banjo1964]

#21919

Hello Doctor:

I was given a glimmer of hope when I found your website. I did a search and some topics were close, but not exactly the answers I need. My journey into chronic pain began when I was six, riding in the back of my mom’s Pontiac Tempest, standing on the back floorboards, when a drunk rear-ended us and I went flying. Then in my early 20’s, I was working at the airport while in college and putting freight in airplanes. My coworker was driving the forklift and putting a fuselage-shaped freight can into the belly of the craft. He hit a bump and the can shifted and came towards me. I was in between the aircraft door and the can, and as it was coming at me I pushed in an awkward position and heard a pop. Fast-forward to 1998 when the cervical pain when barometric pressures were changing became intolerable. I saw a surgeon in Enid, OK who performed an anterior cervical discectomy with fusion of a piece of bone out of my hip, no plate. That lasted for a while then the pain came back with a vengeance in 2010, and a Wichita surgeon performed an anterior corpectomy with autograft fusion and plate. The results were wonderful for a month, then lying in bed one night, I heard and felt a pop or thud, and I suppose that is when the autograft slipped out of the corpectomy slot. Another 3 years go by and now the pain increases drastically. A new surgeon determines through MRI that the old autograft from 2010 had actually eaten through my vertebrae and my neck was about to incur a fracture. The 2013 surgeon, a neurosurgeon, determined that the 2010 autograft had not been shaped to the proper shape by the surgeon, who I then found out had lost his medical license for being a pill-popping drunk. A 19 year old athlete that alcoholic orthopedic surgeon worked on sued him for 19 screws that disabled him, some of which were pressing on the aorta and organs. The 2013 neurosurgeon performed a 360 degree cervical surgery with revision corpectomy and autograft at C5-6, posterior laminectomy and instrumentation from C7 to C3, with Foraminotomy. That helped for about 6 months and I was able to wean myself off oxycodone. Then the pain increased and the same neurosurgeon performed an additional posterior Foraminotomy on the C6-C7 level. I had a terrible staph infection that left a gaping wide scar from C3 to C7. Once I recovered from the fourth and final surgery, I was never comfortable and had various levels of numbness in my right arm, hand and fingers. The pain has decreased and I was told by a Kansas City surgeon that supposedly fixes other surgeon’s mistakes that my only option would be a spinal cord stimulator. My pain levels have increased by the month, and now I am on straight 15 mg oxycodone every 6 hours and 10-325 every 4 hours for pain. In the last 6 months, barometric pressure changes have caused huge grinding headaches and neck aches that the oxycodone do not seem to lessen. A Nikken magnetic necklace seemed to provide a little relief when I bought it and started using it 2 months ago. I am becoming desperate for relief, and the spinal cord stimulator with possibly only 60% relief, if any, is not an appealing option. My question to you doctor, is, is there anything out there short of surgery (which I can’t have due to scar tissue) that could provide relief? If I were not a Christian man and were selfish I would have ended my life by now. Any information on any treatments you think would help would be appreciated. Thank you.

[Donald Corenman, MD, DC]

#21925

OK. You have had a number of surgeries but have not identified the levels of the operations. 1998 had an ACDF and apparently no complaints until 2010 so I will assume a successful initial surgery with a solid fusion. 12 years later, you underwent a corpectomy (removal of two discs and the vertebral body in-between). You don’t identify levels.

I will assume that you had a partial displacement of this corpectomy graft (not necessarily highly unusual). What is highly unusual is that the surgeon did not correct this mechanical problem and you had to live with it for three more years.

You then had a revision of the C5-6 ACDF (I am unclear why just one level as the failed corpectomy should have involved two levels) and a posterior fusion C3 to C7 with decompression. Unfortunately, the staph infection can cause havoc to a healing posterior incision and this could be one problem than keeps causing symptoms.

Did this fourth surgery cause more intense or new symptoms that were not present prior to this surgery?

Headaches can be caused by facet disorders and since you have only the C2-3 level left above your C3-7 fusion, I would suspect degenerative changes leading to posterior headaches. I think you need a new MRI and especially a new CT scan to determine fusion status, the facet integrity of C2-3 (and even C1-2) and if there is any hardware stenosis or residual spur formation causing continued nerve compression.

