Nerve damage

Tagged: Arm pain not relieved by ACDF

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Kathyrob56
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September 28, 2016 at 7:27 am

Post count: 9

#23088

I had a bone spur removed and c4-c5 dissection last year. Pain is same as before surgery. Can this nerve damage be permanent

Donald Corenman, MD, DC
Moderator

September 29, 2016 at 9:05 pm

Post count: 8660

#23090

First, the diagnosis has to be verified. You are assuming that the pain that resulted in the C4-5 ACDF was generated from the C5 nerve. Did you have a SNRB (selective nerve root block) to verify that this was the level of the pain generator? Did you have the shoulder looked at? Did other levels possibly cause this pain?

The C5 nerve will cause pain into the shoulder and down 1/2 way to the elbow (potentially). Does this match the previous diagnosis? See https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/ to understand what a C5 nerve will cause in regards to symptoms.

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.

Kathyrob56
Participant

October 1, 2016 at 11:45 am

Post count: 9

#23107

Dr. Corenman, had the surgery and went back for post op visits. My neurosurgeon became upset with my husband because he questioned if he had done the right level. He rushed me back to xray room and took xray and then said forcefully that he had done the correct level and all the screws and plate were in tact. I did not have a nerve block to assure this was the cause of my hand numbness and pain. My MRI is as follows at C3 C-4 there is no cord compression. C-4 C-5 , there is marked narrowing of the disc, productive changes and probable central disc herniation at the posterior disc margin with 6 mm AP diameter of the central spinal canal and with the cord compression flattening with approx. 3 mm AP diameter of the central cord, consistent with the appearance of cord compression and myelomalacia as seen in previous study and corresponding to the cord compression on Myelogram. There is a vacuum disc phenomenon at C4 C5, with Hypertrophic Luschka joint changes are present, greater at right than left, with mild to moderate C4 C5 neural foraminal stenosis.
At C5 C6 there is disc space narrowing with mild productive changes and ligamentous thickening along the posterior disc margin with 8 mm AP diameter of the central canal, with mild to moderate bilateral neural foraminal stenosis, worse on the left than right. Hypertrophic Luschka joint changes are present. There is vacuum phenomenom with a gas filled cyst at the left inferior aspect of C 5.
At C6 C7 there has been previous fusion, without residual disc herniation, spinal stenosis or cord compression. There is no C6-7 foraminal or spinal stenosis or central canal stenosis C1-2,C3-4,C7-T1 and remainder are unremarkable.

After appt he sent me to orthopedic Dr. who sent me to PT for frozen shoulder.My neurosurgeon also said I have nerve damage because there was no way of knowing how long the spinal cord had been compressed. To give it a year. And said he would see me in 1 year. I now have worsening neck stiffness, shooting pain down left arm when I raise it forward,my hands have burning pain in thumb and index finger. I am on Cymbalta, Neuronton and Celexa. My PCp put me on Cymbalta playing around with the diagnosis of fibromyalgia. I am ready to pull my hair out. Just want your input and thoughts on this. Thank you

Donald Corenman, MD, DC
Moderator

October 1, 2016 at 7:23 pm

Post count: 8660

#23108

You obviously needed this ACDF surgery at C4-5 due to the severe compression and cord injury (myelomalacia). However, you have pretty severe degenerative changes at C5-6 (“mild to moderate bilateral neural foraminal stenosis, worse on the left than right. Hypertrophic Luschka joint changes are preset”). You also have had the prior fusion at C6-7.

The C4-5 level needed to be surgically addressed but the C5-6 level houses the C6 nerve which radiates down to the hand on the thumb side. Your initial arm pain might have originated from this level as the C4-5 level (the C5 nerve) does not go down below the elbow. Your current pain could be from the C6 nerve. A selective nerve root block (while keeping a pain diary) will ascertain if this is the pain generator.

The fusion at C6-7 along with the new fusion at C4-5 places much greater stress on C5-6. Since this C5-6 level is already significantly degenerative and there will be much more stress due to the fusions above and below, you will probably wear C5-6 out faster and need to have this level addressed surgically.

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.

Kathyrob56
Participant

October 1, 2016 at 9:26 pm

Post count: 9

#23112

Dr. Corenman, Thank you so much for explaining this to me. This chronic pain has taken a toll on me. I really appreciate this. Kathyrob56

Donald Corenman, MD, DC
Moderator

October 2, 2016 at 11:22 am

Post count: 8660

#23119

Please keep us informed of your progress.

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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