RADICULOPATHY

Tagged: artificial disc replacement, cervical degenerative kyphosis, Cervical stenosis

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Rozy56
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April 12, 2016 at 5:19 pm

Post count: 29

#21953

I am a 60 year old female with a history of longstanding spinal stenosis. 14 years ago, I had a two level anterior foramenectomy without fusion due to bone spurs compressing the nerves and causing loss of function of my hand. The surgery was a success.

I have had increased pain throughout my necktie the past anout 4 months ago, I developed pain and heaviness in my shoulders radiating into my upper right arm. I recently started to experience reduced strength in my dominant right hand. A few days ago, I started to notice intermittent mild changes in my fine motor skills. I experience intermittent mild pain in my left arm and pins and needles in my left hand. Symptoms persist despite PT, deep tissue massage, Accupuncture, radio frequency ablation, trigger point injections, epidural, pain meds and muscle relaxers

The MRI showed reversed lordosis in the cervical spine as well as grade 1 anterolisthesis c3 upon c4 and c7 upon TI while the MRI from

C2/c3 uncoventtebral hypertrophy with moderate to severe left neural foraminal narrowing

C3/c4 left sided foraminal encroachment

C4/c5 c5/c6 . left disk oseophyte complex causing a mass effect on the ventral subarachnoid spaces abutting (not displacing) the cord

c/6 to c/7 degenerative facet changes with severe bilateral neural foraminal narrowing and mild central stenosis. Marked spinal stenosis secondary to bulging disks and posterior osteophytes and bilateral foraminal narrowing

t1/t2, posterior disc protrusion

t2/t3 slight anterolistesis with posterior disc bulge. Disc appears to contact but not definitely compress the ventral aspect of the thoractic cord

t/3-t/4, I had right paracentral disc protrusion

One surgeon wanted to do a 2 level laminectomy with fusion, another a 2 level posterior foramenectomy, another 2 consecutive artificial discs, another a 3 level ACDF, a different spine surgeon 2 level ACDF and a neurosurgeon C6-C7 anterior foramenectomy.

The idea of a fusion scares me as I don’t want to head down the slope of adjacent segments going. The laminectomy could result in C6-C7 palsy, I have significant facet issues and am hesitant about having a posterior approach which could increase neck pain. There is not much evidence about the longevity of 2 consecutive artificial discs and I don’t know if the abterior foramenectomy would relieve my
Symptons. Any insights would be appreciated

Rozy56
Participant

April 13, 2016 at 9:09 pm

Post count: 29

#21964

For the past few weeks, I have been experiencing frequent headaches. This is atypical for me as normally, I get one or two headaches a year. Could the headaches be caused by my worsening stenosis?

Donald Corenman, MD, DC
Moderator

April 17, 2016 at 6:03 am

Post count: 8660

#21985

You note long standing “spinal stenosis”. I am unclear as to the location as your radiological report does not note significant stenosis except at this confusingly dictated level (“c/6 to c/7 degenerative facet changes with severe bilateral neural foraminal narrowing and mild central stenosis. Marked central stenosis secondary to bulging disks and posterior osteophytes and bilateral foraminal narrowing”). I am unclear as to how you could have “mild central stenosis” along with “Marked central stenosis”.

If I assume you have significant spinal stenosis along with “severe bilateral neural foraminal narrowing” at C6-7, this would make some sense. Your symptoms of “I developed pain and heaviness in my shoulders radiating into my upper right arm. I recently started to experience reduced strength in my dominant right hand. A few days ago, I started to notice intermittent mild changes in my fine motor skills. I experience intermittent mild pain in my left arm and pins and needles in my left hand” fit with the beginnings of myelopathy and radiculopathy (cord and nerve root compression).

Your pattern of significant disc degeneration at C4-7 causing degenerative kyphosis with degenerative spondylolisthesis at C3-4 and C7-T1 is very typical. See “https://neckandback.com/conditions/cervical-degenerative-kyphosis/ and https://neckandback.com/conditions/degenerative-spondylolisthesis-cervical/ to better understand these conditions.

I think you might need surgery but your description of the MRI findings is confusing. An X-ray series with flexion extension films along with a good physical examination and careful evaluation of your MRI will help to alleviate the confusion. The problem of adjacent segment disease accompanying a fusion is really not a worry as you already have this disorder and you never had a fusion. The degenerative slips at C3-4 and C7-T1 are a result of the significant degenerative disc disease causing kyphosis at C4-7 which has mimicked a fusion of these levels. The levels above and below have worn out due to this degenerative “stiff” area.

A posterior approach in light of degenerative spondylolisthesis or degenerative kyphosis of greater than 8 degrees is generally not a good idea.

Headaches can uncommonly be caused by stenosis but upper facet disease is a much more common source of headaches.

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.

Rozy56
Participant

April 17, 2016 at 10:03 am

Post count: 29

#21989

Thank you for your response. I saw a neurosurgeon this past Thursday. For the first time, I had diminished sensation in my right arm. This tone, when my reflexes were tested, they were brisk in three areas. When I put my head back, I experience tinnitus and dizziness. The neurosurgeon said the flex XRays concerned him as I have a reverse lordosis which doesn’t change with flexing. Like you, he said that the MRI doesn’t match with my symptoms. He is ordering a mylogram which he said will provide an accurate picture of where the compression is. The doctor said that 97% if the time. an MRI is sufficient bit occasionally, the MRI does not match the physical findings. He feels that in a mylogram will help to determine the best surgical approach.

Donald Corenman, MD, DC
Moderator

April 17, 2016 at 10:35 am

Post count: 8660

#21991

I would agree that 97% of the time the MRI is sufficient along with the X-rays for diagnosis. I think the MRI probably does match your symptoms but the radiologist report is confusing.

Brisk reflexes would help to support the diagnosis of myelopathy. Where was the diminished sensation in your right arm. This could be a C7 radiculopathy along with myelopathy. See the section https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/ as this will tell you what a C7 radiculopathy looks like.

Also look at the myelopathy section as you can gain knowledge of these symptoms which could be superimposed on the radiculopathy (called myeloradiculopathy-not uncommon).

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.

Rozy56
Participant

April 17, 2016 at 11:59 am

Post count: 29

#21994

The reduced sensation was in the upper right arm. When the neurosurgeon looked at he MRI, the left was worse than the right but most of the symptons are on the right side. Additionally, brisk reflexes were on both sides. The doctor said that he felt that the results of the examination were not consistent with the XRays and MRI. He felt that the mylogram would provide more conclusive information. He feels that in addition to problems with the facet joints and nerves coming from the neural foramen, there may also be central chird compression. The doctor is concerned that the symptons are progressing- especially reduced sensation, mild balance problems and brisk reflexes which were not evident a week ago. He said when I see the results of the mylogram, it will be obvious where the compression is and will dictate surgical approaches. The doctor felt that the facet joints are the source of the headaches and a lot of the pain
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Donald Corenman, MD, DC

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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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