Fusion Recovery with Fibromyalgia

Tagged: #fat infiltration, #muscle pain, ACDF, cervical, degeneration, fibromyalgia, fusion, NECK, recovery, Spondylosis

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SushiCami
Participant

December 13, 2022 at 2:57 pm

Post count: 6

#35392

Hello, Dr Corenman,

In your post regarding how to describe pain, you mentioned patients recovering from surgery who do well for months and then have sudden pain for a week or so (and repeat). In your experience, do these type of patients usually have fibromyalgia?

I’ve had fibromyalgia most of my life, and I am having the same issue after 4-level ACDF surgery. However, the flair-up I’m having now (9 months post-surgery) is much worse and longer than those before. The muscles are cramping in the right side of my neck. The pain is so severe that I can stand or sit for only about 15 minutes before I have to rest my head back. Also, a few times a day, I feel tingling at my suboccipital migraine trigger point. Likely inflammation causing pressure on a nerve, correct? What helps this? It can’t be time.

Only a couple weeks ago, I had been so pleased with my progress. I was finally at a point where I could do almost all essential activities again, including light exercise. If I could go to my Physical Therapist every other day for the rest of my life for manual muscle therapy, I would feel great. Since that isn’t an option, do you have any thoughts on next steps? Pain specialist? Continue PT? Accept this level of functionality?

In your patients, did the flair-ups ever stop long enough so they could fully recover from surgery?

—————
BACKGROUND: I had ACDF surgery, C2-C6, in mid-March 2022. 10-week xray looked perfect. If you’d like, you can read more details in my previous question, #35018 . I have gone to physical therapy for 6 months, which has helped immensely. I have a wonderfully knowledgeable Physical Therapist, who is one of the few who knows how to treat acute pain when it’s all wrapped in chronic pain. It’s been a very long recovery, with flair-ups every month or two causing my progress to backtrack. During these times, only manual manipulation by my PT gets me through (neck, top of shoulders, around shoulder blade).
—————

Thank you for your help,
LeAnn

SushiCami
Participant

March 19, 2023 at 12:31 pm

Post count: 6

#35532

DR. CORENMAN,

When I wrote this latest question, you hadn’t been active in the forum for a time, and I never received a response. I am still struggling with severe neck and upper back pain. Would love to hear your thoughts.

NEW INFO
My last MRI showed heavy marbling of FAT INFILTRATION in the cervical muscles.
(My Physical Therapist had to show me this, since imaging and surgeons don’t check for this important recovery factor (for some reason).

Donald Corenman, MD, DC
Moderator

March 19, 2023 at 1:16 pm

Post count: 8660

#35533

Sorry, but I was out of the country.

Fatty infiltration of the muscles (“My last MRI showed heavy marbling of FAT INFILTRATION in the cervical muscles”) is normally a sign of disuse or even neurological disconnection (nerve loss). It would be the opposite of recovery.

I suspect your current symptoms are possibly from a lack of fusion of a 4-level ACDF. 4 levels is a lot to have to expect that all levels would fuse. Also, the long lever arm on the lowest level (the open C6-7) could wear this level out prematurely.

Your symptoms are more focal and significant that what I would expect from Fibromyalgia (“The muscles are cramping in the right side of my neck. The pain is so severe that I can stand or sit for only about 15 minutes before I have to rest my head back”).

I would say that a new set of x-rays including flexion/extension are necessary and if any questions, a CT scan of your neck could be in order.

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.

SushiCami
Participant

March 20, 2023 at 2:45 pm

Post count: 6

#35534

Dr Corenman,
THANK YOU for your response! Your kindness in starting this forum and continuing to be active on it is overwhelming and touches us all. You allow us to feel that, at least, one person in the world understands. The encouragement we gain here is powerful. I pray that God will give you and your family the same powerful encouragement and that you will not be weighed down by all our constant questioning.
—————

ALREADY HAD XRAYS/MRI
Between the first message (Dec 2022) and the second reminder (Mar 2023), I did have cervical x-rays (including flexion/extension) and an MRI (that’s how we found the fat infiltration). I have not had a CT scan. Results were compared to imaging taken pre- and post- surgery.

