[Longbranch]

#20330

Dr. Corenman

My story is long but I will keep it short. I had an Anterior Fusion and Disc. in 2003 on C5/6 6/7 with titanium rods and screws and never felt better after surgery. I kept on going back to the surgeon and he said everything was fine in fact he took x-rays and said everything was fine that the pain must be “fibromyalgia”!!!
In 2005 (since I wouldn’t go away) He finally sent me for a myelogram an called me that night to come in for a consultation the next day and I was told that I never fused at 6/7.
I have been in chronic pain ever since.My Neurosurgeon says that my non-union is not where my pain is coming from. Have suffered since the year 2000 and have done every treatment possible but still have terrible pain. Recently I have had several opinions by Neurosurgeons, Ortho surgeons to have a Posterior Fusion as they say there is some widening at the gap at 6/7, a small amount of back out of the screws (halos one neuro sees) and now the neuro has sent me to another Neuro who does complex surgeries (professor at a University Hosp.) who wants to use the D-trax cage system on me.
I saw an answer that you gave someone else about the Dtrax that you didn’t like it!!! This surgeon and my other neuro surgeon consult and operate together and they have never done this surgery before. They want to use it to fuse 6/7, (wedge it in to my facets and stop any movement). He says it can be used for other problems I have in the rest of my vertabraes) I have DDD, bone spurs, herniated discs. and above on C4/5 he sees one vertrabrae on top of the other and is talking about a full disc replacement.I have a lot going on which I won’t tell you about, I just want to know what you think about this system?
I am in so much pain and am very confused, can you take a bit of time to tell me what you think!!! I read everything and there is not so much info out there on the Dtrax system?? I did find a link that you compared it to the COFLEX system for back surgery. I haven’t look into that much yet!!!

Thank you so much Dr. Corenman. By the way, I am 64 years old and have lost out on so much of my life since 2003. Should I have had another fusion surgery for my pseudoarthrosis. I have so many x-rays, flexion extension, moving x-rays in flexion extension, cat scans etc. that show clearly 100% that I am not fused!!! At least if I just have this minimally invasive surgery (Dtrax) and it doesn’t take my pain away, then I didn’t go through another major surgery, cutting through all of my muscles in my neck posterially and a large recovery time for nothing, so the Dtrax is a minor surgery to try first!!! I look forward to your reply. Thank you again.
I am so sorry for this long post. My surgery for the Dtrax system was scheduled for the end of October but now has been rescheduled as the hospital hasn’t approved the procedure or the implants yet. They are hopefully looking now at November.

Thank you
Lyn in Michigan

[Donald Corenman, MD, DC]

#20380

DTrax is a facet spacer. It distracts the facet joint which in my opinion should not be performed in a pseudoarthrosis (lack of fusion). You want to encourage the anterior non-union to fuse and distraction is not the way in my opinion. A simple posterior fusion or a repeat ACDF with an autograft (your own bone) would be the way to fuse this pseudoarthrosis.

You however need a work-up to fully elucidate what your problem is. The fact that your C6-7 level did not fuse can contribute to your pain but you should have had good relief for 4-6 months right after surgery before you redeveloped pain. Without that period of relief, the surgery was not effective initially and the diagnosis still is elusive.

You probably need a pain work-up which includes facet blocks, possible discograms and maybe cervical selective nerve root blocks (SNRB). You might consider other opinions from spine surgeons (orthopedically based) to understand your pain generators.

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.

[Longbranch]

#20402

Dr. Corenman,

You have no idea how much I appreciate you taking the time to answer my questions. I have been to so many doctors and so many places to get help and I find myself in the same pain as at the beginning of this terrible ordeal which was the year 2000.

The reason I am telling you this is because you said that (and I tend to agree with you) that the pseudoarthrosis might not be where my pain is coming from? Also that I need to have a work up done to find out where it IS coming from. I have seen 6 Neuro/Ortho surgeons so far that cannot tell me “with confidence” where they think my pain is coming from. 1 Orthopedic Surgeon is pretty sure that if he goes through Posterially and does the surgery to fuse 6/7 that it will take away my pain. He seems to think it will be pretty simple, open me up, just scoop some marrow from my hip and onward and upward, well to me it is not that simple!!! It has been too long!!My chiropractors are so worried that it just isn’t that easy!! I just want to let you know by giving you a compilation of my reports together (leaving out really the pseudoarthrois because I know I didn’t fuse and have the proof of that).

The Wayne State University Doctor says that if the Dtrax doesn’t work that he wants to try to replace the disc at C4-5 to see if that will take my pain away. I have read quite a few of your reports and am nervous that it may not be the answer either. Dr. Corenman…if this is unusual for someone to give you this much information or ask for this much help, PLEASE just disregard my book that I have just written to you.

