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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 assistanceRelief 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 timesWhen 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.
#36285Topic: Thoughts on test results in forum NECK PAIN |Hello,
Thank you for providing this forum. I think it’s amazing that you take the time to help people in need out of compassion.
I’m a 36 year old male with no underlying health conditions such as EDS or Down syndrome. About two years ago my symptoms started possibly due to heavy weight lifting and a lifetime of bad posture (rounded shoulders, forward head, posterior pelvic tilt). There are two moments that come to mind before my issues started which once I felt like my c-7 area moved when I was barbell squatting and once I had a jolt go up my neck behind my ear barbell shoulder pressing. My symptoms started with panic attacks and body feeling extremely stressed (two weeks after feeling the jolt go up my neck) with a racing heart rate at rest which I went to the ER but they found no issues. A month or two later I had to go to the ER because I was unable to urinate but again they found no issues. I was fine a couple days later. These were both one time events two years ago.
My symptoms are lightheadedness, pain in the eyes and neck, high anxiety and trouble focusing. I have myofascial pain syndrome all across my upper torso. My head is also slightly tilted to the left with some dextroscolisious on my thoracic spine. Symptoms improve laying down but get worse the longer I hold my head.
Here are my test results:
MRA of Brain:
No issuesMRI cervical spine:
Cervical spondylosis resulting in multilevel left-sided foraminal stenosis, including mild/moderate stenosis at the C6-7 level. No significant central canal stenosis or cord signal abnormalities.MRI brain:
No issuesX-RAY of thoracic spine:
Mild dextroscoliosis of the thoracic spine.. No significant spondylosis, fracture, or visible bony lesion.X-ray flex and extension cervical:
Mild to moderate degenerative disc disease most pronounced at C6-7.MRI Spine Lumbar:
L5-S1 left posterior paracentral disc protrusion which contacts the descending left S1 nerve root without mass effect. 2. Mild degenerative disc disease at L4-5 without central canal stenosis or nerve root impingementMRI BRAIN MRA BRAIN+MRA NECK
No acute intracranial abnormality.
2. No high-grade stenosis, occlusion, aneurysm, or dissection is identified within the major intracranial or cervical arterial vasculature.CT ANGIOGRAPHY, CAROTID ARTERIES W AORTIC ARCH
Normal CTA of the carotids.Upright Cervical Spine MRI:
Abnormal Clivoaxil (142.7 in neutral and 141.2 in flexion) and Grabb-Oakes (6.5 in neutral and 6.8 in flexion). Straightening of cervical lordosis.Cervical DMX:
PRESSION for patient Steven Schoiber:
• Damage to the anterior longitudinal ligament is indicated by a retrolisthesis at C2 on C3 (2.53mm) and C3 on
C4 (3.04mm).
• Damage to the capsular ligament is indicated by gapping of the facet joint at C5-C6 bilaterally.
• Damage to the capsular ligament is indicated by intervertebral foraminal encroachment of the facet joint at
C3-C4 on the right.
• Damage to the alar and accessory ligaments is indicated by an overhang of the lateral mass of C1 to the left
(7.34mm). Also change in the para-odontoid space during bilateral lateral bending.I’m currently working with a myofascial therapist on trigger points which are improving but still chronic as well as posture correction. The chiropractic office who did the DMX study say I have severe instability specially at c1-c2 and suggested chiropractic adjustments, PT and neck brace. I’m hesitant to do this because I tried a different chiropractor in the past who said my issue was atlantoaxial related and did adjustments which made my symptoms worse and the adjustments would never hold. They did not do anything though as far as a neck brace or PT.
Recently my therapist wanted me to do chin tucks and SCM stretches which made my symptoms dramatically worse. I have severe pain and feels like strain (heart palpitations when touched) in the back right side of my neck all the way up to my c-1. Feels like my splenius capitis is stuck in contraction and so tight that touching it causing my ear to vibrate. Eye pain increased even when laying down, extreme dizziness, heart palpitations and panic attacks. Before those exercises, my symptoms were stable outside of the lightheadedness and myofascial pain. I’m also getting more crunching noises around my c-7 area.
