Archives

I had a c5-c6 cervical disc replacement. The doctor feels great about the placement etc. it’s 10 months later and I still have pain aggravation in the back of my neck. It’s not intense pain just sore and like a 3 level all day every day, more so at night.

Recently saw a pain doctor and got a CT scan. Curious of your thoughts? Results below.

Results:
EXAM: CT CERVICAL SPINE WITHOUT CONTRAST
History: 42-year-old male with cervical radiculopathy. History of prior disc replacement.
Technique: Helical volume acquisition utilizing 2 mm multiplanar reformats. DLP : 179 mGycm
Comparison: None.
Findings: Spine is imaged from level of the sella through T2. AP alignment shows slight anterolisthesis at C4-5. There is reversal of cervical lordosis. An artificial disc is seen at C5-6 without evidence of periprosthetic bone reabsorption or malpositioning. No fracture, lytic, or blastic lesion is evident. To the extent visible paraspinal soft tissues appear normal.
Craniocervical junction, C1-2: Minimal osteoarthritic changes are seen at the dens C1 articulation of doubtful clinical relevance. These levels are otherwise unremarkable.
C2-3, C3-4: No significant degenerative changes are present.
C4-5: Slight disc space narrowing is present. This level is otherwise unremarkable.
C5-6: Artificial disc has been placed. There is minimal left posterolateral endplate hypertrophic change and left-sided uncovertebral hypertrophy without significant foraminal stenosis. No neural impingement is suspected.
C6-7: No significant degenerative changes are apparent.
C7-T1: Hypertrophic facet changes are noted resulting in mild to moderate bilateral foraminal stenosis, slightly greater on the left than the right (5/32). No definite C8 root impingement is evident although clinical correlation is needed.
T1-2: There is moderate disc space narrowing present. No disc protrusion is visible. The neural foramina are patent.
IMPRESSION: CT Cervical Spine Without Contrast
1. Status post C5-6 artificial disc placement. Position and appearance are normal with no evidence of loosening.

2. Potentially significant left C8 foraminal stenosis due to facet arthropathy.

3. No other potential neural compromise is identified.

My daughter is a collegiate athlete (19) and chasing answers for a very specific back pain caused by a very specific movement. She was diagnosed with Bertolotti’s, but then told it could not be the cause of her pain because a bone scan did not show inflammation at the place where her L5 was hitting. She has had MRI, CT scan and a bone scan.

So my first question would be is it impossible for that area to be causing pain even if no inflammation shows on a bone scan? Is it unreasonable for us to ask to have the area injected to see if it helps? At this point I don’t see what she has to lose since she is facing retirement due to the pain.

She does not have pain in 95% of what she does including daily life and most her skills. She is a gymnast. She has pain related to extreme extension of her lower back and it’s a very specific sharp pain related to only one specific skill. The moment she does this skill she has a sharp, shooting pain that is so excruciating it takes her breath away. The sharp pain is quick because the motion that creates it is quick and then it throbs for a few minutes and then goes away until she is asked to repeat that skill. It feels distinctly to her as if something is being pinched or hitting.

Complicating matters is that she does have a L5 pars fracture. She has had this injury since she was 10 years old, so nearing a decade. She has successfully trained and competed for 10 years with no pain from this injury doing the same skill that is causing the sharp pain. The injury remains unchanged. When she did have pain from the fracture when she was 10 years old it was not anything like the pain she is experiencing now. All training hurt: pounding, landings, all extension, sitting in the car, bending etc. So to her this feels nothing like that. That was an overall dull ache and soreness with all training and this very sharp and specific.

Because she does have a pars fracture the Dr she is seeing did an injection in that area and told her there was no evidence it could be the Bertolotti’s so he would treat the pars fracture. She had 100% zero relief from the injection.

As I said at this point she is facing retirement since she can’t do skills required of her without excruciating pain. I feel we should look further into the Bertolotti’s syndrome even if her current Dr does not believe it can be the cause. Thoughts?

Hello Doctor Corenman, before I begin, thank you for the work you’re doing and any help/guidance you can provide is much appreciated.

How I got here:
In 2012 (~16 yrs old), I sustained a herniated L5-S1 injury from intensive weightlifting and soccer, leading to worsening sciatica, left leg weakness, and constant pain, L4 also herniated due to compensation (I kept playing) eventually making the team Dr force me to stop sports in 2014.

