[Donald Corenman, MD, DC]

#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]

#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]

#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]

#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]

#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]

#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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