Looking back, I feel like I possibly injured either my right levator scapula (I also have scapula winging on this side), upper trap, SCM and splenius capitis when I felt that jolt which possibly caused my head to tilt left and body tilt right causing myofascial pain syndrome over the last two years but now I’m concerned that this led the ligament laxity so I’m not sure if muscle rehab can correct my issue. I read that more than 3mm and mine is close to 7mm requires c1-c2 fusion but I’m not sure if that is the case for lateral dysfunction. I also believe my eye pain and lightheadeness are trigger point related.
1) do you think atlantoaxial instability is the root cause of my issues or is it possible that I just need to rehab my neck muscles and that misalignment will correct itself?
2) is there anything here you see that I should seek immediate help. I’ve read that atlantoaxial instability can be life threatening and now my symptoms are very similar to how this started after doing the chin tucks and/or SCM stretch.
Thank you again for your time and sorry for so much info but I wanted to be thorough.
#36279Topic: Bilateral calf & heel pain in forum BACK PAIN |Hello Dr. Corenman,
I posted here a couple of years ago after i underwent two microdiscectomies on my l4/l5 disc and appreciated your feedback greatly. I recently had an MRI done because I am experiencing bilateral calf tightness, cramping and pain as well as bilateral heel pain for the last 8 months. Anytime I increase activity my calves get extremely tight, painful, and crampy. I stretch and exercise daily, get regular massages, have tried acupuncture and dry needling to all help ease the calf tightness. I get a little relief, but then it all comes right back the moment I increase activity.
I am wondering if anything in my MRI results would suggest this ongoing bilateral calf & heel pain. Would mild narrowing of the lateral recesses of my l4/l5 be the cause of this?
MRI results from lumbar spine:
T12-L1: Normal
L1-L2: Normal
L2-L3: Normal
L3-L4: features of mild disc desiccation and mild generalized disc bulge. Linear forms of increased T2 signal intensity left foraminal disc annulus suggestive of a small annular tear without associated protrusion. No signficant central canal or foraminal stenosis.
L4-L5: Features of a prior left laminectomy. Moderate loss of disc height with a mild generalized disc bulge. There is no central stenosis. Mild narrowing of the lateral recesses greater so left than right without focal disc protrusion or extrusion. No postsurgical complication.
L5-s1: minimal bilateral facet arthropathy no focal disc pathology.
Impression: minimal progression of spondylitis change at l3-l4. Stable postsurgical changes l4-l5 without evidence of a recurrent disc protrusion or extrusion. No high-grade central stenosis.
Look forward to hearing back.
KBHi Dr. Corenman, I’m 42 female (5’2 125lbs) with seropositive RA on mtx, all labs normal, no vit deficiency. Until my recent symptoms I’ve been active, running/weight lifting all of my adult life. Rheumatologist denies my neck/back pain are from inflammatory disease. I’ve had chronic neck,spinal stiffness, and whole body muscle twitches/ left arm spasm for about 2 years. I have lumbar spinal stenosis found (incidental )on CT but that pain doesn’t bother me like the upper spine/neck pain/stiffness/headaches.
Back in April, I started having searing stinging sensation with numbness from my feet to my thighs that would come and go. I felt most weakness in my left leg.Then one day the numbness and tingling went up to my belly button. I’ve also had the same sensation down the back of my left arm and sometimes my right- all went away but was left with almost constant numbness in left foot. I often have numbness tingling in both hands, one day my right hand went numb almost as if it wasn’t there. Have some left lower jaw tingling at times. EMG,NCS of my lower extremities showed “nothing serious” per my neuro but he did squeeze the arches of my feet and asked if I had pain? I didn’t and he didn’t say anything else.
