Increasing pain 5 months after ACDF C5-6

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Cynthialrn
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September 12, 2018 at 1:39 am

Post count: 5

#29324

Hi Dr Corenman! I asked a question a few months ago & since then things have gotten worse so here I am again. Thank you in advance for taking the time to answer me. I suppose a little history may help as it may be relevant in determining what may be going on. I was in an accident last november in which I was rear ended while stopped to make a turn, by a bus. I underwent an ACDF of C5-6 at the end of March this year & prior to the surgery had an MRI that showed a large herniation of C5-6 and bulges of the 2 discs above it. Afetr surgery my headaches went away, as did any pain I had been experiencing. However, within a couple of months I began having pain between my shoulder blades whenever I turned my head in any direction. It felt like the pain you get when you have a crick in your neck. Nothing relieved it other than not turning my head. I spoke with my surgeon and based on the fact that the x-rays showed my vertebrae fusing normally, she decided it was probably a sprain. I started PT for this but since then it has only worsened to the point that now I can’t lift my arms without illiciting the same pain. I was reading online that one way to check for cervical radiculopathy is to raise the hands and place them on top of the head and if this stops the pain it is radicular pain. I tried it and it did indeed stop the pain. As long as my hands were on my head I could turn my head without pain but the moment I put them back down the pain returned. I asked my family practice doctor to please order an mri which I am having today. My question to you is this…do you think this is possibly the higher level bulges that have become herniations or do you think, based on where it hurts (right between the shoulder blades) that it’s something going on with the surgical site at C5-6? Again, thank you for your time, your answer will help me talk to my surgeon. I wish you were near me so I could have you do my next surgery if I need one.

Donald Corenman, MD, DC
Moderator

September 15, 2018 at 8:02 pm

Post count: 8660

#29377

If you have posterior shoulder pain after two months of relief after an ACDF, the two potential possibilities are a pseudoarthrosis of the fusion level or a new involvement above the fusion. Since the pain is not into the tops of the shoulders or down the arms (“within a couple of months I began having pain between my shoulder blades whenever I turned my head in any direction”), it may not be a nerve root generated pain but a referral pain from a degenerative disc, even though holding your hands above your head relieves your pain (Bakody’s maneuver). Check carefully the new X-rays including flexion/extenision for motion at the fusion site. A new Mri would also be helpful but if there is motion, a CT scan would be preferable.

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.

Cynthialrn
Participant

September 16, 2018 at 9:36 pm

Post count: 5

#29383

Thanks so much for your answer. I wanted to add that I also have pain in my neck when I move it but it isn’t consistent…it comes and goes. Some weeks I’ll have the same feeling of a crick in my neck and then it’ll go away and only the shoulder blade pain remains. Also, I have been having pain in my right shoulder and arm all the way to my thumb which will burn at the nail bed it seems. However, a recent Mri of the shoulder revealed microtearing of the infraspinatus tendon and a partial tear of the spinatus…on top of that I’m also dealing with tennis elbow. So that arm is extremely painful right now and it’s impossible to tell what pain is coming from where. I suppose I should have the arm removed and then it would definitely stop hurting….no wait, then I’d probably develop phantom limb pain… Ha! I try to stay light hearted about these things. Anyway, if any of this info makes a difference in your opinion let me know. By the way, I’m not a physically active person and I have no idea why these tendon issues keep occurring. Bad luck I guess or bad genes.

Donald Corenman, MD, DC
Moderator

September 20, 2018 at 8:53 am

Post count: 8660

#29391

Tendon issues can be genetically based so lack of activities does not protect you. You could have a shoulder injection to determine what pain is generated by the shoulder vs. the neck. See pain diary: https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/.

X-rays with flexion/extension views can be helpful.

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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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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