Nerve pain, back pain and numbness in hands and feet

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Vjenkins
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April 12, 2014 at 4:15 am

Post count: 10

#10709

Dr. Corenman:

It has been some time since I have been here. About 7.5 months ago I had an ACDF on my neck and all is going well there, healing nicely and bone growth going well.

About 1 month ago I felt this “wiggly” feeling in my toe and was hoping it would go away, it didn’t, after about 3 weeks I called my neurosurgeon and the symptoms were starting to progress before the appt. time. I started having nerve pain, I explain it as branches of nerves flickering, but it hurts, and I developed numbness in my toes, then my foot, then it started in my left toe and foot. It progressed over the course of only 1 week to my hands, with slight numbness and the same nerve pain. The nerve pain is intermittent but the numbness seems pretty constant and my feet are COLD all the time and hands mostly cold as well and I have back pain as well. I went to see my neurosurgeon and had an MRI and I wanted to get your impression on the results as I will not see him for a bit. I went to pick up my medical records and I have the written report and the MRI images. Please see results below: note that I had a lumbar and thoracic MRI done:

MRI: T SPINE W/O CONTRAST

FINDINGS: Thoracic marrow signal is normal. There is no focal cord signal abnormality. The conus is normal, no canal or significant foraminal stenosis.

t1-t2 minimal disc bulge, t2-t3 minimal disc bulge, t3-t4 minimal disc bulge, t4-t5 no sig. abnormality, t5-t6 no sig abnorm., t6-t7 no sig. abnorm., t7-t8 mild disc bulge with small central disc protrusion. No stenosis.
t8-t9 minimal disc bulge, small right sided disc protrusion with some effacement of the thecal sac. No stenosis.
t9-t10 minimal disc bulge, t10-t11 minimal disc bulge, t11-t12 minimal disc bulge
IMPRESSION: MILD MULTILEVEL THORACIC SPONDYLOSIS AS DESCRIBED WITH SMALL CENTRAL T7-T8 AND SMALL RIGHT SIDED T8-T9 DISC PROTRUSIONS. NO CANAL OR FORAMINAL STENOSIS.

MRI: L SPINE W/O CONTRAST

Finding: sagittal images demonstrate mild chronic anterior wedge compression of the L1 vertebral body and mild chronic irregularity of the inferior L2 endplate with small Schmorl’s nodes. No acute compression/marrow edema. Lumbar levels intact otherwise, distal cord/conus normal.

L1-2: mild posterior disc bulge and endplate spur slightly effacing thecal sac, but w/o sig spinal stenosis. Mild facet hypertrophy

L2-3: no disc herniation or sig. spinal stenosis. Bilateral foramina are clear. There is mild facet hypertrophy.

L3-4: very mild lateral recess narrowing predominately due to mild to moderate facet hypertrophy with ligamentum flavum thickening. No disc component or nerve root impingement. Foramina are clear.

L4-5 Mild lateral recess narrowing from mild disc bulging, mild to moderate facet arthropathy with ligamentum flavum thickening. No nerve root impingement. Very mild foraminal narrowing.

L5-S1: very mild posterior disc bulge slightly effacing the epidural space. No sig. stenosis/mass effect. Facet arthropathy w/o significant foraminal stenosis.

IMPRESSION: MILD LUMBAR DDD/SPONDYLOSIS AS DETAILED ABOVE, NO ACUTE APPEARING DISC HERNIATION, MILD CHRONIC COMPRESSION DEFORMITIES L1 AND L2, NO ACUTE FRACTURE/EDEMA.

Sorry for the long message, any advice you would give me would be beneficial as I’m not sure if this means surgery or not.

Thank you and I look forward to your response.

Also wanted to add that I’m feeling burning pain in my right thigh and right buttocks intermittently, my feet are tender and hurt to walk on.

Donald Corenman, MD, DC
Moderator

April 14, 2014 at 6:49 am

Post count: 8660

#10714

Nerve symptoms that spread to hands and feet are called “stocking and glove” paresthesias and pain. There are many different causes of this type of symptom complex and the spine is only one of them. There are metabolic neuropathies (like hypothyroidism), malabsorption neuropathies (like vit. B12 deficiency), infectious neuropathies (like Lyme disease), inflammatory neuropathies (like SLE) and substance abuse neuropathies (like alcoholism).

Neuropathies from the spine would originate from the cervical spine as you have hand involvement. Compression in the thoracic and lumbar spine would not cause upper extremity symptoms.

I am curious about your physical examination as if you had long tract signs (hyperreflexia and Hoffman’s signs among others), that would lead me to look at the cervical spine.

Look under peripheral neuropathy on the website to understand what could be occurring. Maybe consider a neurologist (not a neurosurgeon) and get a consult with an EMG/NCV test to help with your current diagnosis. Maybe a new MRI of the cervical spine should be considered.

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.

Vjenkins
Member

April 14, 2014 at 8:05 am

Post count: 10

#10721

Thank Dr. Corenman for responding. My neurosurgeon took an X-ray of my neck that day and he did not see anything. He said it looked like my bones were healing well. You mentioned another MRI of my cervical spine, I will ask him to do this.

I had recently had my blood checked for GHP and iron, no issues there except low vit D, which I’m taking. I do not think they checked my B12 only my B6 if I recall correctly, not did my magnesium get checked.

I’m not sure what the reference acronyms are but will look up. Also, the exam was very minimal, he only very slightly rubbed the side of my foot, that is all.

I will look into seeing a neurologist as well. My neurosurgeon really didn’t say or do much, just ordered the MRI. It would be great to figure this out.

If you have any other thoughts please post, thank you for your advice.

Donald Corenman, MD, DC
Moderator

April 14, 2014 at 1:59 pm

Post count: 8660

#10731

Unfortunately, your examination was not enough to reveal potential diagnoses. A neurologist consultation and an MRI of the cervical spine might yield valuable information.

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.

Vjenkins
Member

April 15, 2014 at 2:28 am

Post count: 10

#10739

Thanks again for responding and so quickly. I’m going to see about scheduling an EMG and NCV. I’ve been reading a bit about peripheral neuropathy and distal neuropathy. The distal neuropathy, as you had mentioned sounds like what I have. The question is, from what and how to treat? My neurosurgeon hasn’t read the results or contacted me yet, I will definitely mention these issues/concerns and request the above mentioned tests.

What did you think of my MRI results, could you please comment on that?
I’m curious to know what you think of the results.

As always, thanks for your time.

Donald Corenman, MD, DC
Moderator

April 15, 2014 at 11:59 pm

Post count: 8660

#10742

Peripheral neuropathy can be caused by many identifiable processes like diabetes but many times, the process that causes this disorder cannot be identified. Probably genetics will eventually be identified as a significant cause.

The process to treat peripheral neuropathy is to identify any modifiable processes that can cause this disease (diabetes, Lyme disease, hypothyroidism, etc…) and to treat the symptoms that are disagreeable (pain and severe pins and needles). The use of medications (see membrane stabilizers under medications on this website) can be quite helpful for some patients.

Your MRI of the thoracic spine and lumbar spine demonstrates mild to moderate degenerative changes without any specific compression to the cord or nerves. The caveat is that I am looking at your MRI through someone else’s eyes which always makes me nervous.

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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