Viewing 6 posts - 31 through 36 (of 42 total)
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  • Avatarwestie10801
    Participant
    Post count: 84

    Good Evening Dr. Corenman,

    I’m more confused now, sorry, I thought when your fused anteriorly and posteriorly (360 degrees) the facet’s should not cause any pain? I would think no motion should exist at those levels. Placed a call to your office, and spoke to answering service. Will reach out tomorrow, and see if my insurance will cover a telemedicine appointment. Thanks

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7626

    You are correct. We are not talking about neck pain generated by facet disease but nerve root compression of the C4 nerve causing neck pain. The facet I assume is fused but could also be causing foraminal stenosis due to the enlarged uncovertebral joint.

    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.
    Avatarwestie10801
    Participant
    Post count: 84

    I spoke to NP at surgeon’s office and was told “most of your uncovertebral joints are enlarged due to arthritis”. I was referred to my last MRI that notes:

    “C3/4-C6/7 postsurgical changes are noted with anterior fusion plate and anterior fixation screws transversing the C3-C7 vertebral bodies. Graft placement associated with discectomy and fusion procedures are noted at the C3-4, C4-5, C5-6, and C6-7 disc space level. Hypertrophic changes are noted at each level deforming the anterior margin of the thecal sac”. Can enlarged uncovertebral joints encroach on dura and if so can this be a source of pain?

    I inquired about C3-4 facetectomy and was told ” due to previous procedures i.e. cervical laminectomies (C3-C7) foraminotomies (C5-C7), and medial facetectomies (C5-C7), it makes no sense to remove more bone, as any additional removal will cause additional weakening and instability. Your spine is already showing signs of weakness, due to fact that you have post laminectomy kyphosis deformity”. Is there any other procedure that can remove bone spurs without removing more bone? doesn’t appear any procedure that involves bone removal will be performed.

    Avatarwestie10801
    Participant
    Post count: 84

    Good evening Dr. Corenman,

    I will be making a decision soon on which surgeon will perform my Pseudarthrosis correction, however I wanted to obtain feedback from you before I proceed. Both surgeons appear reluctant to address any of the foraminal stenosis, especially, C3-4 moderate to severe foraminal stenosis due to uncovertebral bone spurring. First surgeon, was able to convince not to fuse C2-C3, he would perform T1-T2 with my iliac crest bone and two rods. He did inform me that in approximately 5 years, will need fusion extended to T3. Second surgeon stated he would perform Pseudarthrosis correction with bone graft, and extend fusion to T3. He would increase previous screw tracks hole size and place instrumentation from C5 thru T3. He believes that using instrumentation can probably help with kyphosis and stabilization.

    If you can share your thoughts on these different approaches it would be highly appreciated and helpful in making my determination. Thanks always in advance

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7626

    If both surgeons worry about the level below the pseudoarthosis (T2-3), it seems that addressing it at the time of surgery would make some sense. I would think the second surgeon might therefore be a better fit. I would not be absolutely committed to a formainotomy at C3-4 as with a previous laminectomy and fusion at that level, surgery would be quite challenging in either surgeon’s hands. Plus, you have not had a selective nerve root block to prove that this level is a pain generator.

    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.
    Avatarwestie10801
    Participant
    Post count: 84

    Good morning Dr Corenman,

    I had blocks performed in May and June of this year at C3, C5 and C7. All levels were pain generator’s especially C3-C4 left side. What’s ironic that my pain management pointed to is that I’ve had foraiminal stenosis at these levels before all anterior and posterior procedure’s, i.e ACDF, Laminectomies, facetectomies, corpectectomy and not one procedure has removed these multi level compressions.

    The bone spurs were never removed during my ACDF’s and as you stated earlier it’s very challenging to perform from a posterior approach. What I’m not sure of is can an anterior micro foramenotomy remove these bone spurs? We know these levels are pain generator’s, per injections and EMG studies, the bigger question is how can it be fixed? Thanks again

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