Cervical pain

Viewing 6 posts - 1 through 6 (of 16 total)

1 2 3 Next

Author

Posts
kristina76
Participant

August 25, 2013 at 8:52 am

Post count: 8

#9270

Hi Dr. Corenman,

I have a very complicated cervical pain problem and would love some advice. I’m a Physical Therapist and have had chronic neck/thoracic pain for about 15 years but have always managed it with exercise/massage,etc..

About 9 months ago, it spiraled out of control. I have severe muscle spasms, pinched nerve pain at left C2 and C3 with stabbing headaches, cracking, and any minimal use of my arms causes neck pain and spasms, especially on the left side of my neck. I’ve tried every treatment under the sun with no relief. All kinds of diagnostics as well. MRI shows moderate left foraminal narrowing at C3 and small disc herniation with no cord compression at C4. I am currently pursuing injections. Here are my questions:

1. I can palpate lateral left C3 vertebra which gives a nerve-like pain and there are spasms in this region. I get stabbing head pain that originates from this area. Turning my head to the left is difficult, sleeping makes the pain worse due to pressure on my neck. Its a debilitating pain. Does this sound more like C3 nerve compression from the foramenal narrowing or facet pain? Pain meds hardly even help.

2. I have pain/spasms on the left side of my neck with even the lightest lifting or use of my left arm. I used to think there was some instability (which may still be true) but could the C3 foramenal narrowing or facet involvement cause this kind of severe limitation with use of my arms going right to the left side of my neck? Have you ever heard of this complaint? This symptom is very hard to function with and has pretty much disabled me.

3. If the pain generator is more from the C3 nerve compression at the foramen, would they ever perform a foraminotomy due to the severe pain and radiating into the head? I know the indicator for surgery is usually more arm pain, but the C3 nerve doesn’t go down the arm. Wouldn’t relieving pressure on the nerve still help the localized nerve pain to palpation at left C3 vertebra?

Thank you so much for your time!

Kristina

Donald Corenman, MD, DC
Moderator

August 26, 2013 at 1:40 am

Post count: 8660

#9271

Your symptoms sound more like facet syndrome of C2-3 and C3-4. The reason it is called a syndrome is that you can prove facet dysfunction causing the symptoms by elimination of the symptoms through facet blocks (injections) but you cannot identify the disorder by imaging (X-rays and MRI). Now, you can identify (sometimes) degenerative facet disease by X-rays and MRIs but many individuals with facet degeneration do not have your symptoms and some with symptoms have no identifiable facet disease.

Diagnosis is by history, physical examination and injection studies. Your symptoms seem to fit and you can palpate and reproduce symptoms with deep facet pressure, the physical examination test.

Lifting of the left arm is facilitated through the levator scapulae muscle which inserts in this neck region and can aggravate the symptoms but shoulder disorders can also do this. You must rule out tendinitis or tear of the rotator cuff before the diagnosis can be fully made.

The diagnosis is made by facet block (see website for pain diary) and treatment is by rhizotomy (neurolysis of the medial branch of the posterior fascicle- see website). Generally, surgery is rarely needed.

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.

kristina76
Participant

September 26, 2013 at 7:24 am

Post count: 8

#9473

Hi Dr. Corenman,

Thank you so much for your thorough reply. As time goes on, I feel my symptoms point more and more to facet syndrome at C2-3, C3-4. I am scheduled for facet injections next week.

My only concern is when I palpate near the C3 facet joint, the pain is nerve-like, kind of like pushing on a toothache. And the pain I have from this area going into my head is stabbing in nature. The area is so hyper sensitive that I have pain with any small movement of my arms or even if I push down on a stationary bike with my legs, I will feel that area in my neck.

My theory is that the nerves surrounding the facet joint are irritated due to the swollen facet, or the medial branch itself is getting pinched at the joint. Because the nerves are inflamed, any contraction of my neck muscles to stabilize my arms or legs is pulling on the inflamed facets/nerves in the region.

Have you seen people with cervical facet syndrome with these type of nerve complaints? The nerve symptoms are what concern me the most as they are hard to pinpoint, treat, don’t respond to pain meds, and cause a lot of pain.

