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#34795 In reply to: Post Cervical Disc Replacement pain |
I have personally revised over 20 malfunctioning ADRs with good results. Why your surgeon did not use flexion-extension films is a mystery I can’t solve. A simple way to determine is this level is causing pain is to perform bilateral TFESI/SNRBs and keep a pain diary. If your pain resolves temporarily, this level is causing the pain.
See:
https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/
https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/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.#34792 In reply to: Post Cervical Disc Replacement pain |Thanks for the response Dr. Coranman.
My surgeon requested an mri and X-rays with no flexion-extension imaging, which doesn’t make much sense. There is some degeneration at other levels but the pain I’m experiencing seems to be coming from the surgery sight at c6-7. Feels like a pinched nerve and it extends down into my shoulder and upper arm.
I asked him about revision to fusion and he said threat he’s only done two of those and it didn’t resolve the patient’s pain. He also said that he is in contact with surgeons at the Texas back center and they have also been unsuccessful with the revision. This is some what contrary to what I have read elsewhere. Do you have experience with these revisions and if so have you seen good results?#34788 In reply to: Post Cervical Disc Replacement pain |Unfortunately, MRIs are unhelpful for interpreting ADRs (artificial disc replacements) due to the large metal mass. The way to interpret ADR dysfunction is with flexion-extension X-rays and a CT scan. I would assume that if the other non-operated levels look “normal” that your problem is with the ADR.
Flexion-extension X-rays are a key piece of information. Does the disc move appropriately and are the endplates intact or had the disc eroded into the endplates or migrated? Most likely, a revision to a fusion will help but more information is needed.
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.I’ve had debilitating headaches since 2010 after a chiropractic manipulation of my neck. The headaches have been daily for 12 years and have kept me from what I love most even though I still do it and push through the pain. My quality of life has gone to shit, and this is the only diagnosis I have received after many doctors ER visits and consoles with multiple neurosurgeons. It seems only one neurosurgeon in the country validates this as a issue alongside some Prolotherapy doctors and Rehabilitation clinics. I have had two studies done, and they both show where my C1 slides over C2 on the left side when bringing my ear towards my shoulder. Both studies suggest referral to neurosurgeon, however there has been no neurosurgeon willing to look at the study nor validate if this is a problem. My question to you is are you familiar with this as an issue? Would this be something that could cause issues? Is this even a valid study? Many people who have had C1 C2 Fusion by this particular neurosurgeon after being diagnosed with this problem have claimed their headaches and migraines were resolved after years of misdiagnosis. I believe I was told that my C1 C2 Hang off was above 5 mm however my stationary symmetrical studies show no signs. Nor do my flexion extension x-rays where I bring my chin to my chest and look up. Only one bringing the ear to the shoulder. I am considerably hesitant of course when it comes to such a surgery, and I wonder if this motion x-ray is a scam of course considering I can only find one neurosurgeon who validates its study. After some research, I do believe that C1 should not be shifting or sliding over C2 no matter what someone’s head or neck position is, but I also wonder why this is not a standard when it comes to flexion-extension x-rays as far as taking images of the head bent ear to shoulder. Your response would be greatly appreciated, thank you again for your time.
I have been dealing with spinal issues for the past 30 years. At 25 I underwent L5S1 discectomy and another L5S1 discectomy at 30. I had no problems for years. At 45, I had a C5C6 fusion due to compression and developing motor weakness. At 50, I had interlaminar spacers placed at L3L4 and L4L5. At 51, I had a 4 level C/S fusion (C34, C45, C56, C67). All of these surgeries were 100% successful, but–no surprise–I’m developing lumbar symptoms suggestive of L2 and/or L1 nerve root compression.
As you know, soft tissue hypermobility is on a continuum of Ehlor’s Donlos Syndrome to the opposite end of extreme stiffness. I am definitely near the hypermobile end as I developed a painful right shoulder from years of swimming and the pain was only corrected at the age of 23 with a capsular shift. At 52, I underwent surgery to correct what was diagnosed as Basal Joint OA in my left thumb but one look at the X-ray would show you the extent of dislocation that was present at the trapezium-MC joint. Plus, per the above, I’ve had four spinal surgeries in the last 25 years.
I learned from you that spinal discs lose blood flow circulation when we are very young and clearly, muscle strength alone is not enough to keep our spine from collapsing/deteriorating. (I work in the healthcare field and I have an in-depth understanding of muscles and how they work.) Since I am on the hyperflexible, most likely breakable, collagen spectrum, I tell people my spinal issues are genetic. Would you agree?
