Neck and Shoulder Pain

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

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BRONCOFAN1
Participant

November 5, 2017 at 6:38 pm

Post count: 42

#26768

Interesting… I did wonder if insurance was the reason I had a medial branch block rather than facet injections. I didn’t get a great explanation, and I was a bit disappointed as I know some people, albeit a small minority, get good long term relief from the facet injections. But it occurred to me that insurance might require the medial branch block before an RFA, and if so they’d be trying to skip a step to get straight to the long term solution.

The “good” news is that the right side is orders of magnitude more painful for me, but this scenario would be most irritating (literally) for someone who had more symmetrical facet pain. Also fortunate that it appears I can proceed with the second RFA two weeks later.. I’ve scheduled for three weeks out so if the first one fails I can cancel or push back the second one.

Thanks,
Kevin

Donald Corenman, MD, DC
Moderator

November 6, 2017 at 5:18 pm

Post count: 8660

#26775

Perfect. Some insurance companies require first intraarticular facet injections and then medial branch blocks with good results from each to warrant ablations. There is nothing wrong with that scenario but more injections than I think is needed. Please keep the forum informed of your diagnostic results.

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.

Donald Corenman, MD, DC
Moderator

November 6, 2017 at 5:18 pm

Post count: 8660

#26776

Perfect. Some insurance companies require first intraarticular facet injections and then medial branch blocks with good results from each to warrant ablations. There is nothing wrong with that scenario but more injections than I think is needed. Please keep the forum informed of your diagnostic results.

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

November 13, 2017 at 6:28 pm

Post count: 42

#26818

Hi Dr. Corenman,

3.5 days out from my right side RFA and I am starting to feel some pain relief… seems to confirm again that the facets are the issue here. I understand it can take 7-14 days for the full effect to be reached.

A quick question in the meantime… I am noting significantly more joint stiffness when I bend my neck laterally,particularly first thing in the morning, along with increase cracking or even mild “catching” type sensations with motion. I’m 4 months out from the c5-7 mobi-c replacement. Since it now appears obvious the facets were injured going in, would it be typically for bone spurring / arthritis to develop fairly rapidly? Guess I am a bit concerned that simply trying to manage it is only going to buy a little time before it becomes necessary to explant and fuse anyway. With no natural disc to degenerate further and slow down the segment, is it correct to imagine that the facets will tend to degenerate much more rapidly than they would in a typical scenario?

Thanks,
Kevin

Donald Corenman, MD, DC
Moderator

November 14, 2017 at 5:24 am

Post count: 8660

#26821

It really depends upon the current condition of your facets. If they were somewhat degenerative prior to the ADRs, then the additional change in motion can aggravate them even more. “Cracking”, “grinding”, “sand in the joint” and “popping” are all typical sensations generated by degenerative facets. It may be that you did not develop fast-onset degenerative changes but simply had a change of motion to the joints brought on by the placement of the artificial disc.

No one has studied how much faster a facet can degenerate under the influence of an ADR. That would be a good study but I can’t currently do it as I don’t have enough of these patients in my own practice to have a large enough sample size.

It can take as much as six weeks to understand how much better (or worse) the symptoms can change from an RFA.

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

November 25, 2017 at 3:32 pm

Post count: 42

#26934

Hi Dr. Corenman,

Well, it appears my RFA pain reduction has peaked.. I had about 30% at 7 days and now at 2.5 weeks it is basically unchanged from that. I will give is some more time but I’m going to dual track the prep for a revision to ACDF at this point. Is it unusual to get such a small amount of pain relief after getting 100% relief from an MBB? I’m hoping the MBB relief is a good indication of what I might achieve with a revision to ACDF in any event. My replaced discs are at c5-7.

Two additional questions for you:

1) my c3-5 discs are normal on MRI and recent surgery follow up x rays show no loss of disc height. Any reason for a new MRI before considering a revision surgery? Also, would you be concerned that the flex ex shows 2 mm of motion at the c3-5 levels between flexion and extension? Seems like that is at the high end of the normal range… just curious if that will put me at more risk for developing problems at these levels after ACDF, or of 2 mm is normal enough to potentially not really mean anything…

2). If I do go with the revision route, are there any necessary activity restrictions with a 2 level ACDF? Was hoping to get back to light jogging and such, and a (perhaps misguided) belief that ADR would be better for future activity weighed heavily on my decision to go that route.

Thanks!
Kevin
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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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