XRAY/MRI RESULTS SUMMARIZED
+ According to my neurosurgeon and the reports, fusion at all 4 levels and alignment of cage is still perfect and intact.
+ Lordosis is good, considering.
+ There is no longer impingement of the nerve compared with before surgery.
+ Degeneration at all cervical levels has not changed significantly since surgery.

[FYI – I typed my levels incorrectly before – my fusion is C3-C7. Tried to edit but no option.]

My surgeon did tell me that the levels above and below would eventually degenerate, but I don’t think that would happen within 7 months, especially since I’m not able to do many of the activities I did before (including work).

FOLLOW-UP QUESTIONS
Q1. I am a small-framed 5’1” 110 lb female. Do you think that maybe my muscles were just not strong enough to handle the change in biomechanics of a 4-level fusion?

Q2. My physical therapist said that my cervical muscles were very marbled with fat, so much so that it would be difficult to believe it occurred recently. He also mentioned that fat infiltration is often seen in Chronic Pain patients (of which I am one – Chronic Migraine, Myofascial Pain Syndrome, Fibromyalgia, Bruxism, Major Depressive Disorder, DDD, etc). In your experience, have you seen a significant difference in % Recovery from ACDF between chronic pain patients and non-chronic pain patients?

Thanks again,

Donald Corenman, MD, DC
Moderator

March 20, 2023 at 5:00 pm

Post count: 8660

#35537

‘My surgeon did tell me that the levels above and below would eventually degenerate, but I don’t think that would happen within 7 months”. Very unlikely.

Do you think that maybe my muscles were just not strong enough to handle the change in biomechanics of a 4-level fusion. Probably your muscles were OK. Is your alignment OK (lordosis) or was there a big change?

“Have you seen a significant difference in % Recovery from ACDF between chronic pain patients and non-chronic pain patients”? The difference would be residual pain. If the surgery was performed for the right reasons, the pain created by deformity and nerve compression should be relieved but the chronic residual pain should remain.

What did the radiologist who reviewed the CT scan dictate? You can cut and paste here (without identifying marks).

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.

SushiCami
Participant

March 20, 2023 at 8:10 pm

Post count: 6

#35538

I didn’t have a CT scan, but here is my MRI report. Current imaging (Feb 2023) is compared with imaging prior to ACDF surgery (Dec 2021). Even though the radiologist said C2-C3 was “severe” (in several ways), he also said it was the same as the imagining prior to surgery. I had different pain prior to surgery but not the problems I’m having now. See what you think. Thank you for your help.
______________________________
______________________________

RADIOLOGY REPORT

Spine cervical wo contrast MRI

CLINICAL – M47.812 Spondylosis without myelopathy or radiculopathy, cervical region

TECHNIQUE: Multiplanar multisequence imaging of the cervical spine was performed.
IV CONTRAST: No gadolinium.
COMPARISON: 02/15/2023 radiograph, 12/28/2021 MRI exam

FINDINGS:
C3-C7 ACDF changes are present. No vertebral marrow or paraspinal edema identified.
Spinal cord: Appears unremarkable.

C1-C2: No spinal stenosis or neural foraminal stenosis.
C2-C3: Severe left facet arthrosis with left foraminal osteophytes and severe left foraminal stenosis, similar to prior exam. Ligamenta flava thickening is present without spinal canal stenosis present.
C3-C4: Resolved spinal canal stenosis since prior exam. Severe left facet arthrosis with mild left foraminal stenosis.
C4-C5: Resolved spinal canal stenosis since prior exam. Right facet arthrosis is present with mild right
foraminal stenosis.
C5-C6: No spinal canal stenosis. Bilateral facet arthrosis is present. Moderate left foraminal stenosis due to left foraminal osteophytes.
C6-C7: 3 mm posterior osteophytes with mild spinal canal stenosis and contact with anterior cord margin. Moderate bilateral foraminal stenosis due to left foraminal osteophytes.
C7-T1: Bilateral facet arthrosis with foraminal osteophytes, with moderate left foraminal stenosis. No spinal canal stenosis.

IMPRESSION

1. C3-C7 ACDF with resolved or significantly improved multilevel spinal canal stenosis described previously. C6-C7 mild spinal canal stenosis present.
2. C2-C3 severe left foraminal stenosis. C5-C6 moderate left foraminal stenosis. C6-C7 moderate bilateral foraminal stenosis. C7-T1 moderate left foraminal stenosis.
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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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