-
AuthorPosts
-
Good afternoon Dr Corenman,
I hope all is well on your end. My question is in regards to my continued pain in the base of the neck. Today my pain doctor performed a bilateral block in C3/C4 and I noticed some improvement in that area however no relief in the base of the neck. Because I had a previous bilateral C5, C6 and C7 facetectomy he could not inject those levels.
The question that is now being raised is a couple of weeks ago, I was looking under my bed to retrieve our 8 months old puppy and when i looked up i heard a very loud pop and clunk noise, immediately thereafter the most severe debilitating burning pain can be felt at the base of the neck which transitioned to what i would describe as a charley horse of both muscle’s at the base of the neck. When I mentioned this my pain management doctor, he said that my surgeon should order some scans to take a look, could be something going on with C7/T1? I asked if that would be an Xray (flexion/extension) and was told that an MRI (flexion/extension) may be better, however that’s up to my surgeon.
My question is what would be the difference between flexion extension X-rays verse flexion extension MRI’s?is one better than another, etc? In addition I was told that “The screw in C7 does not look significantly out of place” per my review of my last X-rays. Any help would be appreciated. Thanks
Generally, motion MRIs (flexion/extension) are performed on low signal strength magnets. In addition, you have screws (metal) in your neck which would degrade the signal even more. I think you would be best served with a standard MRI, flexion/extension X-rays and a CT scan. The combination of these tests should give you the cause of your symptoms.
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.Happy Father’s Day Dr Corenman!
I have some additional questions please, after having my standard MRI’s, flexion/extension X-rays, CT scan and EMG/Nerve conduction. My results were:
Thoracic Spine
T1/T2 disc space level, postsurgical changes are noted. Posterior stabilization rod is noted with paired transpedicular fixation screws transversing the T1 and T2 vertebral bodies. No evidence of herniated disc or sideline thecal sac deformity . Loss of disc signal is noted with preservation of disc space height.
T2/3, disc herniation is noted deforming the thecal sac with bilateral paracentral components, Loss of disc signal is noted with partial loss of disc space height.
T3/4, disc herniation is noted deforming the thecal sac with bilateral paracentral components, Loss of disc signal is noted with partial loss of disc space height.
T4/5, left paracentral disc herniation is noted deforming the thecal sac. Loss of disc space height and signal is noted with mild disc degeneration.
T5/6, disc bulge is noted with paracentral orientation deforming the thecal sac. Loss of disc space height and signal is noted compatible with mild disc degeneration.
T6/7, disc bulge is noted with paracentral orientation deforming the thecal sac. Loss of disc space height and signal is noted compatible with mild disc degeneration.
T7/8, disc herniation is noted deforming the thecal sac with bilateral paracentral components.Loss of disc space height and signal is noted compatible with mild disc degeneration.
T8/9, disc herniation is noted deforming the thecal sac with bilateral paracentral components.Loss of disc space height and signal is noted compatible with mild disc degeneration.
T9/10, right paracentral disc herniation is noted deforming the thecal sac. Loss of disc space height and signal is noted with mild disc degeneration.
T11/12, disc bulge is noted deforming the thecal sac. Loss of disc space height and signal is noted compatible with mild disc degeneration.
These extruded disc exert extradural pressure. Ventral dural tube subarachnoid space is impacted upon and deformed. Spinal cord surface is also encroached, without resulting in flattening.
Central canal integrity is partially compromised. Persistent thoracic multilevel discopathy noted
Cervical spine
C2/3 disc space level, disc herniation is noted deforming the thecal sac abutting the spinal cord contributing to mild central spinal stenosis in conjunction with posterior ligamentous hypertrophy. Loss of disc signal is noted with preservation of disc space height.
C3/4-C6/7 postsurgical changes are noted with anterior fusion plate and anterior fixation screws transversing the C3-C7 vertebral bodies. Graft placement associated with discectomy and fusion procedures are noted at C3/4, C4/C5, C5/C6 and C6/C7 disc space level. Hypertrophic changes are noted at each level deforming the anterior margin of the thecal sac. C3/C4 mild left neural foraminal narrowing is noted in conjunction with facet and ucinate hypertrophic changes.
At C7/T1 disc buldge is noted deforming the thecal sac.Loss of disc signal is noted with loss of disc space height anteriorly associated with mild disc degeneration.
