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vinda-lou
Member

October 10, 2012 at 8:26 pm

Post count: 1

#7155
Topic: Post ACDF upper arm pain comes and goes in forum GENERAL |

I had an ACDF back in February 2012 due to a bad herniation (c6-c7? I don’t remember off the top of my head). I had terrible pain in my right upper arm for months leading up to the surgery.

For the weeks following the surgery I had intense arm pain (right arm) in the bicep/triceps area, at times worse than before surgery. Certain fingers would go numb – more of a painful tingling really – and sometimes pain would go up my forearm.

I went to PT, but it was so painful I was told to stop.

An MRI weeks later showed scarring. My doc said that usually around the six month mark the pain due to scarring kicks in. But by then the pain was pretty much gone by then.

However, it keeps coming and going in the same area – my right upper arm. The tingling is long gone – I was prescribed neurontin for a while and it helped, but I seemed to have side effects. I was also on hydrocodone which I stopped taking back in August.

So now there are days when there is no pain at all, but then other days the pain kills. It is like someone is wringing my upper arm but worse than a person could do. I was rubbing my wife’s shoulders last night while watching tv and I had to stop every few minutes due to the arm pain.

Is this normal? Even 8 months after the ACDF, is this sporadic pain normal? Is it even related to the surgery? I’m 40 years old and used to be more active than I am now – but every time I seem to get more active the pain returns. Any advice is welcome!

Donald Corenman, MD, DC
Moderator

October 10, 2012 at 8:12 pm

Post count: 8660

#7153 In reply to: disc herniation and degeneration , pain in leg . |

Your pain is classic for lateral recess or foraminal stenosis. The pain is generated by the congenitally narrowed region that the nerve root passes through. When you stand from a sitting position, the nerve moves and translates not unlike a brake cable on a bicycle. This transitional movement of the nerve can cause it to “catch’ in a narrowed zone. Also, the act of standing causes the lower back to change from a flexed position to an extended position.

This change to extension narrows the two transitional zones (lateral recess and foramen- see website for more details). If these zones are congenitally or developmentally narrowed (you were either born with this narrowing or degenerative changes have narrowed it), the nerve will become pinched and pain in the buttocks and thigh will occur.

Your MRI notes this narrowing (” ANTERIOR EPIDURAL FAT, MILD THECAL SAC COMPRESSION & MODERATE NARROWING OF BILATERAL LATERAL RECESS AND NEURAL FORAMEN”.

If this is the case (a good physical examination and careful evaluation of the images will reveal this), epidural injections can be very helpful. Also, a flat back therapy program will be effective in reducing the lumbar lordosis and therefore reducing the pressure on the nerve root.

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.

Donald Corenman, MD, DC
Moderator

October 10, 2012 at 6:38 pm

Post count: 8660

#7151 In reply to: degenerative disc bulge L5/S1 |

First, a coccygectomy is a very rare procedure. I perform these with the help of a general surgeon and have removed fully two in my career out of tens of thousands of patients I have seen. Both patients had a protruding coccyx that was painful to sit on due to the tenting of the skin. Other than those instances, the coccyx removal is not a procedure that I recommend.

Now I have performed probably ten coccyx injections and most of them have been helpful. There is not insignificant risk for the injection. The area has very thin skin and is full of bacteria. An injection complication can be devastating and these complications do occur occasionally.

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.

Catface
Member

October 9, 2012 at 8:53 pm

Post count: 1

#7143
Topic: Partial Sacralization and Connective Tissue Disorder in forum BACK PAIN |

Greetings,

I’ve been to a doctor prior discussing my lower back pain and during the exam the doctor pressed on a spot in my spine that caused intense pain, but I can’t for the life of me remember where she pressed. I did however get an x-ray done that showed partial sacralization. I was sent in for PT and instructed to do a few stretches: a lower back flexibility exercise, hamstring stretch, and forward lunges. Which I do and it relieves pain for a bit, but it comes back in about 2 or so hours. Also, if I do not do these stretches it is impossible for me to have a bowel movement. I’ve also been diagnosed with an unknown connective tissue disorder, and occasionally have a sharper but intense pain at the very top of my back where it meets my skull, not sure if it is related but thought I’d mention it anyways.

Thank you for your time~

Donald Corenman, MD, DC
Moderator

October 9, 2012 at 4:30 pm

Post count: 8660

#7140 In reply to: Disc Herniation plus other things |

You have three symptoms that might be independent of each other. The numbness of your left two fingers fits with the EMG report of ulnar nerve compression (cubital tunnel syndrome). The nerve is somewhat compressed in your elbow and bending the elbow stretches the nerve, causing numbness of the outside of your hand. For this disorder, you can try a splint that causes your elbow to remain straight when sleeping. There are hand surgeons that can inject a steroid to reduce inflammation and finally, you an have the nerve surgically decompressed.

Pain in the left shoulder blade could be from cervical nerve root compression but the MRI does not confirm this. The EMG test can fail to diagnose this. The EMG depends upon motor nerve compression to diagnose compression. If the motor nerve is functioning well but the sensory and pain nerves are compressed (a common scenario), the EMG will be negative but the pain will still be excruciating. Other disorders that can cause left shoulder pain are rotator cuff problems and instability (common with martial arts).

The right arm weakness could be from the herniation of the C6-7 level. This nerve supplies the triceps muscle, the wrist flexor muscle (it pushes your wrist to the palm side down) and the MCP extensors (I won’t bother you with that description). Normally, the EMG will indicate problems here but the EMG test is operator dependent and subtle findings can occasionally be missed. You can test the triceps muscle with a weight machine. Can you do as many reps with as much weight on the left as you can do on the right?

You need a skilled spine surgeon and a shoulder surgeon to ferret out these complaints.

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.

brianc7
Member

October 9, 2012 at 9:53 am

Post count: 3

#7137
Topic: c7 Weakness in forum NECK PAIN |

Hi Dr. Corenman,
I herniated my c6c7 disc in May, 5 months ago. I had terrible pain in my neck, right tricep and shoulder blade lasting 2 weeks. I had an EMG in May when the pain was much less. EMG said I have significant right tricep weakness, and moderate finger and thumb extensor weakness as well as my latissimus dorsi. my tricep had no reflex. I visited a spine surgeon in May. He said the Prodisc ADR was an option. After discussing the emg report, which stated that if strength was beginning to return, I could follow conservative measures. I felt the pain was lessining and my triceps, finger and thumb strength was getting slightly better, definitly not getting weaker. So I told the surgeon I would like to try to wait and see if it continues to improve. I had started to lift some weights in to strengthen my arm further. About a month ago I started to get some pain in my shoulder blade, and even a little in my forearm. I still have some tricep weakness, but not as bad as it once was. original Report stated a 3/5 and now a 3+/5 or 4/5. depending which doctor.

Originally I thought I had 6-12 months to have good surgical results. Now after reading internet posts and people saying they have not gained any more strength 1-2 years post op,I’m not sure.

Being a c7 nerve, what should my expectations be if I were to have the ADR at about 7 months after injury?

If I do not have the surgery, what are the chances of losing the use of my right arm/hand? I never had any numbness or pins and needles, just weakness.

MRI: Mild central canal stenosis and moderate bilateral neural foraminal stenosis at c6-c7.

Thank you for your help and knowledge on this scary injury,

Brian
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Viewing 6 results - 1,879 through 1,884 (of 2,199 total)

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Donald Corenman, MD, DC

Average rating:

81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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