I cannot comment of the use of a spinal cord stimulator until you can demonstrate that you have a solid fusion, no screw stenosis, no residual nerve compression and no significant wear of the levels above and below.

You will have to be careful with a spinal cord stimulator in the face of a prior cervical laminectomy and posterior wound infection. The stimulator is designed to lie between the dura and the back of the lamina. You no longer have lamina and the dura might be scarred to the posterior muscles after an infection making stimulator placement difficult.

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.

[Banjo1964]

#21947

Thanks for your reply Doctor. My initial problem was a ruptured disk between C5 and C6. I think I incurred the damage when I was around 19 working at the airport. Through the 1980’s and my early marriage in the early 1990’s, I didn’t have much problem except for occasional grinding headaches, When my wife and I lived overseas in South Korea in 1995 and 1996m the problems began to increase with pain, but a great Korean masseuse helped quite a bit when I needed relief. When we returned stateside in 1997 us when I would say the dreadful facet joint headaches started. The surgery in Enid in 1998 was a C5-6 Discectomy with fusion from my hip bone, no plate. I do not know what happened to the hip bone in my neck, but things got bad enough in 2010 to seek out Kris Lewenowsky, who had a good reputation at the time. He performed the Corpectomy over C5-6 with an autograft from a cadaver tibia bone that he misshaped and evidently forced in. The reason the surgeon didn’t correct the bad graft is because he had his license taken away by the KS Board of Healing Arts and then went to a dry-out facility somewhere. I didn’t really know I had a problem until Dr. Dickerson opened me up in 2013 to do the 360 degree and told me afterward that the autograft didn’t fit the slot Lewenowsky made for it, and had subsequently eaten through my vertebrae to where it had nearly severed by vertebrae to cause a broken neck. I felt nominally better well after the 2013 Surgery, enough to get off the opioids for 6 months. Then the pain began to increase and Dickerson performed the laminectomy and supposedly opened up the C6-7 and perhaps T1 lamina and removed bone spurs. I have not been right since that last operation. I awake sometimes with my hands or fingers totally numb. If I hold my arm up my fingers go numb on my right hand mostly, but have had issues in my left. I find that I carry my left arm up to my side across my chest like a sling to get comfort whenever I am not using it. I would say the levels that they work on had to be C5 and C6 with possibly C4, because the last MRI before that had to switch to CT Mylograms to see anything showed a huge graft that looks 3″ tall. My symptoms after the laminectomy have been increasing by the month, with the latest thing being these terrible facet joint headaches that happen when barometric pressure is either rising or lowering, and they are getting unbearable where oxycodone 15 mg and 10-325s are not having any effect in lessening pain. If I am not a candidate for a spinal cord simulator with all this hardware, scarring and wear, what other options are there? Up to 8 months ago I could lay down on my back or side and get mostly relief, but now that is going away.

[Donald Corenman, MD, DC]

#21948

You need a complete work-up including a meticulous history and physical examination, complete imaging studies including a CT scan and an MRI. You probably need then selective nerve root blocks or facet blocks to confirm any diagnoses. It is a possibility you even might need an EMG/NCV test.

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.

[Banjo1964]

#21954

I was told that I went through the last very painful CT Mylagram due to the metalwork in my neck. That was a horrible experience, especially the tilt and the ink going into my forehead making me think my head was about to explode. Wichita is known for doing surgery too much. You seem to be the only doctor that knows what they are talking about. How would someone in Kansas be able to see you for getting repaired?

[Donald Corenman, MD, DC]

#21955

A CT myelogram should be performed with an injection in your lower back, not neck (which is too painful generally). The dye injected into the lower back is heavier than water (CSF) and will flow up to your neck if you are placed in the Trendelenberg position (head down). If you hold your neck in extension while the dye runs up to the neck, it should not go further. Then, the CT scan takes about 5 minutes.

I cannot tell you if you are a surgical candidate but I would be happy to see you to determine what is wrong and let you know if surgery has a chance of helping you.

Please call Lori Fugate at my office to schedule an appointment. Let her know we have been discussing your case on the forum.

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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