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#33895Topic: cervical facet pain vs disc pain in forum NECK PAIN |
Dr. Corenman,
I have had shoulder and scapular pain for almost a year. i had an mri last year and this is what it said. 2020(mri)
C4-C5: Right posterior T2 hyperintense annular fissure with a
small associated right paracentral disc protrusion measuring
approximately 0.7 cm craniocaudal, 0.3 cm AP and 0.9 cm
transverse, contacting and mildly flattening the ventral cord,
with mild canal narrowing. The dorsal CSF space is preserved. No
cord edema or other intramedullary cord signal abnormality is
seen. No significant neural foraminal narrowing.2021 mri
I had a c5 nerve root injection in august which did not help. the pain slowly got better on its own four months after the shot but not never fully resolved. several weeks ago i started developing more scapular and neck pain and fullness in my ear. i got another mri at another facility and this was the report.
c4-c5 level shows broad based subligamentous disc extrusion, flattening of the right ventral cord. it measures 5x7x3 in crauniocaudal, transverse and AP dimensions respectively. there is moderate canal stenosis right of midline. There is obliteration of the of right ventral csf, mild foraminal compromise, mild facet hypertrophy and crowding existing nerve root.
c5-c6 shows 3mm posterior bulge. small central annular tear, mild canal stenosis no cord compression or nerve root impingement.my question is, i am a dentist and i have no weakness just scapular and right sided neck pain and spasming of the upper back which causes some awful head aches. no appreciable weakness, and per my read the MRI’s look similar except for a new bulge at c5-c6. is this progression of disc herniation or could there be some facet pathology? If this is continued disc pathology thoughts on operative treatment ADR vs fusion for someone who is always using their hands?
Appreciate your time and thoughts
#33888 In reply to: Imaging 7.5 months post fusion |Thanks. Below is what my MRI shows. They have ordered an ESI for the pain I have in my leg (I also have back pain). I apparently had this scar tissue six months ago (2 months post op), and I did not have these symptoms then. They have only come up in the last six weeks. This has me worried about lack of fusion, but my surgeon’s PA has told me that my x rays look perfect and so I don’t need a CT scan?
Report
At L4-5, there is no change in a very small broad central disc
protrusion, also associated with an annular fissure at the posterior
midline. There is no nerve impingement or significant stenosis.
At L5-S1, there is no change from prior, compatible with successful
fusion surgery. Fairly extensive epidural enhancing scar tissue is
again noted adjacent to the right S1 nerve sleeve with no change in
its appearance.IMPRESSION:
1. Stable findings from MRI six months ago with findings of prior
anterior discectomy and fusion as well as posterior spinal fusion at
L5-S1. There are no findings to suggest significant postoperative
complications.
2. No significant spinal stenosis or nerve impingement identified at
other lumbar levels. Findings of mild disc degenerative change and
small broad central protrusions again noted at L3-4 and L4-5.#33809 In reply to: thoracic fusion |A typical report for an extension of the thoracic fusion to T4. How did you do post-operatively?
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.#33808Topic: thoracic fusion in forum BACK PAIN |Dr. Corenman, I’m going to copy paste here my recent operative post. I thought you might like to see how it was performed here in Ohio.
PREOPERATIVE DIAGNOSES:
1. Thoracic pseudoarthrosis.
2. Hardware failure.
3. Back pain.
4. Kyphosis.POSTOPERATIVE DIAGNOSES:
1. Thoracic pseudoarthrosis.
2. Hardware failure.
3. Back pain.
4. Kyphosis.PROCEDURES PERFORMED:
1. Placement of bilateral pedicle screws with DePuy Expedium screws
from T4 to T8.
2. Posterolateral fusion from T4 to T11 with autograft and allograft.INDICATIONS: The patient is a 67-year-old female who presents after a
T10 to S1 instrumentation and fusion at an outside institution. She
presented with increasing thoracic back pain. She was found to have
some loosening of her T10 screws indicating a T10-T11 pseudoarthrosis.
She did have some subtle kyphosis at that level. Given the
pseudoarthrosis, extension of her fusion with posterolateral fusion from
T4 to T11 is indicated.DESCRIPTION OF PROCEDURE: The patient was intubated and placed under
general endotracheal anesthesia. She was positioned in the prone
position. All pressure points were appropriately padded. Fluoroscopy
was used to localize the incision. Skin was marked, then prepped and
draped in sterile fashion. Antibiotics were given prior to incision.
Midline incision was made with a #10 scalpel. Monopolar cautery was
used to expose the T4 to T9 lamina in subperiosteal fashion out to the
transverse processes. Dissection was carried up and over the T10 and T9
screws out to the transverse processes. The ends of the rods were
exposed and end-to-end connectors were attached. Attention was directed
to the T8 pedicles. High-speed drill was used to create a starting
point and gearshift was used to access the pedicle. Ball-tip feeler
ensures no cortical breaches. An undersized tap was used followed again
by the ball-tip feeler and placement of bilateral pedicle screws at T8.
DePuy Expedium screws were used. Pedicle screws were also placed
bilaterally from T7 to T4. AP and lateral fluoroscopy ensured adequate
placement of all instrumentation. Screws were all stimulated and found
to stimulate above threshold. Rods were then measured and cut and
placed in the end-to-end connector and the screw heads. Set screws were
placed at all levels. Torque, counter-torque was used to final tighten
all set screws and the end-to-end connector. At this point, the wound
was copiously irrigated with 3 L of sterile saline with vancomycin.
High-speed drill was used to decorticate the exposed transverse
processes as well as lamina from T4 to T9 and a large kit of BMP along
with 60 cc of cortical cancellous chips, and the autograft from the
decortication was placed in the posterolateral gutters and along the
lamina from T4 to oT9 to achieve posterolateral fusion with autograft
and allograft from T4 to T9. Two hubless channel drains were placed
prior to closure. Powder vancomycin was applied to the incision prior
to closure. Fascia closed with 0 Vicryl in interrupted fashion. Dermis
was closed with 2-0 Vicryl in interrupted fashion. Skin was closed with
staples. A Prevena incisional wound VAC was applied to the incision.
The patient tolerated the procedure well with no acute complications.
Estimated blood loss was 300 cc. Following the procedure, patient was
brought to postop anesthesia care unit in stable condition. All needle
and sponge counts were correct. I was present for the entire procedure.#33806Topic: Parsonage Turner syndrome in forum GENERAL |I suspect I have Parsonage Turner syndrome. Initial extreme shoulder pain started beginning of January 2021. Pain resolved itself in 48 hours. It was followed by left/shoulder and arm tingly, numb, extremely weak. Very little ability to use hand. I do have diagnosed auto-immune. (celiacs) Extensive chiropractic work has not helped. I worry that “doing nothing” for this length of time will lend itself to inability for my arm to return to normal. Ideas?
(I do have extensively more info, but in respect of your time, will spare you every detail at this time.)
Kris Otto#33783 In reply to: Indications for surgery |OK, got it!
Before a fusion though, would there be value in getting a CT?
I’ve only had an MRI, and due to the weird nature of my injury, I was wondering whether a CT for spondylolisthesis would have an effect on the surgeon’s strategy for the surgery.
I injured myself doing an extension with rotation movement, which may have broken the pannus on the right pars. I’m guessing that’s why I only have compression on the right L5 nerve – I have almost no symptoms on the left L5. There is potentially some kind of rotation movement going alongside the sliding of the vertebrae.
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