Immediately after my lumbar surgery in 2017, I had numbness on my right thigh in the distribution of the lateral femoral cutaneous nerve. No big deal, it was just numbness. One year ago, 2021, I developed symptoms that strongly correlated with meralgia peresthetica (on the right side), and the neurosurgeon I consulted agreed. During the last three months or so, this numb area has gradually become VERY painful to any pressure. It’s numb to light touch but if I lean against a table or rest the lateral side of my thigh against the arm of a chair–forget it–it’s sharp and very painful and often eliciting an involuntary “Ouch.” I have increasing severity of aching pain in the groin and deep anterior hip and recently the buttocks; hip extension with gait is becoming increasingly more painful, lying supine with legs extended for about 5 minutes results in aggravation of the deep nerve symptoms. All symptoms are right-sided.
Looking back, I think my meralgia peresthtica was related to irritation of the L2 nerve root. yes?
I see my neurosurgeon this week. Any thoughts from you? Any advice for imaging? What might be options for treatment? If surgery, what are options considering I have interlaminer spacers, which, according to my neurosurgeon are intact and look good.
#34661Topic: not fused 16 months post tlif in forum BACK PAIN |Hi dr. Corenman,
I have posted a few questions throughout my surgical journey, i am in the process of scheduling a long distance consult with you, i’m just waiting to hear back from your office. I look forward to getting your opinion on everything. IN the meantime i was hoping you could offer an opinion.
I am 16 months out from L5 S1 tLIF for recurrent herniation causing leg weakness, also i had an l5 pars fx and spondy which developed from the 2 pervious laminectomies that were also done) urgently) for a disc herniation that caused footdrop. My symptoms improved at about 8 months post the TLIF and i started ramping up my activity at that point. Unfortunately shortly after doing so many of my pain and nerve sx became more noticeable and have continued to get worse and worse. I started pushing my surgeon’s office for imaging and they discovered i am not fused.
I have had 2 Cts in the past 5-6 months and i am not fused at all in the posteriolateral areas and apparently i am 80% in the anterior, but not anterior to the cage. The radiologist calls this fused area “minimal” but my surgeon said it is enough. Both radiology and surgeon agree posterior is not fused.
I was under the impression that i needed a revision but now i am being told that all my symptoms are from my 3 surgeries and are related to scarring and nerve damage of my cauda equina (which i didn’t realize was ever damaged). I am not ready to give up. I am hoping you can help.
I find it hard to believe that the spine pain at the end of the day and into the night is all related to nerve damage. It feels like bone pain and it radiates to my tailbone and spreads into my pelvis and it’s intensity is dependent on how active i have been during that day. Below is the CT report. Thank you!
Indication: Assess fusion status post lumbar spinal fusion.
Technique: Helical CT of the lumbar spine was performed according to routine
protocol. The helical data set was reformatted in the sagittal and coronal
planes. Additionally a 3-D model of the data set was performed at an
independent workstation.Dose reduction techniques were utilized including mA
and/or kV adjustment.COMPARISON: CT lumbar spine from 7/9/2021.
Findings:
Hardware: Fusion construct at L5-S1 with bilateral transpedicular screws and
connecting rods. Intervertebral spacer noted at L5-S1. No perihardware
lucency to suggest loosening. Screws appear to be in the expected location.
Hardware appears intact.Osseous Fusion: At the left L5-S1 facet joints, there is marginal bony
bridging, similar in appearance to prior CT. No joint gas identified suggest
excess motion. No right posterolateral osseous union identified.At the L5-S1 disc space on the right, there is minimal bony spicule
formation, similar in appearance to prior study, which may span the height
of the disc space. No intervertebral disc gas to suggest excessive motion.T12-L1: No significant central canal stenosis. No neuroforaminal stenosis.
L1-L2: No significant central canal stenosis. No neuroforaminal stenosis.
L2-L3: Mild bilateral facet arthropathy. No significant central canal
stenosis. No neuroforaminal stenosis.L3-L4: Mild right facet arthropathy. No significant central canal stenosis.
No neuroforaminal stenosis.L4-L5: Shallow concentric disc bulge with mild left facet arthropathy. No
significant central canal stenosis. No neuroforaminal stenosis.L5-S1: Status post right partial hemilaminectomy and medial facetectomy. No
significant central canal stenosis. No neuroforaminal stenosis.The imaged upper sacrum and upper iliac bones appear unremarkable.
The imaged retroperitoneum appears unremarkable.
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