Continued pain and new numbness after C3-C4 + C7-T1 ACDF

Tagged: cervical pinched nerve vs. pinched nerve in arm

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jsb
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September 14, 2016 at 8:50 am

Post count: 4

#22990

Dr. Corenman,

I am 11 weeks post ACDF C3-C4 and C7-T1 for left hand little finger/ring finger/wrist/forearm pain and complete numbness (herniation event to surgery was 4 months.) I also had C4-C7 ACDF 2 years prior for right hand numbness and pain which disappeared after surgery.

I continue to have the same left hand pain when standing, but the pain subsides and the hand is only numb when lying down. I started to develop right hand numbness around week 6. I had a follow-up MRI, with following results;

C3-C4: Bilateral facet hypertrophy is noted. Right paracentral/right foraminal bony prominence is noted. The findings cause mild to moderate right neural foraminal stenosis and very mild central canal stenosis is seen.
C4-C5: Bilateral facet hypertrophy is noted. Left paracentral/left foraminal bony prominence is noted. At the C4-C5 disc level, this mildly indents the spinal cord. No spinal cord abnormality is seen. These findings cause mild left neural foraminal stenosis. No significan central canal stenosis seen.
C5-C6: Bilateral facet hypertrophy is noted. Left paracentral bony prominence is noted which compresses the spinal cord. No spinal cord signal abnormality is seen. Bilateral bony prominences are noted. These findings cause mild bilateral neural foraminal stenosis. No central canal stenosis is seen.

Since the recent surgery, I have noticed significant muscle wasting (divots) between my left hand index finger and thumb and on the outer edge of my hand. If I sleep on my back, my right hand fingers go numb. Sleeping on either side will cause one hand to go numb.

I had an EMV/NCV one month ago on my left arm indicating “left ulnar wave latency” and “moderate to severe left sided C7 and C8 radiculopathies but not active.”

I am going to have the EMV/NCV repeated on left arm to see any further degradation and my right arm to see if there is any new/active denervation. I feel like the test might have shown different results on my left arm if I was standing since that is when the left hand/arm pain presents. The right hand is getting progressively numb. Could this be caused by new C6 compression from the old surgery (bone growth)? Can that be fixed? Thanks.

Donald Corenman, MD, DC
Moderator

September 15, 2016 at 6:04 am

Post count: 8660

#22994

I am unclear about your MRI findings if you had an ACDF (fusion) of C4-7 years ago. These findings note “C4-C5: Bilateral facet hypertrophy is noted” and “C5-C6: Bilateral facet hypertrophy is noted”. If these levels were fused, the radiologist did not note this and if these levels were fused some years ago, facet hypertrophy should disappear over time.

The C3-4 level will not cause hand weakness. This is the C4 nerve which does not descend below the shoulder and does not innervate (activate) muscles down the arm. You might have had the need for surgery due to “mild to moderate right neural foraminal stenosis” but I would have expected significant right upper shoulder/trapezius pain as the symptom present that required surgery.

The C7-T1 level is another story. The nerve that originates from this level (C8) does go to the hand and supply the muscles of the hand. You do not include the findings of the C7-T1 level which are important to know.

You certainly might have ulnar nerve entrapment in the shoulder (thoracic outlet syndrome) elbow or the wrist which could be causing some or all of your symptoms. See https://neckandback.com/conditions/thoracic-outlet-syndrome/, https://neckandback.com/conditions/cubital-tunnel-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.

jsb
Participant

September 15, 2016 at 7:58 am

Post count: 4

#22997

Dr. Corenman,

I omitteded the preface for each level which was the same… “There has been anterior discectomy and fusion. Anterior fixation hardware and disc prothesis noted with associated artifacts.”. The C7-T1 comments on the report are not in the conclusion section and only note the same hardware and “Mild facet hypertrophy is noted.”

I will ask the neurologist about eliminating the other possible entrapment locations. The original MRI looked bad at the C3-C4 and C7-T1 levels and much improved after the fusion. Perhaps the pain and numbness are from stretching the decompressed nerves as well as the progressing muscle wasting in the left hand and the new numbness in the right hand. Thanks for your advice, your site is outstanding.

Donald Corenman, MD, DC
Moderator

September 17, 2016 at 7:17 am

Post count: 8660

#23002

I worry that your compression might be from an entrapment neuropathy (as noted by my previous post). The EMG/NCV test will be helpful to determine this but a good clinical examination is important too. Please keep us informed.

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.

jsb
Participant

October 9, 2016 at 11:07 am

Post count: 4

#23167

Dr. Corenman,

I had the NCV on my right arm which showed moderate chronic denervation in the right triceps, FDI and EDC and mild chronic denervation of the APB. The report indicated moderate, chronic right sided C7 and C8 radiculopathics with nothing active. The right shoulder blade, right forear pain continues with dull pain in the center of my back. The finger-tip and thumb numbness is constant. Why is this presenting now when I had no right side symptoms before the fusion? How could C7-T8 be causing new problems (after fusion)?

I was also examined by a specialist for thoracic outlet syndrome. His feeling was that “while you very well might have thoracic outlet syndrome” he would not continue with anything until the original work was considered stable. He was concerned about the muscle wasting on my left hand having progressed so much after surgery.

The right hand/arm issues that started one month after fusion are not getting any better and the left side is still painful with no improvement in strength. I am concerned about losing right hand dexterity. I am hoping there is some way to identify the source of the new pain.

jsb
Participant

October 14, 2016 at 12:20 pm

Post count: 4

#23202

Dr. Corenman,

The second NCV on left side (2 months between) shows worsening. I am having a constant ache from the tops of my shoulders down the forearms and into index fingers when I stand. Lying flat on my back, I can make the little fingers go numb, standing or sitting, it moves the ache to the front of my arms and causes hand weakness and numbness in my index/thumb area. Since the problem is on both sides, I think there has been a shift in my spine or the fusion site is moving. Shortly after the ACDF, I felt a hump sensation when lying flat on my back on a hard surface. I also had sciatic leg pain. After a month of doing light abdominal exercises, the leg pain went away along with the hump feeling. Is it possible that my spine rotated and shifted upward (or downward) and I am feeling pressure at the nerve outlets of C8 (foramen)? It makes sense to me that there was initial downward pressure that I felt in my lower back and that strengthening that area pushes the whole works back up. It also makes sense that the pressure is from the bottoms of the outlets since I can reproduce numbness by tilting my head to either side (numbness is opposite the side I tilt towards) or rolling my shoulders inward. I am assuming the fusion is fixed after 3.5 months. The ACDF folks are suggesting a myelogram. Should I be looking at an MRI or X-Ray while flexing?
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Donald Corenman, MD, DC

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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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