permanent cervical radiculopathy

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mom4kids4cats
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April 16, 2013 at 12:06 pm

Post count: 6

#8446

I am 10 years out from an anterior fusion of C5-6 and a posterior laminectomy (one month after my first surgery) and 4 years out from an anterior fusion of C3-5. I have had pain in my right arm since my very first surgery and was diagnosed with cervical radiculopathy this year-most likely from the C6-7 nerve area. All the information I can find on this is pre-surgery and how it resolves on its own. I have been unable to get a straight answer from anyone as to the permanent nature of this condition. I am in PT and just starting on Neurontin. The PT has helped my muscle pain in other areas (shoulder, trapezius) but has not touched the pain in my upper right arm. At times it is intense and disabling-I am trying to keep working as disability payments would only be a fraction of what I am earning in my new position. After 10 years I suspect this is permanent but can never get an answer to this question. Help!

Donald Corenman, MD, DC
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April 20, 2013 at 10:38 pm

Post count: 8660

#8471

You now have a fusion of C3 through C6. The C6-7 disc has broken down and you have pain in your upper right arm. The question you pose is whether you have new pain from the C6-7 level vs. pain from chronic radiculopathy (the injured nerve or nerves that did not heal after your first, second or third surgeries).

I would assume that your pain is probably chronic radiculopathy as this pain has been present by your statement; “I have had pain in my right arm since my very first surgery”. See the sections on the website “chronic radiculopathy” and “nerve injuries and recovery” to understand this condition. I also assume that you mean the pain in your arm did not “go away” after the first surgery and did not occur as a result of your first surgery.

The way to determine if the C6-7 level is causing at least some of your arm pain is with a highly specific C7 nerve root block. This will temporarily anesthetize the nerve root. The relief you gain in the first three hours after the injection will indicate how much pain is generated by the C7 nerve root (see “pain diary” on this site).

The injectionist has to be meticulous and precise. Too much numbing medication injected into the C6-7 foramen can flood the canal and “travel up” the spine. This medication can also anesthetize the other roots in the canal giving a false positive test. This means that you would gain temporary relief as maybe the C5 or C6 nerve was also unknowingly but inadvertently numbed and the good results were thought to be from only the C7 nerve.

You can use this technique to also identify the individual nerve that was initially injured if the C7 block yields no relief. This test is useful to determine if other treatment is to be considered such as a spinal cord or peripheral nerve stimulator is contemplated.

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.

mom4kids4cats
Member

April 21, 2013 at 12:12 pm

Post count: 6

#8483

Thank you for the reply! Unfortunately I am a bit skittish about nerve blocks and injections in my spine. I recently found out that the pain clinic I went to put down the incorrect diagnosis and gave me injections in the thoracic and not the cervical spine. This was right around the time that patients who received these shots got meningitis. Thankfully, this did not happen to me; however, I did not get pain relief (obviously). I was set to get an implant for pain when I found out what happened with the first pain clinic mess up. The emg that I had in the meantime suggested that the nerves in my arm were ok but I had “large units” of old/chronic cervical radiculopathy. When I called to ask if the Dr. could be more specific-the nurse responded rudely with, “I don’t know how much more specific you want him to be!” I guess I will have to deal with large units of pain because the medical establishment has entirely failed in my case. Thank you for a great site-your information is the best I have found online! Having knowledge and answers to questions about my health is just as important (if not more so) than medication.

Donald Corenman, MD, DC
Moderator

April 21, 2013 at 8:42 pm

Post count: 8660

#8484

“Large units” of old/chronic cervical radiculopathy” most likely means that the EMG/NCV noted course firing when the examiner asked you to contract certain muscles while the needle recorded the muscle activity. This occurs due to chronic nerve injury and “nerve budding” (see the section under “nerve injuries and recovery”). It would be helpful to know what muscle or muscles were tested and found to have course firing. Get a copy of the consultation. This is your property and you should have all the office notes and dictations from your examinations as well as the doctor’s conclusions.

I understand your reluctance to have spinal injections from all the terrible problems due to the infections from injections. This debacle occurred due to some injectionists wanting to inject a similar product that was cheaper in order to make more profit. These injectionists purchased from this lousy “compound pharmacy” where the product was more inexpensive but the quality control was obviously faulty. The problem has been remedied and in the future, I do not think any injectionist will use any company but the actual manufacturer. You should however ask where the source of the injection material is from just to be sure.

Checking on your diagnosis and correct treatment algorithm is important to prevent mistakes which can inevitably occur in some practice situations. The implant suggested to you sounds to be a spinal cord or peripheral stimulator. Find the best person in your area to do this procedure or call the office and we will give you the name of the one we think is the best.

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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