[westie California]

#22900

Hello Dr. Corenman,

I hope all is well and that your enjoying the remaining days of summer.

My question continues to relate to my neck and the constant day to day pain. The base of my neck, arms(biceps),shoulder blades, shoulders and right side occipital headaches with dizziness. I’m still hearing popping and crackling when i move my neck in different directions. Sitting or walking will significantly magnify the pain and discomfort. Also chin tucks brings on additional pain around the C7/T1 bone area in the back part of my neck.

My recent EMG/Nerve conduction shows moderate chronic C5, C6, C7 radiculopathy bilateral nerve irregularity.

8/23/16 MRI states the following:

C3/4-C6/7 post surgerical changes are now identified. Anterior fusion plate is noted with anterior fixation screws transversing the C3,C4, C5, C6, and C7 vertebral bodies. Post surgical changes compatible with discectomy and fusion are noted at C3/4-C6/7. Hypertrophic changes are noted at each level deforming the anterior margin of the thecal sac. C3/4 mild left neural foramina narrowing and C5/6 mild right neural foramina narrowing are noted in conjunction with hypertrophic changes.

At C7/T1, a disc budge is noted deforming the thecal sac. Neural foramina stenosis is not suggested.Loss of disc signal is noted with partial loss of disc space height.C7/T1 disc bulge represents mild progression compared to prior study.

At T1/T2, a disc budge is noted deforming the anterior margin of the thecal sac. Right proximal neural foramina extension is suggested. There is no evidence of left neural foramina stenosis.Loss of disc signal is noted with anterior hypertrophic changes and anterior disc extension.

At T2/T3, a disc budge is noted deforming the thecal sac. Left proximal neural foramina extension is suggested. There is no evidence of right neural foramina stenosis.Loss of disc space height and signal is noted with anterior hypertrophic changes and anterior disc extension.

Cervical spine straightening is noted.

Pain doctor performed Occiptial nerve block which helped with headaches for approximately 4 days. The pain came back.

Over the past 2 months pain doctor performed bilateral C2, C3, C4, C5, C6 and C7 radio frequency ablation. The bulk of my pain resides at my lower cervical spine area.

My spine surgeon started I have a solid fusion, however the laminectomy was not performed well by my previous surgeon. He would need to revisit C5, C6 and C7, extend fusion to T2 with instrumentation and perform foraminotomy.

My question is before going forward with an additional surgery (which would be my 6th),would it be worthwhile to have a thoracic block and possibly an RFA and see what happens before undergoing the knife? Thanks in advance for any input.

[Donald Corenman, MD, DC]

#22903

It appears that you had a C3-C7 ACDF type fusion in the past. There are not severe compressive changes noted at the operated levels (“C3/4 mild left neural foramina narrowing and C5/6 mild right neural foramina narrowing are noted”).

There are degenerative changes at C7-T1 below the fusion without nerve or cord compression (“disc budge is noted deforming the thecal sac. Neural foramina stenosis is not suggested.Loss of disc signal is noted with partial loss of disc space height”). There are degenerative changes at T1-3 with some “suggested” nerve root impingements at various levels.

There was no reason for C3-7 facet blocks or ablations as these levels are fused and will not produce pain (as long as they are solidly fused).

It sound like your current surgeon is contemplating a posterior decompression and fusion at C7 through T2 (T3 I would assume to take care of the degenerative level at T2-3). Is there any proof that these levels are pain generators? Are there nerve root blocks, facet blocks or discograms that would confirm these levels are pain generators or is this an educated guess on his or her part?

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.

[westie California]

#22904

Good evening Dr Corenman,

In the past three ACDF’s were performed covering C3-T1 (C3-C7 – two plates, C7-T1-Peek Cage).

My surgeon would like to re-operate and revisit laminectomy at C5, C6 and C7 (feels laminectomy at C3 & C4 are fine), extend fusion to T2 with instrumentation and perform foraminotomy. I still have pain base of neck, arms(biceps),shoulder blades, shoulders and right side occipital headaches with dizziness.

In terms of pain generators my surgeon feels the above along with herniations, and nerve root impingements below fusion are the root of my pain.

I would like my pain doctor to perform thoracic blocks and see if my pain decreases, and if so perform a radio frequency ablation before going forward with any additional surgeries.

Will RFA address pain associated with disc bulges and nerve impingement? Thanks

[Donald Corenman, MD, DC]

#22905

I am unclear as to why the laminectomies will be “revisited” as C5-7. Has there been compelling evidence that the central canal is not open (not noted by the radiologist)? Maybe he means foraminotomies, opening of the nerve holes. Still, I would like to see SNRBs to prove that any pain you have is being provoked by nerve compression. Even positive blocks (temporary pain relief) does not prove that decompression will relieve this pain as a nerve that is chronically damaged (chronic radiculopathy) will gain temporary relief with this block.

There still seems to be no evidence that fusion below the current T1 level will lead to relief. I would want at least relief from an epidural if not SNRBs or discograms to determine if these levels are causing pain (see pain diary).

RFA (radio-frequency ablations) will only relieve the pain from facets, not from nerve compression or disc 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.

[westie California]

#22911

Thank you so much!

[Donald Corenman, MD, DC]

#22918

Please keep us informed.

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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