Facet Joints

Tagged: chronic neck pain - multiple surgeries

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westie California
Participant

August 9, 2017 at 3:26 pm

Post count: 138

#25965

Good afternoon Dr Corenman,

I have listed every spine surgery in chronological order as requested:

October 2012

ACDF – C4-C5, C5- C6

Diagnosis:herniated disc, nerve root compression, spinal cord compression, cervical radiculopathy, cervical spondylosis

Symptoms : neck pain, arm pain, headaches, dizziness

August 2013 —two procedures

ACDF C3-C4, C6-C7

Bilateral decompressive laminectomy with fusion C3, C4, C5, C6, C7 – right dural tear

Diagnosis : degenerative disc disease, cervical spondylosis, herniated disc, cervical nerve root compression, radiculogpthy

Symptoms : neck pain, arm pain, headaches, dizziness

November 2014

left C6-C7 foraminotomy

Diagnosis: left radiculopathy

Symptoms : neck pain, arm pain, headaches, dizziness

August 2015

ACDF C7-T1-placement of cage

diagnosis cervical radiculathypathy and anterior subluxation

Symptoms : neck pain, arm pain, headaches, dizziness

January 2017

Posterior cervical laminectomy with foraminctomies, medial facetectomies at C5-C6, C6-C7, and C7-T1
posterior segmental instrumentation C5, C6, C7, T1 and T2

Diagnosis :evidence of residual foramina stenosis and kyphosis at C7-T1 and psuedoarthrosis C7-T1

symptoms every time I go for walks and sitting causes my pain level at the base of my neck, arms, and shoulder blades to become unbearable, headaches, arm pain, dizziness

Current symptoms :walks and sitting increases my pain level at the base of my neck, arms, and shoulder blades to become unbearable, headaches, fingers tingling both hands, triceps hurt, forearms, numbness /weakness in arms, I also noticed my gait has worsen.

MRI’’s performed July 2017

Cervical reports states:

There is no evidence of frank instrumentation failure or pseudoarthrosis formation.Shallow desiccated annular bulges arise at C2-C3 and C7-T1. These discs mildly efface epidural compartment and thecal sac.

Facet joint and uncinate exhibit some sclerosis.

C3-C4, C4-C5 and C5-C6 right neuroforamina encroachment.

Multilevel anterior-posterior spinal postoperative changes with stabilization and decompression.

No central spinal stenosis produced

Spinal cord well preserved

No gross lesion or collection suspected

Thoracic reports states

There are minimal discogenic endplate irregulateries present.

Small posterior sub ligamentous herniations at T2-T3, T3-T4, T7-T8 and T8-T9.

Small right posterolateral sub ligamentous hernatiated component at T9-T10

These extruded disc exert increased extradural pressure. Ventral dural tube subarachnoid space is impacted upon and deformed. Spinal cord surface is also encroached, without resulting in flattening.

Shallow annular bulges arising at T4-T5, T5-T6,and T6-T7. Another annular bulge is identified at T11-T12. These disc further efface epidural compartment and thecal sac.

No gross lesion suspected.

I’m due to have an EMG at the end go August and a CT Scan. Let me know if there is anything i can do to help reduce my pain. Thanks as always.

Donald Corenman, MD, DC
Moderator

August 9, 2017 at 9:56 pm

Post count: 8660

#25966

So we need to correlate your surgeries to your current symptoms. I have your report of symptoms but do not know which symptoms improved, became worse or was of new onset after each surgery. You reported; “After surgery my right arm pain went away, however its back. The left bicep never improved. The pain is really bad on both sides of the base of my skull, both traps and at C7/T1 area both sides with a lot of muscle spasms. In addition my headaches in the occipital area has worsened (right side only). I also have pain in both shoulders, dizziness, left elbow pain, all my fingers are tingling at times”.

I am confused as to the need for a posterior decompression and fusion after a prior anterior fusion and posterior decompression and fusion of the same levels. Did you have a pseudoarthrosis (lack of fusion) and an incomplete decompression before? You had a January 2017 Posterior cervical laminectomy with foraminctomies, medial facetectomies at C5-C6, C6-C7, and C7-T1 posterior segmental instrumentation C5, C6, C7, T1 and T2. This was after an August 2013 “Bilateral decompressive laminectomy with fusion C3, C4, C5, C6, C7 – right dural tear”. Why was a third surgery necessary? What did this surgery do regarding symptoms?

You still have “C3-C4, C4-C5 and C5-C6 right neuroforamina encroachment”. After three separate surgeries, I am unclear why you still have nerve compression.

I don’t think you will find much on your upcoming EMG test unless you have demonstrable muscle weakness which would be obvious by physical examination anyways. These tests do not work for finding pain origination.

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
Participant

August 10, 2017 at 6:25 am

Post count: 138

#25967

Good morning Dr Corenman,

My surgeon indicated to me that I had pseudoarthrosis (lack of fusion) and an incomplete decompression before my surgery in Jan 2017. My surgery did not improve my symptoms at all and I have more pain at the base of my neck/traps, my gait seemed to worsened and my left elbow pain is new. The surgeries that were performed in 2012 and 2013 were done by a previous surgeon.

I was seen by the second surgeon last week who performed 2014, 2015 and 2017 surgeries and was told that
“C3-C4, C4-C5 and C5-C6 right neuroforamina encroachment is due to the way my body is healing. He doesn’t know if the encroachment is from scar tissue or bone or both, and that will be determined by CT Scan he is ordering.

Can my thoracic herniations, bulges, and spinal cord compressions contribute to my symptoms, i.e gait, base of neck pain/traps, etc?

Thanks

Donald Corenman, MD, DC
Moderator

August 10, 2017 at 10:10 am

Post count: 8660

#25972

Generally, base of neck pain is caused by the cervical spine but there are rare instances where upper thoracic spine disorders can also cause these symptoms. To understand these relationships, selective nerve root blocks and keeping a pain diary would help to distinguish what symptoms are caused by what disorders (https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/ and https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/).

You have had three decompressions already for your lower cervical spine (ACDF, 2 posterior decompressions and fusions) so I am unclear why you still have continued compression regardless of the current cause.

Do you have solid fusions now of all the prior surgical levels?

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
Participant

August 10, 2017 at 11:39 am

Post count: 138

#25973

My surgeon gave me a script for a CT scan without contrast and that will determine if I have a solid fusion of all surgical levels. The MRI showed compression, he wants to confirm with CT Scan also.

I’ve had six spine surgeries and still feel like i’m chasing my tail.I guess the question is can bone spurs grow and impinge on nerves in such short time frame?

I don’t know if you would be willing to review my case and work with me? It would be nice to move forward from this nightmare. This has taken a toll on myself and family.

westie California
Participant

August 21, 2017 at 6:01 pm

Post count: 138

#26030

Good evening Dr Corenman,

Just heard from my surgeon and the CT scan shows solid fusion of all prior surgical levels. In addition it states multi level foraminal stenosis (C3, C4, C7 left side and C3, C4,C5 right side).My surgeon feels an implantable spinal cord stimulation device may help.
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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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