5 Level Cervical Laminectomy w fusion

Tagged: cervical muscle spasms, pain after 360 fusion

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Donald Corenman, MD, DC
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April 18, 2021 at 1:12 pm

Post count: 8660

#33970

See if these symptoms fit with TOS.
https://neckandback.com/conditions/thoracic-outlet-syndrome/

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
Participant

April 24, 2021 at 3:33 pm

Post count: 138

#34004

Good afternoon Dr. Corenman,

I want to thank you for your continued support before asking my question. The latest is on Thursday, pain management performed an EMG and Nerve conduction and gave results verbally. I’m still waiting for official report and will post upon receipt. The results showed mild left carpal tunnel, and moderate to severe left side C5, C6, C7 and C8 radiculopathy. The doctor told me, I didn’t heal from my surgery in December 2020 and he doesn’t think it’s permanent nerve damage. He became very upset, when I kindly mentioned that my surgery in December 2020 was on T2-T3 level (fusion) and that C5 thru C7 were operated back in 2017, so how can more time be needed to heal?

He said in a stern voice that I can cut 50% of the nerve and strengthen the muscle and you would not be able to tell. I was instructed to report to office next Wednesday and he will administer Botox in the morning, and to return in afternoon to hospital so he can perform injections in front of neck “scalene muscles”.

My questions are:

1. After 4 years is it safe to say this is chronic radiculopathy?

2. Can chronic radiculopathy cause neck muscle spams?

3. I read your article on thoracic outlet and and see arm and shoulder pain, however no neck pain listed as a side effect of TOS?

4. Can one developed some kind of muscle dysfunction after posterior spine fusion’s that would cause severe spams?

Thanks in advance

Donald Corenman, MD, DC
Moderator

April 25, 2021 at 10:55 am

Post count: 8660

#34005

“I can cut 50% of the nerve and strengthen the muscle and you would not be able to tell”. Well, the simple answer is that he is wrong. After 4 years (if there is no continued compression), it is safe to say this is chronic radiculopathy. If there is still significant compression remaining, maybe not.

Chronic radiculopathy can cause neck spasms but a multilevel fusion can do that too.

Generally, with TOS there can be a minor component of neck pain.

A multilevel fusion can cause severe spasms, especially if there is malalignment (lack of lordosis).

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
Participant

April 25, 2021 at 12:16 pm

Post count: 138

#34006

Thank you so much Dr. Corenman!!!

I am extremely thankful for your answers. I have “Lordotic Straightening” which sounds like lack of lordosis? So would the best treatment be Botox for severe spasms? Thanks

westie California
Participant

May 24, 2021 at 12:24 pm

Post count: 138

#34084

Good afternoon Dr. Corenman,

Wanted to give you an update on the following results from testing, Imaging and ask some questions please Dr.:

MRA

“Mild to moderate extrinsic compression of subclavian veins on hyperabduction, without distention or thrombosis in neck veins or cephalic veins”.

EMG

“Evaluation of the Left median sensory nerves showed prolonged distal peak latency (4.0 ms). Needle evaluation of the Left biceps and the Left triceps muscles showed diminished recruitment. The Left mid cervical paraspinal muscle showed moderately increased spontaneous activity. Abnormal study. Electrodiagnostic testing reveals evidence of left C5-6 cervical radiculopathy without distal denervation. There is also evidence of left neuropathy at the wrist without distal denervation.

The graph shows: left biceps C5-C6 abnormal and left triceps C6-7-8 abnormal

The last time we spoke you mentioned “Chronic radiculopathy can cause neck spasms but a multilevel fusion can do that too” and “A multilevel fusion can cause severe spasms, especially if there is malalignment (lack of lordosis)”.

I still have severe pain and muscle spasms with lack of lordosis. My previous CT scan mentioned “Spondylitic ridging and uncovertebral spurring at C4-5, C5-6 and C6-7, mildly progressive since 5/19/2018. Foraminal narrowing, mild on the right at C4-5, and C5-6, mild on the left C6-7.

C3-4 Bilateral uncovertebral spurring and bilateral facet arthropathy, mildly progressive since 05/19/2018. There is associated mild right and moderate to severe left foraminal narrowing.

Any recommendations on what I should do next? I’m not sure if those Spondylitic ridgings and uncovertebral spurrings are contributing to my issues and if so what surgeon would want to go back in and perform revision ACDF’s? also because of my malalignment what part of this condition is the source of pain? The pain in the base and mid neck is much more painful then my biceps. Thanks

Donald Corenman, MD, DC
Moderator

May 25, 2021 at 9:42 am

Post count: 8660

#34085

“I still have severe pain and muscle spasms with lack of lordosis. My previous CT scan mentioned “Spondylitic ridging and uncovertebral spurring at C4-5, C5-6 and C6-7, mildly progressive since 5/19/2018. Foraminal narrowing, mild on the right at C4-5, and C5-6, mild on the left C6-7”.

It is very unclear as to why you continue to have pain. It could be from malalignment, adjacent segment disease (unlikely if fused down to T3 except for C2-3), chronic radiculopathy or compressive radiculopathy. There is no real way to determine which radiculopathy you have with a solid fusion. Any surgery to correct malalignment may not help and is a big surgery for questionable results. Redo decompressions may do nothing for you if you have chronic radiculopathy. You might consider a peripheral nerve stimulator.

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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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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