Neck and Shoulder Pain

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

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BRONCOFAN1
Participant

August 5, 2017 at 7:50 pm

Post count: 42

#25923

Hi Dr. Corenman,

I can’t thank you enough for your time in replying to my many questions, and wanted to post a quick update. I went ahead with the ADR back on 7/20. It was so helpful to be able to know what factors would make an ADR a viable option for disc pain, and in my case I met all of the criteria you laid out (<50% loss of disc height, good segment motion without instability, lack of facet pain, and relief of arm/neck pain from SNRB). All of this allowed me to ask better questions of my surgeon and feel good that the surgical plan was correct.

While I’m still in recovery mode the surgery seems to have relieved all of my primary symptoms.

Thanks for all you do here on this site and forum to help educate and allow patients to advocate for their own best care! I will post another update in a few months.

Kevin

Donald Corenman, MD, DC
Moderator

August 5, 2017 at 11:36 pm

Post count: 8660

#25924

Thanks for the kind words. Glad you are doing better.

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

September 19, 2017 at 8:05 pm

Post count: 42

#26396

Hi Dr. Corenman,

I’m now almost 9 weeks out and continuing to get closer to normal! I did have one more question for you. Do you generally advocate any activity restrictions after a 2 level ADR (C5-7)? My discs above and below do not show any degeneration or narrowing, I don’t have in mind to do anything too crazy but would like to get back to my routine of jogging a few miles every other day. My surgeon thinks that would be fine to ease back into about 12 weeks post op assuming everything is still healing nicely. I’m only 39 though, so I need to get a few more miles out of this neck and don’t want to do anything that would significantly increase the risk of more degeneration.

Thanks,
Kevin

BRONCOFAN1
Participant

October 12, 2017 at 8:40 am

Post count: 42

#26574

Hi Dr Corenman,

Well, I’m now almost three months out and unfortunately having some issues. While the two level c5-7 mobi-c replacement eliminated my pre surgery issues, I have persistent pain at the back sides of my neck. It feels muscular in nature, as if those muscles are just constantly overworking. My neck range of motion is still fine. Is this something that happens often with the ADR? And if I can’t get the situation to improve with physical therapy, would conversion to ACDF be a reasonable option?

Thanks,
Kevin

Donald Corenman, MD, DC
Moderator

October 13, 2017 at 3:21 am

Post count: 8660

#26584

First, you need to find out what is causing this pain. I will assume the other levels appear normal on MRI and X-ray. The complaint; “those muscles are just constantly overworking” in the back of the neck could be generated from the facets. ADRs (artificial discs) can allow more motion that the previous degenerative discs allow, overloading the facets to cause pain. I think the next step is to have facet blocks and keep a pain diary to determine if you gain 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

October 13, 2017 at 1:05 pm

Post count: 42

#26594

Hi Dr. Corenman,

Thanks – I have scheduled a Monday visit with the injectionist to see about getting facet blocks done and will see my surgeon on Tuesday to discuss with him. You are correct, all levels other than C5-C7 appear normal on both X-ray and MRI.

Based on the location of the pain, the facet’s seem like the logical culprit. I am really surprised by the outcome, as pre surgery I had all the right indications for ADR and no real relief from facet blocks. My facet joints show no real signs of arthritis… My pre-surgery symptoms are all gone, so the disc was pretty clearly causing them. I can see now why you lean heavily toward ACDF in cases with significant neck pain, as even with all the right boxes checked it seems my ADR did not work and in fact seems to have caused new problems!

One additional question – if the facet blocks give me pain relief, would you suggest leaving the ADR in place and attempting an RFA? Or in that case would you typically convert to ACDF?

Thanks,
Kevin
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Donald Corenman, MD, DC

Average rating:

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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