I might be 64 but I am just too young to have gone through all of this so early in my life and I want my LIFE BACK. I want to play with my grandchildren and enjoy them, I don’t want to have to say, “oh before careful near Grama, remember my sore neck”, with this comes no energy and I just try and research constantly to be my own advocate and try to get some help for myself. Could you please see if you could see anything that comes to mind in looking at my x-ray compilation.

I would be forever greatful and so would my family, they have seen me struggle so much and they want me to feel better also!!!
I am going next week to one of the two neuros. that wanted to do the Dtrax to get an appt. to start having some facet blocks again maybe in different areas. The TMJ doctor that did my consultation said that he can tell that the way my jaw is placed that I have both TMD and cervical disorders and I do get my neck, spine and back adjusted every week and my jaw by my chiropractors.
I am sorry for this long letter!!!

The first Neurosurgeon (who did my surgery… who is a top Neurosurgeon in Michigan) that said “I can help you” (I was desperate and still am)I jumped at the word HELP and 2 weeks later was in the hospital having an Anterior Fusion and disc. on C5/6 and C6/7 and never got any relief at all!!

The chiropractor that was working on me at the time, the first appt. he told me that he didn’t even need to get out of bed to fix me up…He looked at me and told me that “MY WHOLE SPINE WAS DISLOCATED” and he proceeded to adjust me so aggressively that I laid there screaming for a few minutes as I didn’t know what was going on. Then he reefed my neck out that day pretty hard and adjusted it!!!! I guess he thought he had fixed me!!! I never felt any better after going to him for over a year and buying all of his Standard Process products. He did find out that I had Epstein Barr virus and CMV but said my neck didn’t look that bad but I went to this Neurosurgeon (and the chiro/homeopathic) even checked him out for me and he told me he could help so I let him do the surgery. I was in pain for over 3 years by then!!!

When I woke up in recovery I didn’t feel any different, I had a headache all together for 5 years and had gone to several neurologists and had a cat scan of my brain that was normal, have a small node on my maxillary sinus that is still there, so many reports, no cause for my headaches, Neurosurgeon thought my headaches would go away. I woke up with same headache, same pain in arm, shoulders, face pain and at this time my arm pain in 2003 was left sided. I had EMG testing done before surgery and they told me then I had Myotonia Congenita which everyone ignored because nobody had ever heard of it!!! They ended up putting me on Topomax for seizures which I am still on and keeps my headaches at bay!!!

I can’t tell my whole story because I would have to write a book. I am on my 7th chiropractor now (2 of them Family Practice who are wonderful). They both say I have a “Military Neck”, Forward Posture, Dowagers Hump, Right sided pain in shoulder, small tear in rotator cuff, arthritis in right shoulder, numb ring and pinky finger which I believe is ulnar. Kyphosis, just found out after years of facial pain that I have bad TMD and they want to make a splint!!!

I am so scared to have another surgery because I have been told that maybe I should live with this pain because I might be worse off afterwards, well I couldn’t be worse off than I am feeling right now!!!

C6/7 did not fuse but my new Neurosurgeon who is from Wayne State University who specializes in complex spinal surgery is the surgeon who wants to try this Dtrax system. After listening to your advice I believe I am going to hold off on having this done right now. You advised me to have facet blocks, nerve root blocks and possibly a discogram. In the early part of 2003 before my surgery in May I had Facet Medial Branch Blocks under Fluoroscopy left side only as it was mainly on the left at that time at C3-C6 and med. branch blocks bilaterally at C2-C3 in June and July of that year also and lots of shots across my shoulders. Also in July I had a Greater Occipital Nerve block, unfortunately I never got any relief from these injections. After surgery still not having any relief they start doing Nerve ablations, first one side and then the other a few weeks apart. Unfortunately they never worked on me properly or never lasted very long, they worked like an irritating burning sunburn sensation, I had 8 sets of them and then stopped and gave up on them. Have been on the DRX9000 machine 42 times and never felt any relief.

My Neurosurgeon that I am working with now that has sent me to this Ass. Prof. at Wayne State is not sure what he thinks, has read my cat scans, flexion ext. moving xrays mri’s of 2010,2012,2014, 2015 and to put them all together he sees and other neuro and ortho’s :

First of all, I brought in my x-rays before my surgery on Nov. 29, 2003 and he reviewed them and found at

C5-6 and C6-7…Disc. Bulges without significant herniation!!! That is what my original surgery was based on!!

Now to go on!!!

