Paraspinal muscle spasm radiculopathy?

Tagged: Muscle spasm degenerative disc neurogenic

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Rburgess
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August 17, 2016 at 7:15 pm

Post count: 3

#22817

Hi Dr. Corenman
In your experience is is possible for paraspinal muscle spasm to occur in the absence of pain? I have had tight paraspinals for 20 years after an episode of LBP that lasted for about 6 months. Initially the tension was localized to the lower right but now extends to the thoracic R&L and the R paraspinals are hypertrophied vs the L. My MRI shows a 40% loss of disc height at L4/L5 and broad central disk bulge with a small R side protrusion and moderate loss of foraminal height. I experience paresthesia in the 1st 2 toes and sole of the right foot with any weight bearing but no pain. More debilitating is the muscle spasm that occurs after standing or sitting for as little as 10 minutes. I think all the multifidus strengthening that was prescribed was not beneficial.I can sit for long periods if I slouch and keep the lumbar spine flexed. A soft bed will also trigger the spasm unless I elevate my lower back. All the reports of neurogenic muscle spasm that I have read relate to the extremities. I also have a central disk bulge at C5/C6 that is borderline stenosis but no myelopathy symptoms. Is it possible that posterior compression of the spinal nerve within the foramina by the superior articular process could impact the dorsal rami? Would an interspinous spacer potentially provide any benefit?
Thank you in advance.
Ron

Donald Corenman, MD, DC
Moderator

August 19, 2016 at 10:59 am

Post count: 8660

#22818

I would assume that the “muscle spasm” sensation that you note is probably discomforting but you don’t interpret this sensation as pain. Muscle spasm can be reactive due to pain or instability or protective to prevent motion that could be painful. With loss of disk height and bone spur formation at L4-5 along with “moderate loss of foraminal height”, this sounds like foraminal collapse. See https://neckandback.com/conditions/foraminal-collapse-lumbar-spine/.

The foramen changes shape (volume) with flexion and extension. Flexion (bending forward or “slouching”) will “open” the canal and conversely, extension (standing/walking) will narrow this canal. This seems to fit with your symptoms even though there is “no pain”.

It is highly unlikely that the cervical spine is affecting the lumbar symptoms.

I am not a fan of interspinous spaces. The cause a forced flexion of the vertebra to “artificially” open the foramen by causing a flexion deformity (kyphosis) of this segment. Increased flexion will increase the stress of the levels above and below. In addition, these deforming devices are “wedged” between the spinous processes and I have seen many erode into the bone which returns the alignment back to normal which then allows the foramen to be recompressed.

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.

Rburgess
Participant

August 19, 2016 at 12:19 pm

Post count: 3

#22819

Hi Dr Corenman
Thank you for your quick and informative reply.
The spasm can be quite painful when it lingers.
My impression over the years is that the muscles seem to have a few chronically active fibers, the tension of which extends from the sacrum to the skull. Stretching produces a burning sensation along the muscle and they are thermally warm in specific areas. What I am wondering is if lumbar foraminal stenosis can result in chronic low level paraspinal muscle activation by compression of the portion of the exiting nerve that becomes the dorsal rami rather than pain avoidance. Probably a moot point but lumbar and cervical disc herniations seem to co-occur rather frequently. I am hesitant to undergo surgery for a bit o sciatica, but if the muscle spasms can be eliminated I would a sign the waiver tomorrow.
Thank you for the wonderful website.
Ron

Donald Corenman, MD, DC
Moderator

August 20, 2016 at 9:39 am

Post count: 8660

#22822

There are muscle diseases (polymyalgia rheumatica or muscular dystrophy) and muscle injury disorders (most famous being “tennis elbow”) so muscles can generate pain but typically, the muscles are the respondents of the disorder. The pain from the muscle may be nerve generated or muscle tightness from protection or activation by nerve compression.

The best way to determine if the nerve is the cause of the muscle spasm is with a SNRB (selective nerve root block). Aggravate the muscle spasm and then get the injection. If the nerve is the cause of the muscle spasm, the muscle spasm “pain” should be relieved temporarily with the injection (see pain diary).

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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