[Donald Corenman, MD, DC]

#33915

“ACDF’s were performed in 2012 and 2013, how can they not dissolve after 8 to 9 years? Was told in my case give it a little longer, it takes a very long time. This does not sound right to me”. In absolute agreement. ‘Give it 25 years and you’ll be OK’ is not a timeline I would endorse.

“I asked about moderate to severe noted on my CT scan at C3-C4 and was told that the radiologist over stated the degree of compression”. That is not uncommon for a radiologist to overstate the degree of compression. However, if a C4 radiculopathy fits with your remaining symptoms, a selective nerve root block with immediate 3 hour relief is a confirmation that the nerve foramen compression is part of the problem.

“if you have an instrumented fusion, how would one develop severe kyphosis after laminectomy”? You wont develop a kyphosis at fused levels but at the levels adjacent to the fusion. If the fused levels develop kyphosis later, you don’t have a fusion.

A new CT is going to be valuable to determine fusion status.

“He didn’t address nerve channels during last surgery, because in his opinion the level below my previous fusion T2-T3 should be pain generator. I’m scratching my head on this one also, by no means I’m a spine surgeon, however this is strange for a pre surgical plan to be drafted only to be scraped during surgery”. Not sure what to make of this statement.

“His plan is to order for my next office visit flexion and extension x rays – next week”. These will help with current understanding of stability.

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.

[westie California]

#33928

Good evening Dr. Corenman,

I hope all is well Doctor and that you had a great day.

I have some questions on verbiage in a CT scan report and what treatment would you recommend if any?

1) “There is degenerative osseous fusion of bilateral facets from C3 through T1″.

2)”Dorsal epidural soft tissues at all levels from C3-C4 through C7-T1, is most likely granulation tissue”

Thanks

[Donald Corenman, MD, DC]

#33931

“There is degenerative osseous fusion of bilateral facets from C3 through T1″. not sure why the radiologist used the term “degenerative osseous fusion” as this was an intentional surgical fusion but this reading indicates that there is a solid facet fusion at those levels.

”Dorsal epidural soft tissues at all levels from C3-C4 through C7-T1, is most likely granulation tissue”. I assume that he or she means scar formation at the laminectomy site which is to be expected.

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.

[westie California]

#33936

Hello Dr. Corenman,

1) you mentioned “A new CT is going to be valuable to determine fusion status”. In 2019 a CT scan was performed at a different hospital setting from 2020 Scan, that stated “degenerative osseous fusion” and from your last message “reading indicates that there is a solid facet fusion at those levels”. So it probably safe to say C3-T2 is fused, with T2-T3 pending?

2) My pain management physician states the following:

“Patient presented in office today for evaluation of neck pain and bilateral upper extremity pain. His pain is most likely due to a combination of post laminectomy pain syndrome, cervical radicular pain, facet arthropathy, and myofacial pain.It was discussed in detail regarding patient’s pain management options, including medications, interventional pain procedures, physical therapy, and surgery. Patient is interested in spinal cord stimulation therapy. I explained to patient that he had undergone ten C-spine surgeries. He has extensive scar tissue and altered anatomy in his cervical spine epidural space. The risk of complication outweighs the potential benefit of the SCS. I do not rec this procedure for him”

I’ve had EMG’s that shown abnormal results from chronic radiculopathy at C5, C6, C7 and C8 nerve roots. My Neurosurgeon is reluctant to perform any posterior foraminotomy procedures at these levels due to significant scar tissue encountered during my last hardware removal that required emergency consultation with a plastic surgeon to remove scar tissue, perform an excision and debridement of upper back and neck wound and reconstruction of flaps. My last CT scan shows

C3-4: No significant disc disease. Bilateral uncovertebral spurring and bilateral facet arthropathy, mildly progressive since 5/19/2018. There is associated mild right and moderate to severe left foraminal narrowing.

C4-5, C5-6, C6-7, C7-T1: Postsurgical changes. No significant disc disease. Spondylitic ridging and uncovertebral spurring at C4-5, C5-6 and C6-7, mildly progressive since 5/19/2018. There is associated foraminal narrowing, mild on the right at C4-5 and C5-6, mild on the left at C6-7. No significant foraminal narrowing at C7-T1. No significant central canal stenosis at any of these levels.

3)If I remember correctly from past questions, if one is fused 360 then facets should not cause pain because one there’s no motion and two those nerves were obliterated during fusion?

4) My last block’s that was performed in 2020 at C3, C5 and C7 bilaterally resulted in a greater improvement at C3 with smaller amount’s at C5 and nothing at C7 (probably not a pain generator). Previous year injections at C4 and C6 resulted in a positive pain reduction. My question is would an RFA be the next course of treatment for these?

5)You state that CT Scan “is stating a solid facet fusion”, if one is fused 360 anterior (ACDF) and posterior(Facets) shouldn’t radiologist comment on fusion status of disc space? How does one know if front is not moving without any reporting on status?

6)Can these “Dorsal epidural soft tissues at all levels from C3-C4 through C7-T1” cause radiculopathy, muscle spasms or pain?

Thanks for your continued support!

[Donald Corenman, MD, DC]

#33961

“So it probably safe to say C3-T2 is fused, with T2-T3 pending”? Yes

“My pain management physician states the following: His pain is most likely due to a combination of post laminectomy pain syndrome, cervical radicular pain, facet arthropathy, and myofacial pain”. I don’t like the term “post laminectomy pain syndrome” as it does not describe the pain generator and blames the pain on prior surgery.

You do not have facet arthropathy pain as your facets are fused and motion is required to cause facet pain. Of course, you could generate pain from the movable levels above and below the fusion levels.

Radicular pain is possible if you have chronic radiculopathy (See; https://neckandback.com/conditions/chronic-radiculopathy-neck/) but you don’t have any evidence of severe foraminal stenosis at the operated levels. You do have significant narrowing at the C3-4 level on the left above your fusion, so that level can be evaluated.

“Patient is interested in spinal cord stimulation therapy. I explained to patient that he had undergone ten C-spine surgeries. He has extensive scar tissue and altered anatomy in his cervical spine epidural space. The risk of complication outweighs the potential benefit of the SCS. I do not rec this procedure for him” This might very well be true but you could still be a candidate for peripheral nerve stimulation.

If you have a solid facet fusion, RFA would be pointless.

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.

[westie California]

#33967

Dr. Corenman,

Thank you so much, I really appreciate that! My surgeon sent me to a thoracic outlet specialist this past Friday for an evaluation. The specialist said there’s some concerning observations and that he’s ordering an “MRA Scan”.

Can this condition also cause base of neck pain, shoulder, bicep pain, etc.? I’ll keep you posted after scan is performed. Thanks

[Author]

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