Skull base, neck, should and arm pain on left side

Tagged: CSF leak, Neck pain, Nerve damage, skull base pain

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jrsigurl
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April 5, 2019 at 12:41 am

Post count: 2

#30305

Hi Dr. Corenman,
I found your site while trying to understand the C-Spine MRI which I had taken recently. I have been having pain for about 1.5 years now, the pain begins in my head at the base of the skull and down to the neck on the left side. The pain radiates down my shoulder and into the left arm. I had sinus surgery, septoplasty and submucous resection of turbinates 2 years ago and have been having increasing symptoms of this nature and other pains since the surgery, dry nose and eyes, ears popping and ringing mostly on the left side. The pain in the back of my head is always in the same spot more to the left and I can feel pressure that sometimes alleviates or gets a little dull after taking pain medication and antibiotics. I have asked the ENT if I had a CSF leak or some other injury during the surgery and they replied that I do not have a CSF leak and stated I would know if I did. I’ve never had a CSF leak so I don’t know how I would automatically know. They told me to see my primary Dr which I did and he said I had spondalysis which I don’t understand how I can suddenly develop that. The ENT suggested another surgery which I am not eager just to have another surgery without understanding or getting a true diagnosis. I have since seen a neurologist and am waiting for diagnosis. I would like to know what questions to ask to help determine if I had/have CSF leak, nerve damage or some other injury which I suspect is a result of the surgery.

Thank you in advance for your time.
Val

Donald Corenman, MD, DC
Moderator

April 6, 2019 at 11:21 am

Post count: 8660

#30309

I have only base knowledge of intracranial disorders so my information will be limited. CSF leaks cause base of the skull headaches when upright and go away with lying down. Facet disorders will also cause headaches that are worse with loading (upright posture) and go away with off-loading (lying down).

Symptoms of preexisting but asymptomatic facet disorders can be triggered by surgery as if you are asleep, you cannot protect your neck. Positioning can aggravate these disorders. Sinus surgery can also trigger cranial nerve disorders such as trigeminal neuralgia which can sensitize you.

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.

jrsigurl
Participant

April 10, 2019 at 9:07 pm

Post count: 2

#30354

Thank you for your response. I did receive a C-Spine report which I am hoping you can give an opinion as I believe these issues are a result of the sinus surgeries I had. It indicates the following:

Ossesous Structures: There is anterior subluxation of the right lateral mass of the vertebral body C2 relative to C1 measuring 1.3 mm. The left atlantoaxial joint demonstrates normal alignment. Vertebral bodies C2 through C7 demonstrate normal alignment. There is mild reversal of the normal cervical lordotic curve, which may reflect positioning, muscle spasm or spondylotic changes. There is disc height loss with endplate marrow changes at the C5-C6 level, consistent with degenarative disc disease. To a lesser extent, there is also degenerative disc disease at the C4-5 and C6-7 levels.

C2-3: At this level, there is a minimal 1.9 mm broad based disc bulge, which minimally encroaches on the anterior subarachnoid space. No significant central canal stenosis or neural foraminal encroachment is apparent at the C2-3 level.

C3-4: At this level there is a minimal 1.0 mm broad based disc bulge which appears to nearly abut the anterior cervical cord and results in mild central canal stenosis. The neural foraminal are patent bilaterally at the C3-4 level.

C4-5: At this level there is a mild 2.50 mm broad based disc bulge which abuts the anterior cervical cord and results in mild central canal stenosis. Primarily as a result of unconvrtebral joint spurring. There is mild left neural foraminal encroachment at the C4-5 level. The right neural foramen is patent at this level.

C5-6: At this level there is a minimal 3.1 mm broad based disc bulge, ecentric to the left which nearly abuts the anterior cervical cord. There is mild ligamentum flavum hypertrophy with overall mild central canal stenosis. Primarily as a result of unconvertebral joint spurring, there is moderate left neural foraminal encroachment at the C5-6 leel. The right neural foramen is patent at this level.

C6-7: At this level there is a minimal 4.4 mm broad based disc protusion, which abuts the anterior cervical cord. There is mild ligamentum flavum hypertrophy with overall mild to moderate central canal stenosis. Primarily as a result of unconvertebral joint spurring, there is moderate bilatural neural foraminal encroachment at the C6-7 level.

C7-T1: At this level there is a minimal 2.0 mm broad based disc bulge, which encroaches on the anterior subarachnoid space. No significant central canal stenosis is apparent at this level. Primarily as a result of uncovertebral joint spurring, there is mild bilateral nueral foraminal encroachment at the C7-T1 level.

Spinal Canal and Contents: The cervical cord demonstratoes intrinsically normal signal.

Adjacent strucutres: There is partial visualization of the maxillary sinuses. There is extensive mucosal thickening withing the right maxillary sinus, consistent with severe sinusitis. There is also a 0.9 cm fluid level within the dependent portion of the left maxillary sinus, consistent with acute sinusitis. The inferior aspect of the sphenoid sinus is visualized and also demonstrates mucosal thickening.

Thank you for your time,

Jrsigurl

Donald Corenman, MD, DC
Moderator

April 11, 2019 at 7:38 am

Post count: 8660

#30360

If your head is not perfectly straight in the CT scanner, you will have some rotation of C2 on C1. This could explain the finding “There is anterior subluxation of the right lateral mass of the vertebral body C2 relative to C1 measuring 1.3 mm”. I don’t think this is a really significant finding.

Your findings of “disc height loss with endplate marrow changes at the C5-C6 level, consistent with degenarative disc disease. To a lesser extent, there is also degenerative disc disease at the C4-5 and C6-7 levels” can cause symptoms. See: https://neckandback.com/conditions/cervical-degenerative-disc-disease/

This might also have significance; “there is moderate left neural foraminal encroachment at the C5-6 leel. The right neural foramen is patent at this level. C6-7: At this level there is a minimal 4.4 mm broad based disc protusion, which abuts the anterior cervical cord. There is mild ligamentum flavum hypertrophy with overall mild to moderate central canal stenosis. Primarily as a result of unconvertebral joint spurring, there is moderate bilatural neural foraminal encroachment at the C6-7 level”

See: https://neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/ and https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/.

I think is this concerning also: “There is partial visualization of the maxillary sinuses. There is extensive mucosal thickening withing the right maxillary sinus, consistent with severe sinusitis. There is also a 0.9 cm fluid level within the dependent portion of the left maxillary sinus, consistent with acute sinusitis. The inferior aspect of the sphenoid sinus is visualized and also demonstrates mucosal thickening”.

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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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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