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#34796Topic: Coflex Removal in forum BACK PAIN |
Hi Dr Corenman
I had a Coflex l4/5 and a non instrumented ls/s1 facet fusion surgery performed in February 2021 by a surgeon who puts coflex in a lot of his patients combined with decompression. Unfortunately i didn’t get a second opinion and watched a couple of coflex testimonials on youtube.
About 6 weeks out i started to feel a host of new symptoms.
I have pain in extension from l3 to t12 and in flexion at t11/12, L1. My TLJ feels extremely painful and there is a burning irritation in the mid and lower back, Pain around the tops of my illium and into my groin and what feels like the SI area. Both sides. My left leg weakness also seems to be getting worse.
The only pain i had before surgery was mechanical lower back pain.
The operating surgeon kept saying the symptoms should resolve. I have lost confidence in him.
I have seen another surgeon who believe some of the symptoms could be coming from the Coflex as my discs are very degenerate. He is willing to take it out on the NHS.
Myquestion is what problems could possibly arise as the supraspinous and interspinous ligaments have been removed?
Thank you
Stephen#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.
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