Undiagnoised Pain

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connect2maryk
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November 9, 2014 at 1:58 am

Post count: 8

#11702

Dear Dr. Coreman,
I am currently seeing three doctors, a neurosurgeon, a movement specialist and a pain management doctor for my symptoms.
In 2008 I had a laminectomy for (L1-L3) extradural intraduaral schwannoma. The debilitating pain was gone, but a new pain arose as years passed with neuropathy on the bottom of my feet.
When I was diagnosed for the schwannoma I had strange sensations at times in my right hand. This has progressed through the years, last year reaching it peak into my right forearm (feels as if it is broken), right shoulder blade, neck and middle finger through pinky. It hurts to blow dry my hair.
I had a CAT Scan of my neck. The results: minimum anterolisthesis C7-T1, numerous luciencies throughout vertebral bodies, spinous process and posterior element- particularly C7-T2. No pathologic fracture. Disc height preserved. No tissue swelling. Small broad based protruded disc C5-C6. No significant spinal stenosis. Slight reversal lordosis centered at C5.
With these findings Multiple Myeloma tests were ordered. All blood and 24 urine culture were negative.
At the time I was told to come back in 6 months to repeat CAT Scan.
Since this event, I had a brachial plexus MRI with was unremarkable. The vertebra’s were mentioned on this report once again only this time they were referred to as hemagiomas or lipomas.
I am now being told the repeat 6 month CAT scan for these luciencies do not need to be repeated.
The movement specialist prescribed Botox injections for my surgery site L1 through T1 and the brachial plexus region on Monday – 300 units. My incision site felt about 50% better until Friday (Feels like I’m lying on glass). I have felt no difference in the brachial plexus region or my arm.
I will be receiving a steroid lumbar injection on the 20th for the my neuropathy in the my feet as well as low back pain and a buzzing sensation in my hip (possibly due to L5-S1). I am being told that if this injection relieves some pain I should go ahead with minimal invasive bone fusion.
My question, I am in such extreme pain with my right arm. I am not driving. It goes into my should blade and neck. At first I saw a diagnosis of Brachial Neuropathy, now I saw it is paraspinal muscle spasm.
I have also had a diagnosis of Fibromyalgia; although, all my pain is on the right side with the exception of the neuropathy in my feet.
I am nervous to consider a bone fusion as most of the symptoms for my lower body I see are related to post laminectomy surgeries. I do not want to end up crippled in my 70’s so I am hesitant.
I must say, this upper body pain at times is far worse that my lower body. I am so discouraged with the pain. There are just no answers for this issue or medication
Last but not least I have had an allergic reaction to almost all of the drugs I have tried for nerve pain.
Thank you,
Mary

Donald Corenman, MD, DC
Moderator

November 10, 2014 at 12:19 am

Post count: 8660

#11707

First, the surgery at L1-3 for schwannoma removal will not cause your symptoms in the shoulder. The neuropathy in your feet probably is caused by typical aging nerve degeneration over time (I assume you are in your 50s or 60s). See the section on peripheral neuropathy on this website).

If you have neck pain and unilateral shoulder/arm pain, you do not have fibromyalgia. Fibromyalgia is pain found in all four quadrants of the body.

Lower back pain is diagnosed by discograms if pain is generated by the disc and if generated by nerve compression, an epidural will give you some clue as to pain origin. You will not have any relief of your bilateral foot symptoms if these symptoms are truly generated by the peripheral neuropathy.

Did you have a diagnostic SNRB (selective nerve root block-see website) in your neck? This will help diagnose the origin of the arm pain. Did you have a shoulder specialist look at the right shoulder to rule out pathology here? Did you have an EMG/NCV (see website) to look for nerve disorders that would reveal themselves with these tests?

You need a well skilled diagnostician to look for the source of these symptoms.

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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Undiagnoised Pain – 2 years