About the same time, I had an RA flare,and was treated with 5days oral Prednisone 40mg and thankfully it helped with he neuro symptoms. I still have occasional numbness and tingling in legs, hands, left lower jaw but I feel so much better. Then went for Brain/neck MRI. Brain is clean, neck MRI is following.
My questions to you, are my symptoms explained by my MRI? Could this be from my lumbar stenosis as well? And could this be from an inflammatory source vs OA? Is there anything concerning about my MRI given my symptoms or can they be conservatively managed? Thank you!
TECHNIQUE: Multiplanar MR sequences of the cervical spine were acquired without IV contrast.
Craniovertebral junction: There are degenerative changes of both atlantoaxial joints, left greater than right. There are small bilateral atlantoaxial joint effusions.
C2-3: There is mild bilateral facet arthrosis. Otherwise, normal.
C3-4: There is mild bilateral facet arthrosis. There is no significant encroachment.C4-5: There is mild loss of height of the intervertebral disc. There is no significant uncovertebral hypertrophy or facet arthrosis. A posterior broad-based bulge subtly flattens the ventral aspect of the cord. The central spinal canal and both foramina are patent.
C5-6: There is mild loss of height of the intervertebral disc. There are small bilateral uncovertebral osteophytes. There is mild bilateral facet arthrosis. A posterior broad-based bulge flattens the ventral aspect of the cord subtly narrowing the central spinal canal. The right foramen is patent. There is mild left foraminal encroachment.
C6-7: There is mild loss of height of the intervertebral disc. There are small to moderate bilateral uncovertebral osteophytes. There is mild bilateral facet arthrosis. A posterior broad-based bulge produces no deformity of the spinal cord or central canal encroachment. The right foramen is widely patent. There is mild narrowing of the left foramen.
C7-T1: There is mild bilateral facet arthrosis. Otherwise, normal. The paraspinal soft tissues are within normal limits
#36206Topic: Neck pain w/severe widespread tension/burning headache/pain in forum NECK PAIN |Hello, I am a 40 year old female who has suffered from neck pain that has progressively worsened over the past 15 years. I have also suffered from various types of headaches since I was about 14 years old including migraines with auras, tension headaches, and hemiplegic migraines. I have been treated for these with many different types of treatments. About 15 years ago I began to have widespread body soreness and pain. I constantly had what I felt was a tension headache because it seemed to begin in my neck area, but I also had some soreness and pain in my large joints, and continuously felt as if I had flu like symptoms, or body aches. I was first diagnosed with fibromyalgia, but then was sent to a rheumatologist where she diagnosed me with undifferentiated spondyloarthropathy,or ankylosing spondylitis, I never really understood clearly which one. A short time prior to this I had neck X-Rays done where I was told I had a few cervical vertebrae, more specifically C2 and C3. The clinicians or specialist I was seeing at the time kept insisting I had fusion surgery and continuously ask me the date of my surgery. I kept insisting I would have remembered neck surgery and I had not had any surgery performed on my neck at any time. I tried to gather past Imaging from when I was a teenager to prove that I had never been told that I had any type of fusion of my cervical vertebrae and that I had had multiple Imaging performed because of my headaches between x-rays, CT scans, and MRIs, and was not told one time that I had fused cervical vertebrae. When I was about 15, I had an MRI performed after passing out at school while having a headache, they informed us at the time they saw a tumor on my spine around C2 and C3. I was brought in one week later for a CT scan where I was told that it was just a glitch in the MRI and there was no tumor there. I continue to have headaches almost daily, migraines at least 15 times a month. I recently had to switch rheumatologist due to insurance where I was then told he felt I was misdiagnosed and that I did not have any type of autoimmune or Rheumatic disease. He performed x-rays again of my cervical vertebrae and the radiologist reported A congenital Fusion like with Klippel Feil syndrome. After performing my own research extensively, I do not exhibit any other physical sign or feature of this syndrome including the short neck or low hairline, and am wondering or curious why the cervical fusion did not present or show up in any of the multiple Imaging I had throughout my young adulthood. Most recently in the past 6 months to a year, my neck pain and headaches related to my neck pain have increased