Cervical spine straightening is noted
Ct Scan – Per doctor noted straightening and solid fusion
Flexion/extension Xray – no instability
EMG/Nerve Conduction states abnormal study:
1.Mild left carpal tunnel syndrome
2.Chronic lower cervical radiculopathy bilaterally at C5, C6, C7, and C8 nerve roots
3. Acute findings affecting the cervical paraspinals/dorsal roots.
My surgeon would like to perform a two step procedure, first remove posterior instrumentation since he feels this is likely causing nerve irritation, and second have a plastic surgeon work on trapezius muscles his opinion is there is displacement of the muscles.
I’m really hesitant on having a seventh spine surgery and was told this surgery may improve my symptoms. As you know, i’m still having great amount of pain at the base of the neck, shoulder’s pain, occipital headaches on right side with dizziness, both biceps pain, fingers tingling, etc.
My pain doctor told me he can’t inject C5, C6 and C7 because there is no joints and he does not perform SNRB in the neck area.
Can you give me any recomendations? Thanks
Happy Father’s Day Dr Corenman!
I have some additional questions please, after having my standard MRI’s, flexion/extension X-rays, CT scan and EMG/Nerve conduction. My results were:
Thoracic Spine
T1/T2 disc space level, postsurgical changes are noted. Posterior stabilization rod is noted with paired transpedicular fixation screws transversing the T1 and T2 vertebral bodies. No evidence of herniated disc or sideline thecal sac deformity . Loss of disc signal is noted with preservation of disc space height.
T2/3, disc herniation is noted deforming the thecal sac with bilateral paracentral components, Loss of disc signal is noted with partial loss of disc space height.
T3/4, disc herniation is noted deforming the thecal sac with bilateral paracentral components, Loss of disc signal is noted with partial loss of disc space height.
T4/5, left paracentral disc herniation is noted deforming the thecal sac. Loss of disc space height and signal is noted with mild disc degeneration.
T5/6, disc bulge is noted with paracentral orientation deforming the thecal sac. Loss of disc space height and signal is noted compatible with mild disc degeneration.
T6/7, disc bulge is noted with paracentral orientation deforming the thecal sac. Loss of disc space height and signal is noted compatible with mild disc degeneration.
T7/8, disc herniation is noted deforming the thecal sac with bilateral paracentral components.Loss of disc space height and signal is noted compatible with mild disc degeneration.
T8/9, disc herniation is noted deforming the thecal sac with bilateral paracentral components.Loss of disc space height and signal is noted compatible with mild disc degeneration.
T9/10, right paracentral disc herniation is noted deforming the thecal sac. Loss of disc space height and signal is noted with mild disc degeneration.
T11/12, disc bulge is noted deforming the thecal sac. Loss of disc space height and signal is noted compatible with mild disc degeneration.
These extruded disc exert extradural pressure. Ventral dural tube subarachnoid space is impacted upon and deformed. Spinal cord surface is also encroached, without resulting in flattening.
Central canal integrity is partially compromised. Persistent thoracic multilevel discopathy noted
Cervical spine
C2/3 disc space level, disc herniation is noted deforming the thecal sac abutting the spinal cord contributing to mild central spinal stenosis in conjunction with posterior ligamentous hypertrophy. Loss of disc signal is noted with preservation of disc space height.
C3/4-C6/7 postsurgical changes are noted with anterior fusion plate and anterior fixation screws transversing the C3-C7 vertebral bodies. Graft placement associated with discectomy and fusion procedures are noted at C3/4, C4/C5, C5/C6 and C6/C7 disc space level. Hypertrophic changes are noted at each level deforming the anterior margin of the thecal sac. C3/C4 mild left neural foraminal narrowing is noted in conjunction with facet and ucinate hypertrophic changes.
At C7/T1 disc buldge is noted deforming the thecal sac.Loss of disc signal is noted with loss of disc space height anteriorly associated with mild disc degeneration.
Cervical spine straightening is noted
Ct Scan – Per doctor noted straightening and solid fusion
Flexion/extension Xray – no instability
EMG/Nerve Conduction states abnormal study:
1.Mild left carpal tunnel syndrome
2.Chronic lower cervical radiculopathy bilaterally at C5, C6, C7, and C8 nerve roots
3. Acute findings affecting the cervical paraspinals/dorsal roots.
My surgeon would like to perform a two step procedure, first remove posterior instrumentation since he feels this is likely causing nerve irritation, and second have a plastic surgeon work on trapezius muscles his opinion is there is displacement of the muscles.
I’m really hesitant on having a seventh spine surgery and was told this surgery may improve my symptoms. As you know, i’m still having great amount of pain at the base of the neck, shoulder’s pain, occipital headaches on right side with dizziness, both biceps pain, fingers tingling, etc.