Thereafter, over the years, my sciatica didn’t get much worse BUT other symptoms began and gradually worsened including severe fatigue, brain fog, incontinence, reduced energy, and diminished sexual function. I saw Drs in Canada during this time but none of them looked into my back issues nor did I think for a second my back could be causing this. Finally, in 2022, a sports physical therapist I saw in NYC (MOCEAN PT) did testing and noted chronic pain was keeping my nervous system in a sympathetic state. This pain likely stemmed from the 10 yrs of nerve irritation/pain, even if I didn’t feel the pain it affected my system.

In 2023, I saw a postural restoration specialist and a custom dental splint (I have bad occlusion) improved my symptoms, posture and stability, but I still experience flare-ups and it’s tough to know how I’ll feel day to day. I also have flare up resulting in not being able to walk for ~7-10 days. In addition, more recently, I started having periods of blurry vision, intense headaches, nausea, and disorientation triggered by certain movements like raising my hands above my head to decompress my spine. I had to visit the ER ~2 weeks ago due to this. I recently completed a brain and back MRI. Back results are below. Brain MRI looked good, I just need additional testing for Idiopathic intracranial hypertension.

Summary of my MRI lumbar MRI report from last month:

“indicates stable degenerative disc conditions at multiple levels. Specifically:

L3-L4: Stable small central disc protrusion with mild canal narrowing, but foramina remain patent.
L4-L5: Degenerative disc desiccation with a small central disc extrusion that impinges on the bilateral L5 nerves. There is mild canal and foraminal narrowing with compression.
L5-S1: Disc desiccation and bulging causing moderate left foraminal narrowing, compressing the exiting left L5 nerve. There is also narrowing of the left subarticular zone and compression of the left S1 nerve.
No fractures, marrow edema, or significant findings at the sacrum or higher spinal levels were reported.”

Below is a list of what triggers my symptoms (brain fog, tension etc):
• Sitting (especially in soft chairs; immediately triggers symptoms).
• Lifting over ~5lbs (body/system immediately becomes tense; start to experience below symptoms).
• Any exercise, even if not weight bearing (e.g. push-ups, pull-ups, running etc; walking is ok; experience below immediately after)

Here are the symptoms when triggered:
1. Initial symptoms (no severe pain but):
o Extreme stress throughout mind and body, overthink, and significant brain fog
o body tension, feel “locked up”/body feels disconnected (torso and legs); hard to engage/properly flex muscles/become relatively weaker
o Fatigue – oversleep for ~4 hrs and will still feel tired; increased hunger.
o Can’t (much harder to) sweat and decreased sexual function.
o Worse incontinence (always have but become worse when have flare up).
o Swelling/inflammation across my body, as noticed by third parties.
o Very cold hands and feet, for no reason.
o Noise sensitivity
o Body shakes when minimal pressure applied (e.g. if hold arms out to the side and someone tries pushing them down I’ll shake; this also occurs when I feel “normal”, but less intensive)

2. As symptoms improve:
o Start to feel pain (all on my left side) in lower back, inner/outer hip, under my rib cage, groin and pelvic bone area, and calf cramps/tingles.

3. Severe flare-ups (~4x in last 8 months):
o Extreme pain causes me to drop to the floor. Have to crawl for next ~5 days. Sharp leg and back pain with any movement.
o Relief through “legs up on the wall” pose, muscle relaxants, ice/heat. Takes ~7 days to walk without assistance

Relief Mechanisms:
• PRP (March 2023): 3 days of immense relief. Most effective to date, but only 3 days.
• The below aren’t perfect like PRP but help:
o Lying down for extended periods (I have to lie down all day, incl for work)
o Muscle relaxants (not Advil).
o Spine-decompressing stretches (at times).
o Tried Ozone and it didn’t work. Chiro worsens symptoms. Osteo helps at times

When Feeling “Normal”:
• Significantly improved focus, information processing, and memory retention.
• Significant improvement in sexual function.
• Less risk-averse, more creative and energetic.
• Wake up earlier and feel well-rested, with less sleep (require less).
• Other minor changes: increased saliva, able to sweat, have dreams when sleep, enhanced taste and smell, and more.

I understand this is a lot but any guidance would be extremely appreciated. I’m located in Canada and the system is extremely slow.

Also, I called your offices yesterday but wasn’t able to get in touch. A paid consultation would be great but all of my files are online, and I wanted to see if I could just share my files via our online portal (Pocket Health). Otherwise, I’ll have to print 200+ images and not sure if this is the best route here. Thanks again.