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

October 13, 2017 at 11:25 pm

Post count: 8660

#26596

If facet blocks give you relief, I would do the simplest treatment that can give you pain reduction-RFA (radio frequency ablation). If you don’t get relief, there are two options. One is to do an intradiscal block of lidocaine to see if the actual bone-metal interface is causing pain. The problem is that the anesthetic agent might not distribute to this interface and you might have a false negative (pain not relieved where this interface is really causing the pain). Or you can revise these ADRs to ACDFs without that last step.

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 26, 2017 at 10:49 am

Post count: 42

#26694

Hi Dr. Corenman,

I am having the facet blocks performed tomorrow… will update once those are done. I am almost certain these facets are the issue as I have developed a persistent dull ache at the back of the neck near these levels and have some stiffness / crackling noises when I stretch my neck side to side that is increasing with time.

My surgeon is advising patience, but I am curious about your experience. What I have read about the artificial disc procedure leads me to believe that at 3 months out if I am having these significant problems they are unlikely to get better with more time… read somewhere the ADR is typically either a home run or a strikeout by 3 months out.

Thanks!
Kevin

thisiskmb
Participant

October 26, 2017 at 3:31 pm

Post count: 2

#26697

Hi there. I have a question – I have been experiencing neck pain since an assault three years ago. I went to a chiropractor for about 8 months to no avail. Here are my x-rays from 12/2014.

I was also recently diagnosed with Lupus, Rheumatoid arthritis (again; originally diagnosed as a child, went into remission in teens; I’m 33 now), Sjorgen’s, Raynaud’s syndrome and Hashimoto’s Hypothyroidism.

I’m not sure if the pain is a RA or muscle problem as it appears to be triggered by even the slightest neck movement some days, and is then fine for months. Lately, however, I have had recurring neck and shoulder pain for weeks.

I’m not sure if my x-rays shed any light (I was told they are relatively normal, minus the slight curvature of my spine), and that there wasn’t much damage otherwise.

The pain starts in the “center” of my neck and radiates either through my shoulders or up into my head. I’d say it ranges from a 3-8 in terms of a 1-10 scale of pain. It’s mostly achy when it’s a 3-5, and stabbing/sharp when it’s more painful. My range of motion (turning my head side to side is only affected when it’s hurting.

Wondering if this is likely related to my autoimmune conditions or if it’s the result of the 2014 assault I experienced (if it’s something I just need to deal with/expect vs. something that could be fixed).

Thank you for your help!
Kristianna

Donald Corenman, MD, DC
Moderator

October 27, 2017 at 10:01 am

Post count: 8660

#26703

Sorry to hear of this assault some years ago. Sorry but I can’t click on external links. You have autoimmune syndromes that any one (Lupis, RA) could cause involvement of your neck as well as trauma. You need an MRI and a spine consult.

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.

thisiskmb
Participant

October 27, 2017 at 10:05 am

Post count: 2

#26704

Thank you, Dr. Corenman. I’ll schedule something with you shortly. I appreciate it!
Kristianna

BRONCOFAN1
Participant

October 27, 2017 at 11:21 am

Post count: 42

#26708

Hi Dr. Corenman,

I had bilateral medial branch blocks done this morning. They did medial branch nerves 4,5, and 6, which they indicated would correlate with my surgical levels of C5-7 (mobi-C). I had immediate pain relief on both sides, however on the left side I developed some injection site soreness after about thirty minutes that made it more difficult to track the effect on that side. My symptoms are normally fairly similar on both sides, although typically quite a bit worse on the right side.

I had almost no pain response to typical painful activity for about 2 hours, then had a gradual return to my normal symptoms over the following hour. Is this timing typical for a medial branch block? Many websites note 4-6 hours, but your site indicates 2-3, more in line with my experience.

I will see my pain management doctor on Thursday of next week – would you consider the above strong enough evidence to proceed with an ablation? The posterior neck pain has gotten to the point where if the ablation does not work I am going to strongly consider a conversion 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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