[westie California]

#34525

Thank you so much Dr. Corenaman!

One last question please, I really appreciate all your feedback and can’t thank you enough! In the past we’ve spoken about disc herniations, kyphosis, stenosis, etc. as a source of neck pain, however I don’t recall much about paraspinal muscle atrophy as being a possible source of pain after cervical laminectomy surgery. I’ve seen some literature that suggests that one can develop neck pain after cervical laminectomy due to muscle trauma. My questions are can this condition cause muscle spams, pain, burning sensation, etc. due to the fact that those muscles can weakened during surgery. From what I’ve read it appear these muscles provide stability to cervical spine and any weakness will cause pain.

I bring these questions up because I’ve had dehiscence and rotational flaps work performed, so I don’t know if paraspinal muscle atrophy can be contributing to my dilemma? If so, are there any treatments? Can Peripheral Nerve Stimulation be indicated for this condition? Thanks

[Donald Corenman, MD, DC]

#34533

You have a long fusion so of course the muscles are going to atrophy as they have less demand. Also, long fusions can be painful even if done to perfection.

“I’ve seen some literature that suggests that one can develop neck pain after cervical laminectomy due to muscle trauma”. That can be true but you had a fusion along with the laminectomy which reduces the muscle pain (due to reduced demand).

The two biggest problems with a long cervical fusion (as long as cord and nerves are decompressed and not injured) is adjacent segment disease (at top or bottom) and alignment pain (typically fused into kyphosis).

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]

#34535

Thank you so much Doctor!

It appears from what I’ve read that thoracic outlet syndrome can cause muscle spasms between base of neck and shoulders?

T”he most common symptoms of TOS are:

Numbness and tingling of the fingers or in the arm
Pain in the shoulders, neck, and arms
Impaired circulation to the affected areas
Muscle spasms in the scapular area or upper back – the area between the base of the neck and the shoulders
Chest pain, frequently mimicking a heart condition, that does not go away with rest, and is often relieved with the elevation of the arm
Headaches
Wasting in the fleshy base of your thumb (Gilliatt-Sumner hand)
Weakness of the arm and hand with weakening of hand grip on the affected side
Symptoms become worse with repetitive or overhead activities”.

So if this is the case, and we’re saying less stress is on the muscles because of fusion, and if nerves are not injured or compressed, does this give high probability to TOS as the source of muscle spasms?

[westie California]

#34543

Good afternoon Dr. Corenman,

I hope all is well and do have some additional updates. Per consult today with a D.O. (orthopedic spine surgeon) he went over he’s findings with me:

1) The recent CT Scan was performed using an upgraded apparatus (64 slice verse 16 slice). The 64 slice scanner provides “more detailed imaging”.

2) In 2017 developed kyphosis and pseudarthrosis at C7-T1. A peek cage was utilized at this segment which is “below” previous C3-C7 ACDF’s and laminectomies with instrumentation / fusion. A posterior fusion performed to address pseudarthrosis, however fused in a kyphotic position. The doctor tried to address kyphosis with a partial corpectomy in 2018, however it did very little to address kyphosis.

3)A 2019 Ct scan shows epidural fibrosis “scar tissue” from C3-T1. Can these contribute to nerve pain? It’s possible.

4)The upgraded CT scanner 2020 shows residual foraminal stenosis at C3-C4 left side, which can cause you radiculopathy complaint, however no one in his/her right mind will go in and decompress, since it’s probably permanent in nature, and there’s no way to tell, unless decompression takes place.

5)The base of neck pain is coming from a malalignment of C7-T1. This would probably require an osteotomy down to T4 and would be a significant undertaking with high risk of complications. In his opinion he would avoid any surgery at all cost! He’s advice is work with pain management, physical therapy, try to loss weight, stress management, etc. He agreed that placing a spinal cord stimulator in cervical region is not a good idea, however placement in thoracic area could provide significant relief. He mentioned spinal cord stimulator’s has broader coverage than peripheral nerve stimulator. Any thoughts on this?

[Donald Corenman, MD, DC]

#34545

“Ct scan shows epidural fibrosis “scar tissue” from C3-T1. Can these contribute to nerve pain”? Scaring of the nerve can cause nerve pain.

“He mentioned spinal cord stimulator’s has broader coverage than peripheral nerve stimulator. Any thoughts on this”? He is correct here also. Spinal cord stimulation covers cord distribution which is much greater than peripheral nerve coverage but since you have had a laminectomy already, you are not a candidate for cord coverage. That’s why I recommend peripheral nerve coverage.

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]

#34567

Good morning Dr. Corenman,

I’m still dealing with bizarre issues and its become to the point where I don’t know what to do next. I’ve had Botox injections in traps a month ago and some of spams improved and within 2 weeks its back to pre injection status(Botox should give 6 months?). Also during the past 2 weeks I’ve been utilizing a NMES, IFC and Tens combination unit for a minimum of 4 hours a day and still my back of neck is hard like a rock. I’m also in my 9th week of physical therapy and no improvement. The therapist’s all tell me my traps and scalene muscles are all extremely tight.

All I’m told is there’s some residual foraminal stenosis, even after decompressive ACDF’s, laminectomies, facetectomies, foraminotomies and I was fused in a kyphosis at C7/T1. Can C7/T1 kyphosis cause severe spams in traps? thanks

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