in frequency and intensity. They have gotten to the point where I can’t move for extended periods of time sometimes days, the throbbing pain surrounds my whole head, my neck, both shoulders down into my bicep area, and now it has been progressively extending further down my back almost to my lower back. When I have these headache or pain episodes they can last up to three or four days, many times preventing me from falling asleep, and sometimes when I am able to fall asleep I wake up with the pain worse and more intense especially in my head area. The throbbing that I experience is more in my head area and somewhat in my neck but the burning sensation that I have is all over my head and face in my neck, down my shoulders and arms, and down my back. And when I say it feels like it’s on fire, that’s an understatement, and if I try to stretch the muscles at all during this burning sensation it makes it worse. It has severely interfered with my everyday functionality, and I cannot get any of my providers or Physicians that I have been seeing to take me serious. The only provider that has been willing to treat my everyday pain, unfortunately is in pain management, and has been doing so through monitored opioid pain medication. I follow his prescribed regimen very carefully, I meet with him monthly, and he is diligent on not keeping the dosage and type the same for an extended period of time as to not allow any type of Tolerance build up to avoid having my body become addicted. It has been the only relief that I have had, and although I would prefer an alternative, i am a single mother of two, one of which is disabled, so I don’t have the luxury of being down with severe pain for a long period of time, so pain management has been my own way relief. None of the clinicians were providers that I’ve seen have much experience with klippel feil syndrome, and during my own research I found a small amount of information about single level spontaneous cervical vertebral Fusion, but hardly any information on the symptoms. My question after this long explanation that I apologize for, because I don’t have the normal features of someone with klippel feil syndrome, and because it was never reported to me that I had any cervical vertebral Fusion in any of the many Imaging test I had throughout my childhood and young adulthood, could this Fusion have been something that developed over time, and if so could that have just progressively caused my neck pain to get worse? Is there a specific diagnosis for something like that? Treatment? Prognosis? What can I do to get the doctors to help me? Just to add also, I have had for motor vehicle accidents in my lifetime, each one being where I was rear-ended, three of those have been within the past 7 years but the cervical fusion was first found prior to any of those three, but about 15 to 20 years after the first accident when I was a teenager. I’m just looking for some guidance or at least reassurance that I’m not crazy. Thank you for your time I apologize for the lengthy message and all the information
#36190 In reply to: Upcoming L5-S1 procedure |Thanks! So – 4 weeks out, I have an ache in the lower right back which is what I had pre-surgery, but this is not as bad. I don’t recall having it in the first week or two. I guess it came on with increased activity (bike, elliptical, life) — but just wondering if that’s normal and would be expected to calm down. I pasted the part of the surgery that was very right focused. Also feel a dull but not horrible ache and tingle in right buttock. I start PT on Tuesday. Until how long after surgery is it normal to feel similar (but less intense) pre-surgical symptoms, if at all?
RIGHT L5-S1 HEMILAMINECTOMY WITH PARTIAL MEDIAL FACETECTOMY: The retractor tube was removed and then attention was turned to the right side. A second separate fascial incision was made to the right of midline and sequential tube dilation was performed until a 4 cm x 18 mm tube was placed clearly visualizing the right-sided hemilamina. A crosstable fluoroscopic radiograph was taken confirming the appropriate level with a Woodson elevator underneath the lamina. The operative microscope was brought into the sterile field again. Soft tissue was denuded from the right L5 lamina. A motorized high-speed bur was utilized to perform hemilaminectomy and partial medial facetectomy. This was completed with 3 mm 4 mm Kerrison rongeurs. The cephalad aspect of S1 was also decompressed and removed utilizing Kerrison rongeurs. At the termination of decompression the traversing right S1 nerve root and thecal sac were noted to be free of further compression. Hemostasis was confirmed. Then, 1 mL of 80 mg Depo-Medrol was instilled into the spinal canal as an epidural injection.
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