My pain doctor told me he can’t inject C5, C6 and C7 because there is no joints and he does not perform SNRB in the neck area.
Can you give me any recomendations? Thanks
First, you need to paste the radiological report here from the CT scan. That is an important missing piece of information.
Second, you have a significant genetic component of disc degeneration with almost all your thoracic levels degenerative and herniated. The report does not give details of how severe but you could have thoracic disc pain and even some nerve roots that are being compressed (thoracic radiculopathy).
Why would your surgeon think that the hardware removal should allow nerve root decompression if all the screws in the cervical spine are well placed? This is why the radiological CT report would be very helpful.
The comment “have a plastic surgeon work on trapezius muscles his opinion is there is displacement of the muscles” has me very confused. I have never ordered or seen a consult ordered that involved this disorder. Why is it needed?
No facet blocks would be possible if there has been an attempt at fusion in the neck along with retained hardware so your pain doc is spot on.
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.Good afternoon Dr,
The doctor did not order an additional CT scan said it was too soon, however I’ve attached one I had done 10 months ago:
Procedure: CT-CERVICAL SPINE WO
CONTRAST
CLINICAL HISTORY: Cervical fusion.PROCEDURE: Contiguous non-contrast axial images were performed through the cervical spine. 2-D sagittal and coronal reformatted images were obtained.
FINDINGS:
There is straightening of the cervical lordosis. There is preservation of vertebral body height. The C2-3 level is unremarkable.
The patient Is status post anterlOr cervical fusion from C3-C4. There is anterior and posterior cervical fusion from CS-Tl. Wide bilateral laminectomles are present from the C3-4 to the CS-Tl level.The C3-4 level there is anterior cervical fusion utilizing a plate and vertebral body screws and intravertebral graft material. There is good alignment of C3 upon C4. There is osseous signal intensity across the disc space consistent with osseous fusion. There is good posterior decompression secondary to wide laminectomy. There is good alignment of C4 upon CS. There is osseous signal intensity noted across the disc space. Intravertebral graft material is
present. There is good posterior decompression of the spinal canal.The CS-6 C6-7 and C7-Tl disc space levels demonstrate osseous signal intensity course the disc spaces consistent with osseous fusion. There is anterior fusion utilizing anterior plate and vertebral body screws there are bilateral pedlcle screws with vertical stabilizing rods from CS-T l. There is wide laminectomies with good posterior decompression of the spinal canal. The neural foramina
are patent.IMPRESSION:
Status post anterior cervical fusion and laminectomy at the C3-4 level. There Is anterior and posterior fusion from CS-T1 with wide laminectomles with good posterior decompression of the spinal canal.
VRTs 3-D reformatted images of the bony structures demonstrate good alignment of the cervical vertebral bodies and good positioning of the hardware.
Page 2 of 2Addendum 1
Addendum: 8/28/17.
Reporting
Date: 8/28/2017A previous MRI of the cervical spine dating 7/16/17 is now available for comparison.
At the C3-4 level the patient is status post anterior cervical discectomy and fusion. A plate, vertebral body screws and intravertebral graft material is in place. There is osseous attenuation across the disc space level consistent with good osseous fusion. There is a wide bilateral laminectomy with good posterior decompression of spinal canal. The neural foramina are patent.
At the C4- 5 level there is good alignment of C4 upon CS. There is a wide laminectomy with good posterior decompression of spinal canal.
The patient is status post posterior fusion utilizing pedicle screws and vertical stabilizing rods from the C5-T2. There is anterior fusion with an anterior plate and from the C6 -Tl level. At the CS-6 level there is good posterior decompression of spinal canal. There is osseous attenuation across the disc space level consistent bony osseous fusion. The CS-6 neural foramina are patent.
At the C6-7 level there is good posterior decompression of spinal canal. There is osseous attenuation across the disc space level consistent with fusion. The C6-7 neural foramina are patent. There is good alignment of C6 upon C7 with osseous attenuation across the disc space level.
There is good alignment of Tl upon T2 and Tl-2 neural foramina are widely patent.
Signed by:
Signing Date: 8/31/2017In reference to the muscles, the physician mentioned there is a problem with the wound and requires a wound revision. After my posterior spine surgery, the trapezius muscles from C5 to T2 appears disfigured and are extremely painful. There is also a large indentation at approximately C7/T1. thanks
-
AuthorPosts
- You must be logged in to reply to this topic.