Neck and Shoulder Pain

Tagged: ADR (artificial disc replacement) vs Fusion, Neck pain, RFA, X-raysh

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Donald Corenman, MD, DC
Moderator

July 4, 2017 at 7:08 am

Post count: 8660

#25394

It would be highly unusual to have a C6 nerve symptom picture without nerve compression in the neck. There are other disorders that can cause a C6 type of symptom complex like carpel tunnel syndrome and thoracic outlet syndrome as well as metabolic disorders like diabetes and Lyme disease. Having a negative Spurling’s test leads away from a neck disorder diagnosis and foraminal stenosis is almost always associated with neck extension and lateral bend to the side of the pain.

Facet pain can be related to some shoulder pain but not arm pain.

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.

BRONCOFAN1
Participant

July 4, 2017 at 7:44 am

Post count: 42

#25399

Thanks Dr. Corenman,

I appreciate all the help… this has been hard to figure out! My NCV was negative for Carpel Tunnel and showed no evidence of Brachial Plexopathy. Just had blood testing and no diabetes, and I have not had any tick bites leading up to these symptoms or other symptoms of Lyme.

I’m kind of at a loss, essentially the symptoms are a gnawing pain at the back of my neck (relieved / prevented with muscle relaxants), burning pain at the base of the neck that will spread to either side, and shooting / burning pains in the arms. EMG shows evidence of subtle bilateral C6 radiculopathy and left C7 (triceps).

I have read that some people get substantial pain from degenerative discs without nerve compression, potentially from the loss of disc integrity and resultant micro motion instability at that level.. could that cause inflammation that potentially impact the nerve root?

Maybe I should ask my Dr. to order another MRI? Previous MRI was on 5/8 on a 0.6T machine – I know you are not a fan of those!

Thanks again.. it is wonderful of you to give up your own personal time to help all of us on this forum!
Kevin

BRONCOFAN1
Participant

July 4, 2017 at 7:52 am

Post count: 42

#25400

Hi Dr. Corenman,

Also forgot to mention, I had another neurosurgeon consult…

1’st Opinion: Thinks symptoms are due to 2 levels of disc lack of integrity/stability despite lack of compression, recommended either continuing PT / injections or 2 level Mobi-C replacement.

2’nd Opinion: Believes there is an intermittent / dynamic nerve compression/irritation, recommends one more ESI followed by facet blocks. If unsuccessful, he recommended either 2 level ACDF or a partial laminectomy.

Kevin

Donald Corenman, MD, DC
Moderator

July 4, 2017 at 8:32 am

Post count: 8660

#25401

If your main complaint is neck pain (shoulder pain can be radiation from the neck or nerve compression), then you probably have degenerative disc disease as your primary pain generator. There is the chance that degenerative facet disease could also play a role. For neck pain, odd are that 70% comes from the disc and 30% originates from the facet.

However, even with those odds, generally I do like to get patients with mainly neck pain facet blocks initially. This is because treatment of facet pain (ablations or rhizotomies) is a relative non-surgical procedure and if not successful, does not burn any bridges (pun intended) to fixing the pain with an ACDF.

If neck pain is the predominant symptom, I generally do not advocate an artificial disc replacement. Motion is the pain generator and the goal is to eliminate motion from the painful segment. I have seen too may ADRs need revision to a fusion due to lack of neck pain relief.

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.

BRONCOFAN1
Participant

July 4, 2017 at 8:56 am

Post count: 42

#25406

Dr. Corenman,

I was just reading the section on cervical DDD on the site and came to the same conclusion. Neck/upper trap region pain is the main problem in my case, pain into the arms is intermittent and manageable. I had really assumed this was nerve compression pain because it is a burning sensation that is not relieved at all by NSAID or even Medrol. Seems that might lessen the odds of this being facet pain as well?

DDD seems to make sense given that the oral anti-inflammatories likely don’t get to the area of pain well, while the two ESI’s provided about a week of relief from the burning.

I do also have very good ROM in my neck without pain and no sign of degenerative facet disease on Xray / MRI.

Can DDD pain burn itself out in time if surgery is avoided?

If I go with a surgical option, it will be a tough decision. I am only 39 and have good range of motion, so 2 level ACDF seems likely to reduce ROM and I have a lot of years left for adjacent segment degeneration to add up. If the disc itself generates the vast majority of the pain, I assume ADR would then be fairly successful?

Thanks,
Kevin

Donald Corenman, MD, DC
Moderator

July 4, 2017 at 11:31 am

Post count: 8660

#25408

Facet or disc pain can be improved by the same oral medication and provoked by the same activities. DDD can easily be identified by X-ray and MRI. Determining range of motion of each segment can be performed on the flexion/extension X-rays. ADR can work for disc pain where the disc has not lost more than 50% of the original disc height and has no instability. If the facets are causing pain however, an ADR can cause increased pain due to increased range of motion. Before a disc replacement, facet blocks should be considered. If good temporary relief, an ADR is contraindicated.

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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