My MRI does not show much degeneration or disc problems, so I am hoping the facet is inflamed, not permanently damaged, and that facet injections may calm the area enough for me to be able to restore normal joint mobility in my cervical spine with treatment and stop the irritation. (I think faulty joint motion that I am currently treating may have cause excessive stress to C2-3 facets) I don’t believe there is nerve entrapment due to scar tissue because I have already treated and addressed that and still have the pain.

What are your thoughts about the nerve irritation and prognosis of pain relief with injections? I’m concerned about the whole chronic pain cycle that can be started and is hard to reverse. I think the problem has been building over time, but only this bad for about 10 months.

Thank you so much for all your help! I wish more Doctors were like you.

Kristina

Donald Corenman, MD, DC
Moderator

September 26, 2013 at 10:58 pm

Post count: 8660

#9481

Your observations are spot on. The medial branches of the facets are painful and palpation will reveal the types of pain you experience.

Don’t worry too much regarding the chronic pain cycle starting up. Most patients when treated for the pain generator will not have continuing pain.

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.

kristina76
Participant

June 27, 2014 at 4:06 am

Post count: 8

#11103

Hi Dr. Corenman,

I had contacted you a while back regarding C2-3, C3-4 facet pain. I had received some pain relief with my second cortisone injection, though not complete relief, so this tells me that at least some of my pain is facet related.

I am currently considering the ablation procedure and had a few questions for you.

1. I have heard that the C2-3 facet is a more risky area for ablation, and that it doesn’t have as high a success rate due to involvement of the occipital nerve. Do you find this to be true in your experience?

2. I am a PT and given my anatomy training, I am concerned about nerve damage/worsening pain from the ablation. I know this is rare, but can you give me a ballpark idea of how frequently this occurs? I have heard some people get great relief, and others where it seems like a horror story of worsening nerve pain after the ablation.

3. I also have researched pulsed radiofrequency ablation, where the nerves are stunned instead of burned. This seems like a safer option, but not many doctors in Mass. do this and I have also heard people may not get as good pain relief. What are your thoughts?

4. And finally, I have also read that Cat Scans are best for getting a better view of the facets. I have had multiple x-rays and MRI’s which show some degeneration in the facets, but not bad. I was wondering if it would be beneficial to get a Cat Scan to rule out any bone spurs around the facet joints? I just don’t want to expose myself to extra radiation if it’s not necessary since I’ve had so many tests.

If you don’t mind taking a few minutes to answer these questions, I would greatly appreciate it. I just can’t deal with this nerve pain anymore!!

Thank you,

Kristina Jaeckel

Donald Corenman, MD, DC
Moderator

June 29, 2014 at 5:16 am

Post count: 8660

#11112

Facet rhizotomies are relatively safe but this really depends upon the experience and care of the treating physician. C2-3 and C3-4 facets are the most common of all the facet treatments I order.

Ablation depends upon normal anatomy. The “burn zone” from the treatment probe in my understanding is about 3-4 mm. If the nerve is not in a normal anatomic position, the burn zone may “miss” the nerve. If the nerve is in the outside edge of the zone where a partial burn occurs, this could theoretically damage the nerve without fully destroying it.

In my experience, this procedure works about 75% of the time. There are a small subset of patients that become worse but normally, the flair-up of symptoms resolve in about three months. About 30% of patients need a repeat rhizotomy after about one year due to the nerves attempt to grow back.

Pulsed ablation in my understanding is more common in the thoracic spine where the medial branch nerves are much closer to the origins of the roots and there is some increased concern of injury. In my experience, pulsed frequency is less effective.

Cat scans may not be necessary in the case of facet originated pain. Sometimes, the facets may not look too degenerated but still will cause pain. Using the X-rays, MRI and a good physical examination should reveal facet mediated pain in the majority of cases. There are circumstances that CT scan is valuable but less than you might think.

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.
Author

Posts

Viewing 6 posts - 1 through 6 (of 16 total)

1 2 3 Next

You must be logged in to reply to this topic.

Donald Corenman, MD, DC

Average rating:

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel