strange neuro symptoms

Tagged: NECK, PAIN, poor blood perfusion to hands and feet, weather related

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kaparker65
Participant

July 8, 2018 at 10:42 pm

Post count: 14

#28720

Late note: the neurologist did nerve conduction tests on 05/30/2018. He said all normal except mild carpel tunnel on left wrist. The MRA of the arteries were done prior to surgery on June 6.

kaparker65
Participant

July 8, 2018 at 11:02 pm

Post count: 14

#28721

I had MRA on 6/7/2018. The neurologist repeated my nerve conduction test and did EMG on my extremities bilaterally. Everything normal except mild carpel tunnel on the left.

Donald Corenman, MD, DC
Moderator

July 9, 2018 at 10:19 am

Post count: 8660

#28727

First, EMG tests are generally not useful for many radicular disorders. They will not demonstrate central cord syndrome (myelopathy) nor will an EMG note sensory neuropathy (arm pain from sensory nerves). Really, the only things EMGS are good for in the upper body are motor deficits (which can be defined by a thorough physical examination) and peripheral nerve entrapments (carpel tunnel syndrome and such).

You have had two failed attempts to fuse the C6-7 level. Generally, a pseudoarthrosis twice of one level will cause nerve root compression from bone spur production due to the collapse and aberrant motion of that level. This would cause a C7 radiculopathy. See https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/.

Your complaints fit with continued radiculopathy as well as recurrent laryngeal nerve (RLN) paralysis; “My right arm was still numb especially into my shoulder, back of arm, into my ring and pinky finger. I also went to gym and worked to stabilize my muscles. I continued to have laryngitis and coughing fits. I went to my ENT who diagnosed me with right vocal cord paralysis. It stayed paralyzed until 6 months post op”. I assume you have been operated on by a neurosurgeon who traditionally approaches the surgical site on the right side which puts the RLN at some risk. You had a retraction injury of that nerve and thankfully, the nerve recovered.

The continued arm symptoms are probably from continued compression of the C7 nerve but the pattern of numbness is somewhat off. Your complaints of numbness “into my ring and pinky finger” fit better with a C8 radiculopathy or ulnar nerve compression.

“The first week of April, I started having sciatic pain in my right buttock then my left. Then my thighs and ankles felt heavy and tired and weak bilaterally. I felt like I would hit the floor every time I stood up. I got very SOB, I still had dysphasia, by this time I lost 15lbs, I could not write or type with either hand. My symptoms had spread over to my left side and I had now had the same symptoms in my left side as I did my right. I had problems with urination. My big toes began to get numb, my hands and feet got red then mottled, very cold, and purple”. This sounds more metabolic in nature. Something like hypothyroidism or Cushing’s syndrome. It would not be spinal related.

The numbness of your ulnar hand symptoms do fit with “nerve conduction tests which showed Ulnar Cubital tunnel syndrome bilaterally”. Why this surgeon immediately wanted to decompress your ulnar nerves with all your other symptoms so pervasive remains a question that I cannot comment on.

Huh????? “On June 14 I had ACDF c4-6. He cut the old surgical site anteriorly. He made a second incision at my C6 and placed a drain”????? Your major pain generator remained the failed fusion C6-7. Why he or she did not address this level with redo surgery and loaded a 2-level fusion on top of this failed level is confusing. Have your symptoms changed since this surgery/ If so, how?

I think we need to do a long distance consult together. Please call 888 888-5310 to talk to my manager Lori.

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.

kaparker65
Participant

July 9, 2018 at 8:16 pm

Post count: 14

#28733

Neck still feels unstable. I have no range of motion in my neck. I feel like I am growing into a flexed forward position. My right arm has no change in symptoms. I have noticed that my index finger bilaterally is stiff and and the joints look like they are getting bigger. Right hand feels very weak. I cannot write, type, and grasp with index finger and thumb. The right index finger is very stiff and it feels good to relief the pressure when I crack my knuckles. I feel a pinch and severe pain at the base of my neck when I hyperflex my head or turn suddenly. I still have occipital pain. I have noticed that my right ring and pinky finger is trying to curl. When I pick up something with my right hand I will drop it automatically. My neck feels more stable post op. I am having pain shooting into my right ear. My shoulders are very painful and muscle spasms are horrendous
And I have no range of motion to speak of in my shoulders bilaterally. The MRI bilaterally done in April 2018 says I have bursitis both shoulders right worse than left and a myelopathy on the right.

I will call tomorrow and set up time to consult with you. Thx

kaparker65
Participant

July 9, 2018 at 8:44 pm

Post count: 14

#28737

Correction: right and left tendonopathy not myelopathy.

Donald Corenman, MD, DC
Moderator

July 9, 2018 at 8:55 pm

Post count: 8660

#28738

I will await your call.

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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