C1-C2 moderate degenerative changes seen at Odontoid process and the arch of the C1 junction (irregularity at the tip of the odontoid)..(arthritis)

C2-C3 no evidence of herniated disc, spinal canal stenosis or neuro.foram. enchr.

C3-4 Anterior osteophytes are seen marginally on x-rays

C4 There is an Anterior osteophyte projecting from the body of C4 (cervical spine view)

C3ONC4 Shows there is mild anterolithesis of 3mm (flex ext x-rays also have moving x-rays chiropractor)

C4-C5 Anterior Osteophytes noted Marginally as seen on several x-rays and scans and Cat Scan,flex.ext.

C4-C5 Small Right Paracentral Disc Protrusion with Mild Flattening of the Thecal Sac

C4-C5 There is minimal broad-based disc bulging without significant stenosis or neuroforaminal encroachment. (These two could be the same opinion from different scans and different doctors?)

C4-C5 A small spondylyotic ridge is seen with minimal effacement of the anterior thecal sac. No evidence of myelographic block is seen (minimal degenerative disease is seen) This is from the myelogram of 2005

C4-C5 Bilateral foraminal stenosis, right side greater than left (MRI 2010)

C5-6 There is broad based disc bulging at this level with minimal effacement of the anterior thecal sac. There is no significant stenosis or neuroforaminal encroachment. (MRI of 2015) This disc was one that I had fusion surgery on in 2003 and is definitely FUSED!!!!

C7-T1 There is no evidence of herniated disc, spinal stenosis or neuroforaminal encroachment. MRI of 2015

C7ONT1 There is minimal Anterolisthesis of C7 on T1 as seen on flexion view only.

C6-C7 – are definitely not fused (Pseudoarthrosis) and are seen on Cat Scan of 2010, 2012, 2015 and MRI’s
there is a small amount of back out of the screws and halos seen at C6 an C7

There is so much more I could say, I know there is not much here but I have to keep on going and hope that someone sees something that gives me a bit more hope!! I was really thinking that the Dtrax could work but in hindsight that small implant would be too much of a miracle to take away all of the pain that I have!!!

Thank you so much Dr. Corenman, I appreciate your advice on the Dtrax and I believe that the surgery was postponed for a reason so that I could write to you on your forum and get your expert and excellent opinion.

Take care
Lyn in Michigan

[Donald Corenman, MD, DC]

#20434

You have what I call “CNS” (crappy neck syndrome). This does not mean that the pain “is in your head” but that your genetics allow significant degenerative changes of multiple levels. The key here is to do a complete neck workup to determine your pain sources. This may be facet blocks, cervical SNRBs. cervical discograms or even pseudoarthrosis blocks (at C6-7). When your neck is “mapped”, them appropriate suggestions can be made to determine your potential non-surgical or surgical intervention.

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.

[Longbranch]

#20504

Dr. Corenman

I thank you again so much for answering my post. Definitely some food for thought. I have had all of the workups that my doctor wants to do at this moment and he said that I would not get the answers that I am looking for with the facet blocks and the cervical SNRB’s. I have had all of these done and they didn’t give me the answers either.

I will possibly get one Diagnostic Facet Block into the 6/7 sight to see how much pain it will take away from that area. I had them done many years ago but it will be worth it to try again maybe in one area. My doctor is sending me to a pain specials to try again.

I am still waiting for them to give me a new date for the Dtrax but the meeting between the hospital and the doctors isn’t for another few days. I am pretty sure I am going to cancel that one. I want to make the right decision on this surgery, I want this not only to be the right decision but the only surgery I need to have again!!!

What do you think about a Bone Scan, I was told or I read some where that they should be able to tell if the pain is coming from my pseudoarthrosis by having one of them done. You suggested a discogram and my Doctor said definitely no!!! I am trying so hard to be my own advocate! It should show definitely by a bone scan that I am not fused (which we have that information from a myelogram and several cat scans) but will that tell if my pain is coming from there if they see inflammation?

Thank you Dr. Corenman for any information you can give me. I appreciate your time very much.
PS…I was told this Dtrax is not necessary so Minimally Invasive either and that it is just a fad. I don’t necessarily want to be a guinea pig at my age either. I am in chronic pain and I just want my life back.

Thank you
Lyn

[Donald Corenman, MD, DC]

#20505

A Bone Scan will not yield much information regarding pain generation. You still need a full work-up and it appears you are not going to get it with the group you are currently seeing. See the sections on discograms, facet blocks, selective nerve root blocks and especially pain diary. Read and understand what the diagnostic portion of the block confers and make sure you keep this pain diary accurately.

You might have undiscovered pain sources and keeping the diary is the only way to understand these problems. Again, Dtrax is not the way to go to fix a pseudoarthrosis in my opinion.

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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