Long sorry!-osteophytes

Tagged: CRPS and neck pain/fusion

Viewing 5 posts - 1 through 5 (of 5 total)

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Verojay
Participant

November 6, 2016 at 9:27 am

Post count: 8

#23372

Hello! You were kind enough in the past to answer some questions. A lot has happened in last six months. Quick recap. I had fusion of c5-c7 in Jan. 2015. After surgery, I have major issues with left arm. I couldn’t lift it past waist, I had tremors, constant pain, weakness, etc. I also had constant neck pain. After a poorly performed EMG/NCV (we found out Dr’s tests were not valid for many patients)-I demanded a new one. It showed chronic denervation-which explained left arm issues. I had completed 10 months of PT so I assumed this was as bad as things could get. I was wrong.

The pain continued and it got worse. At some point my left arm swelled up after a small mosquito bite (like I get all the time) and it got red and nerve was on fire. Dr thought RSD was the culprit. In the meantime, he had been trying to get a repeat MRI -just to rule out any issues with fusion bc MRI didn’t show C6-C7 very well in last scan. It was declined by insurance multiple times though. They finally approved a CT scan (after six months of denials). Last MRI was in Dec. 2015 and did show moderate c4 herniation-I think.

About five weeks ago my right arm suddenly started having problems. It started as nerve pain but quickly turned to arm, elbow pain and weakness. It’s declined very quickly. Due to pain and weakness I’m having trouble pulling pants on, squeezing ketchup type bottles, turning keys in doors, lifting cups, etc.

Results- 2mm rt & left posterolateral disc osteophytes at C3-4 with mild/moderate disc degeneration. Also left C3-C5 facet joint arthropathy with mild left anterior C3-C4 disc facet joint osteophytes formation. There’s also resultant moderate left C3-C4 foraminal stenosis.
– there’s a mild anterior disc degeneration at C4-C5 and mild right C4-C5 facet joint arthropathy. A prominent 5 mm x 6 mm anterior right C4-C5 facet joint osteophyte contributed to severe right C4-C5 foraminal stenosis with anatomical potential for impingement on the exiting right C5 nerve.
– mild right anterior disc degeneration at C7-T1 without significant neural impingement.
-C6-7 there is 3mm right posterolateral disc osteophyte without significant neural impingement.

My left arm was this bad right after surgery so don’t think what’s going on now is having a huge affect on it except maybe on pain. But I’m assuming the right arm is because of this. The decline of my arm is worrying me. It seems to be happening quickly.

I’m assuming treatment for osteophytes is usually surgery? And it’s an easier surgery than fusion? I don’t have an appointment for two weeks. I will still look for a dr to talk about RSD, as well. Tired of so much pain!

Sorry it’s long! Thank you:-)

Veronica

Verojay
Participant

November 10, 2016 at 12:30 pm

Post count: 8

#23396

Just follow-up. I saw the surgeon. The bone spur is very large he said in c4c5. It takes up a good part of disc into cord. He said I likely shouldn’t wait even 4 months before surgery but he doesn’t want to jump yet. He said a shot likely won’t help much. But, we could try. It won’t get rid of the spur and it seems like a temporary fix. My insurance isn’t great and financially we are struggling. Even the injections cost be $1500 out of pocket. Surgery with my out of pocket max will cost around $4500. But he said my c3-c4 doesn’t look great either. It would be fusion of c3-c5. If I wee older, he’d do it. I’m afraid I’m risking damage. Can I fall, get into a car accident, etc. and have that bone spur cause major issues?

Donald Corenman, MD, DC
Moderator

November 13, 2016 at 10:48 am

Post count: 8660

#23431

OK-you have a fusion at C5-7 now. I am worried about your post-operative arm pain and weakness. Did you have an injury to your C6 or C7 nerves? Check the section https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/ to see if any one nerve fits with your post-operative findings. If you had CRPS, a sympathetic block should have given you some temporary relief. Did you have this block?

Your C5 nerve compression (“5 mm x 6 mm anterior right C4-C5 facet joint osteophyte contributed to severe right C4-C5 foraminal stenosis with anatomical potential for impingement on the exiting right C5 nerve”) does not fully fit with your symptoms. Your complaints of “right arm suddenly started having problems. It started as nerve pain but quickly turned to arm, elbow pain and weakness” does not fully correlate with only the C5 nerve being involved. The C5 nerve does not supply the elbow but mainly the right shoulder.

You might have a pseudoarthrosis (failure of fusion) of your C5-7 levels and some compression there. Did you have a new MRI and especially a CT scan of these levels?

How does C3-4 “look”. This level typically does not cause nerve problems and if it is degenerative but not “too bad”, can be left alone.

There are many more questions that need to be answered.

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.

Verojay
Participant

November 13, 2016 at 10:18 pm

Post count: 8

#23434

Hello!

Yes, my left arm has chronic denervation-according to three neurologists it is permanently damaged. I can’t extend at elbow, lift it past waist, it hurts all the time and has tremors. I haven’t had any blocks for it. Money is an issue for my medical care. I am what you call “underinsured”. My deductibles, etc. are very high. RSD is a likely culprit in that arm now-especially because of swelling.

My right arm hurts from the shoulder down to the elbow. I should have been more clear. However, even today when I slammed it against the door-that got the nerve screaming at me and I am in so much pain. Neck hurts-I can feel a deep and painful pinch in it.

The following was said about c3-c4:
-2mm rt & left posterolateral disc osteophytes at C3-4 with mild/moderate disc degeneration. Also left C3-C5 facet joint arthropathy with mild left anterior C3-C4 disc facet joint osteophytes formation. There’s also resultant moderate left C3-C4 foraminal stenosis.

I am thinking my neck is an issue but also RSD. My fusion looked great-according to the MRI and CT scan. No issues.

I am worried on losing any use of my right arm-like I have lost in my left. He didn’t even think he would be comfortable waiting 2-3 months before possible surgery again-if other treatments didn’t help. He said my neck looked really bad.

Tonight my medications aren’t even touching the pain…this is so old! Thanks:-/

Donald Corenman, MD, DC
Moderator

November 15, 2016 at 7:06 am

Post count: 8660

#23444

The swelling and pain could be due to CRPS (see website) but typically, weakness is not a significant part of CRPS. I assume that you have a solid fusion of C5-7 but are the foramen open. There are times that even with surgery, there can be continued compression of these nerves.

The right arm pain could be from the C4-5 level. You can get a selective nerve root block of that level and keep a pain diary to determine if this level is causing your right arm pain.

C3-4 is degenerative and certainly could be a problem in the future but is not causing right arm pain now. There are arguments to include it in a fusion and also arguments to leave it alone.

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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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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