Cervical Questions

Tagged: C4-5 C5-6

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Mindy1198
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March 10, 2020 at 4:18 pm

Post count: 1

#32261

Hello Dr. Corenman,

I have had pain in my neck primarily on the right side, right shoulder muscle tightness that goes down to the shoulder blade, this radiates to close to my armpit in the shoulder and down the right arm with majority of the shooting/somewhat sharp pain to my elbow. I have pin and needle pain in my hand usually felt in my thumb first then the pointer, and middle finger but tends to increase as it continues to tingle.
I have headaches that start at the base of my skull and move forward as it intensifies, its a constant headache with no shooting or sharp pain just a constant pain that starts dull and gets more intense throughout the day. The neck pain and headaches are aggravated by anything overhead. I used to participate in Crossfit but have since stopped as it was irritating my symptoms. Now I go to a regular gym and avoid anything overhead but still have intensified pain with upper body exercise.

Percentage of pain by location 50% neck & headaches 40% shoulder 20%arm.

Pain intensity varies: Daily 4-6 in the neck. Daily Headache 3-5. Daily Arm pain 2-4. Neck and head pain close to once a week gets to about a 9 with arm getting to about 6.

Weakness: General over head press weakness but I’m not sure if this is strictly due to avoidance from pain.

Incoordination and Numbness: None

Onset and Length of Time Symptoms Have Been Present:
Pain started about two and a half years ago, was very active in Crossfit, Gymnastics based classes, and Running. Symptoms started with neck pain, shoulder and headache. Arm pain became increasingly noticeable over a month or so while visiting chiropractor.

No injury.

Had previous compression fracture of the C5 from a water skiing accident in 2005. Causing extreme headaches and burning down my whole right arm and hand. Completed therapy, steroid injections, and work neck brace for 8 weeks. Problems subsided.

Activities:
Lifting heavy at the gym aggravates symptoms sometimes causing an intense headache generally squatting or leg press.
Biking for 8-10 miles irritates neck and arm pain.
Laying down on heating pad can curb the neck and shoulder tightness but does little for the arm pain and headache.
Generally I wake up in pain and the pain intensifies over the course of the day and builds over days.

Pain Intervals:
Daily pain that can range from annoying to debilitating.
2 pain level / annoying pain days are rare but celebrated, and I intentionally will not go to the gym or anything that might cause an increase.

Activity and Occupational Restrictions:
Pain has changed my life a great deal, I have went from highly active in different activities to two days a week at the gym with modified lifting.
I have a management / 80% desk job with no physical demands but walking.
I have missed work around 1-2 days a month due to pain and headache intensity.

Previous Consultations or Treatment:
I have been seeing a Neurologist for about 2 years primarily treated for Migraines – Clear Brain MRI results and normal EMG results. Currently getting monthly Amovig shot and Botox with no improvement.
2018 was visiting a Chiropractor, some headache improvement but no help with arm and shoulder pain.
I have had Physical therapy for 12 weeks unsuccessfully causing increased pain.
Acupuncture down right side of neck, shoulder and arm. No results.

Neurologist currently seen, indicated my MRI results were normal from the radiologist report.

MRI completed on 2-21-2020
Report:
Indication/History: History of headaches neck pain. History of stiffness radiating down right arm:

Procedure: MRI cervical spine without contrast

Comparison Plain film cervical spine performed 5/17/2018

Findings:
STIR sequences demonstrate no focal height loss or diffuse marrow edema.

There is diffuse disc desiccation.
Cervical cord demonstrates normal signal intensity. Cerebellar tonsils unremarkable.

C2-3: There is broad based posterior disc bulge. There is mild to moderate bilateral neural formainal encroachment and at least mild central canal stenosis.

C3-4: There is broad based posterior disc bulge with mild ventral thecal sac deformity. There is mild to moderate bilateral neural foraminal encroachment and at least mild central canal stenosis.

C4-5: There is broad based posterior disc bulge with mild ventral thecal sac deformity. There is mild to moderate bilateral neural foraminal encroachment and at least mild central canal stenosis.

C5-6: Posterior paracentral disc protrusion with ventral thecal sac deformity. This does not abut the cord. There is mild to moderate bilateral neural foraminal encroachment and at least mild to moderate central canal stenosis.

C6-7: Endplate spur visualization, mild ventrical thecal sac deformity and mild bilateral neural foraminal encroachment with mild central canal stenosis.

C7-T1: No disc protrusion, neural formainal encroachment or central spinal stenosis.

Impression:
At least mild to moderate central canal stenosis due to posterior paracentral disc protrusion identified at C5-6 that does not abut the cord.

Donald Corenman, MD, DC
Moderator

March 14, 2020 at 11:46 am

Post count: 8660

#32279

You note “pin and needle pain in my hand usually felt in my thumb first then the pointer, and middle finger” and then “pain in my neck primarily on the right side, right shoulder muscle tightness that goes down to the shoulder blade, this radiates to close to my armpit in the shoulder and down the right arm with majority of the shooting/somewhat sharp pain to my elbow”.

Your symptoms are consistent with a C6 or C7 radiculopathy. The symptoms noted “The neck pain and headaches are aggravated by anything overhead” could be from tilting your head back (extension) which is normally associated with overhead work and associated with cervical radiculopathy (pinched nerve in the neck) but can be associated with thoracic outlet syndrome.

See: https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/
https://neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/ and
https://neckandback.com/conditions/thoracic-outlet-syndrome/

Your MRI notes “mild to moderate bilateral neural foraminal encroachment and at least mild central canal stenosis” at almost every level so this confirms the symptoms could be from nerve root compression but does not specifically identify the level or levels involved.

I think the next step is a very thorough physical examination to determine if one or two roots can be identified. Most likely the C6 and C7 roots. Then a selective nerve root block with a pain diary would be used to “drill down” to the suspected root(s) involved. Then depending upon your structural anatomy, an ACDF or an ADR can be used to treat this condition surgically. See:

https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/
https://neckandback.com/treatments/diagnostic-therapeutic-neck/
https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/
https://neckandback.com/treatments/anterior-cervical-decompression-and-fusion-acdf/
https://neckandback.com/treatments/artificial-disc-replacement-adr-for-cervical-spine/

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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