Neck and Shoulder Pain

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

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BRONCOFAN1
Participant

January 18, 2018 at 4:37 pm

Post count: 42

#27338

Hi Dr. Corenman,

Quick update – 5 weeks out and I am extremely satisfied with the results of my ACDF (c5-7) – this was a revision of failed ADRs at those levels.

Range of motion is great, and the only remaining issue is a little bit of muscular strain late in the day, particularly on the right side where my facet syndrome was the worst. My guess is the muscles need some strengthening / rebalancing after a year of muscle spasms and disfunction from DDD first and then the failed ADR.

Will update again after my X-rays but everything is going great!

Kevin

Donald Corenman, MD, DC
Moderator

January 19, 2018 at 8:10 am

Post count: 8660

#27348

Thanks for your follow-up. Your participation is appreciated!

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

March 18, 2018 at 8:16 pm

Post count: 42

#27903

Hi Dr. Corenman,

Another quick update – now about 3 months post C5-7 ACDF to replace failed ADRs and continuing to feel much better. Wanted to share a couple of observations with your forum for other who may be suffering with neck pain from DDD from my experience as a patient.

1) You should feel considerably better by at least 6-8 weeks after surgery.. in my case I still had severe pain after the ADRs at that stage, but my surgeon told me I needed to give it more time. Said the same thing at 3 months. At 4 months I insisted the ADRs had failed and scheduled a revision to ACDF (after facet injections / RFA failed to fully relieve the intense facet pain that was made worse by the ADRs).

2) If most of your pain is in the neck itself, you do have to be patient during the recovery process. You should feel quite a bit better at 6-8 weeks, but even at 3 months I still have some nagging muscular pain in the back of my neck, particularly in the morning. It is improving with time, and is much better that pre-surgery. Unfortunately, from what I understand, it is not uncommon to have muscular imbalances develop when you have severe muscle spasm from DDD in the muscles at the back of the neck. Physical therapy is important to help correct this – so follow your surgeons instructions on exercise and PT! From what my PT indicates, the deep neck flexors toward the front of the neck often become very weak / inactive after months of neck pain as the spasms in the back of the neck tend to inhibit these muscles from working normally. They are important to the overall stability of the neck, and take time and work to get back to normal. While that process is ongoing, he says it is not atypical to still have some muscle pain from overworked muscles in the back of the neck.. For Dr. Corenman – curious how often you see this kind of pattern with your neck pain patients?

Thanks again for all your help!

Kevin

Donald Corenman, MD, DC
Moderator

March 24, 2018 at 3:38 am

Post count: 8660

#27935

I think your discussion is a generally accurate note of the progress expected after an ADR to ACDF revision surgery. Some patients get immediate relief but some note mild initial improvement that continues to drop symptom intensity over three months.

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

April 25, 2018 at 12:44 pm

Post count: 42

#28160

Hi Dr. Corenman,

Well, sorry to have to endlessly post questions here, but wanted to get your thoughts on my status. As a review, I initially had some severe gnawing pain at the base of my neck, neck stiffness, and a burning type sensation from the lower neck that would spread out toward the shoulders on both sides, worse on the right and made worse by activity of any kind, impact or exercise. Imaging showed a diffuse bulging disc at c5-6 and annular bulge at c6-7, without foraminal stenosis. Flex-ex showed 2 MM of movement between views at both c3-4 and c4-5. Discs at those two levels both look fine. After 6 months of pain, I had ADR (Mobi-C) in July 2017… initially I was optimistic as the gnawing pain and neck stiffness went away (surgeon said the C5-6 disc was very badly degenerated even though it had not collapsed very much prior to surgery), but I developed some severe facet pain and the burning sensation in the lower neck continued. Medial branch blocks yielded good pain relief, and an RFA on the right side did reduce the severity of the pain considerably. However, since the pain was still significant I had a revision to ACDF in December. I am no longer on any medication post surgery.

While generally pleased with the ACDF revision results, I have noticed I still have quite a bit of what feels like muscular pain near the base of the neck, sometimes extending up into the mid neck region but no longer past the neck area toward the shoulder. The pain is always off center and is on both sides, maybe a bit worse on the right. The severity is reduced from both pre original surgery and ADR, but it is still quite bothersome. Muscle relaxers actually seem to make it worse, and NSAIDS that I am now cleared to take don’t seem to do too much good. It is relieved with rest (lying down) and heat. I continue to work on exercises targeting the deep neck flexors, around the worlds, etc. that the physical therapist recommends.

In your experience, do some people just take quite a lot of time to get the muscular balancing correct again after surgery… there seem to be just an awful lot of wildly varying opinions about why some people still have chronic neck pain after surgery, in the absence of any obvious pain generators… Some articles seem to believe that long term spasms in the back of the neck can lead to very weak / deactivated deep neck flexors that cause chronic overuse of the muscles at the back of the neck. That seems like it matches with my experience, but I’ve been trying to keep working on strengthening those muscles without much impact. Can the facets at the operated levels just take a very long time to completely calm down? I know your experience is that 3 months should be enough time to evaluate pain relief after ACDF, but I’ve also read other articles that say improvement might continue for longer as the neck adjusts to the new mechanics, etc. I recall you joked once in the forum that if you asked 5 spine surgeons a question you’d get 10 opinions, and that certainly rings true for me!

I wonder a little bit about the 2 MM translation at the levels above the fusion, but I would think c3-5 might cause more mid neck / headache issues rather than pain at the base of the neck.

I will have another flex-ex and visit with the surgeon next week so I can post again if that turns up anything of note. At this stage, is there anything else you would recommend? I don’t think a CT is necessary unless the flex-ex shows something worrisome – I don’t feel there is any indications the fusion has failed as the symptoms just never fully resolved. I had expected to just see gradual progress, but unfortunately it seems to have stalled at this point.

Thanks again for your time… hope someday I won’t need to ask anymore questions!

Kevin

Donald Corenman, MD, DC
Moderator

April 25, 2018 at 2:14 pm

Post count: 8660

#28162

Pain generation could be from the lack of fusion (pseudoarthrosis) of the C5-7 conversion levels (from ADR to ACDF), to continued facet pain from those levels (highly unusual after 3 months with a solid fusion) or from the levels above or below. A systemic meticulous workup with physical examination, imaging studies and diagnostic blocks is the technique I use to determine what is and is not causing 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.
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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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