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Good morning Dr. Corenman,
I couldn’t respond to your last request so I’ll post it here and hope it works:
Symptoms:
• Is the pain burning, stabbing, sharp, shooting, dull, aching, electrical, gnawing or pins and needles? I have pain in my neck and at the base of my skull. It is always there. Either dull or more prominent ache which gets to a point of causing nausea. It spreads up the back of my head and on the sides of my ears. I feel pressure as though someone is strangling me. I get a strange sensation in my neck when I swallow – not pain but feels a little constricted.
• Does the quality of pain change with activity? The pain gets worse as the day goes on regardless of what I am doing. Sitting and standing make it progress faster.
• Is the skin hypersensitive to touch? no
• Are there associated skin changes like thickening, color change or nail changes? This is important in the shoulder, arm and hand. no
Percentage of Pain by Location
• What is the percentage of pain in the neck vs. shoulder and arm? 60% neck 30% base of skull and 20% from the inside of the elbow down to the wrist. My wrists become painful when I hold things and they are weaker than they used to be. For example, I cant take a baking pan out of the oven with one hand anymore. Its very painful and my wrist strength won’t support it.Intensity of Pain
• Pain started at a zero in January and progressively got worse over the last few months. It ranges from a 1 usually in the morning to a 5 in the evening every day. Only once I had a pain that went to an 8, it was a about a month ago. The pressure in my head was so severe I debated going to the hospital. The pain in my lower arms and wrists is only when I use them and it’s a 3.
Weakness
• Is there weakness associated with the pain? The weakness occurs only in my wrists and forearms. I get a numbness down my left leg into my pinky toe occasionally. I’m not sure what triggers it.
• Is the weakness due to pain inhibition (the muscle is weak from use due to pain) vs. neuropathic weakness (is muscle is weak because the signal from the brain is interrupted due to a pinched nerve)? I don’t feel like any muscles are weak. It seems like its neuropathic weakness. I am extremely clumsy with my hands also.
• Is there now an inability to lift the arm due to pain or to weakness? no
• Are certain activities more problematic like pushing away or throwing (due to weakness and not pain- such as a weak triceps muscle) or lifting due to a weak deltoid or biceps muscle? Just my forearms have limited strength with pain.
Incoordination and Numbness
• Are there now some noticeable problems with coordination and walking? Hard to say because I’ve always been a klutz. I trip sometimes, particularly walking up stairs. My coordination isn’t good but it never has been.
• Do you find yourself unbalanced when you walk? no
• Do you “misstep” unintentionally much more than you use to do? On stairs, yes
• Do you have trouble keeping your balance in a pitch black room? A little
• Has your handwriting changed? no
• Do you now have trouble picking up a dime off a counter, zipping a zipper or buttoning a button? yes
• Do you find lightening type electrical charges down your spine if you tilt your head backwards? no
• Have your bowel and bladder function substantially changed in association with any of the above symptoms? no
Onset and Length of Time Symptoms Have Been Present
• How did the pain start? I’ve always had neck pain and headaches that I attributed to muscle tension. The more severe neck pain started in January and has been progressively getting worse.
• Was it a gradual onset over years or was there one specific activity or injury that caused it? I don’t’ know if there was something in particular that triggered it in January.
• When did that injury occur? Don’t know
• Describe the activity or action that brought on the pain. Was it a lifting injury, a bike accident or did the pain onset come on gradually? It came on gradually
• How long have the symptoms been present and have they changed in quality or intensity? The more prominent symptoms have come on over the last few months. The intensity seems to have stabilized.
• For example, did you lift something one year ago that caused neck pain and in the last month you have developed severe arm pain that radiates down to the hand?
Activities
• What activities increase or reduce the pain? Turning my head side to side or up and down makes the pain worse. Sitting and standing for long periods make the pain worse. Laying on my side with a pillow under my head provides temporary relief. I need to switch positions every 20 minutes or so to keep the relief.
• Think carefully about this question as the information produced is very valuable. Is it sitting that increases the pain where standing reduces the pain or visa versa?
• Can you sit for 15 minutes or one hour before you have to get up? How far can you walk? I get up every 20 minutes or so to get relief. I cant walk for very long. Maybe 20 minutes before I’m need to laydown on my side.
• Does prolonged exposure to the activity cause more pain? yes
• What does bike riding, sitting, standing, walking, lifting, jumping, computer work, driving or flying do to the pain? They all make the pain worse.
• Does the activity cause different symptoms? No, just more intense discomfort.
• Does the neck hurt with sitting and bending but the arm hurt with bending the head backwards? no
• Does the neck pain become worse with bending forward vs. backwards? no
• Does raising the arm cause pain or does it relieve pain? neither
• What does overhead activity do? Makes it more uncomfortable
• Does sleeping relieve the pain or does the pain wake you at night? Sleeping relieves the pain. Sometimes I will wake because of pain.
• Is there instability pain? That is, is there only mild pain with activities that becomes excruciating with a certain movement that you avoid like the plague? Running, or any activity that requires turning my head side to side or up and down
• Does daily function go relatively smoothly unless you lift something up? no
Pain Intervals
• Describe the pain intervals. Constant
• Are you pain free for certain times of the day or with certain activities? Pain is only relieved with laying down
• An example would be that you are pain free sitting but have pain with computer work only at the end of the day. Are there flair-ups that occur?
• Are you pain free for most of the day but by the end of the day, pain onset occurs?
• Do you get pain crises? no
• Are you free of pain for a week, month or even year but one event will cause severe, incapacitating pain? No, it is constant
• When the pain crisis occurs, how long does it last? I have some patients who are pain free for months but once every three months or so, a pain crisis would occur that would last one week or more.
Activity and Occupational Restrictions
• How has the pain changed your life? Immensely
• Have you adapted to the pain by limiting your activities? If so, what activities do you now avoid? Do you no longer participate in recreational activities that you once did? Which activities have you eliminated? What activities have you modified (bike riding for ½ an hour vs. a previous typical100 mile ride in the past)? You might have given up on running but now swim for fitness.
I have adapted the way I drive. I turn my whole body to check blind-spots so I don’t have to turn my head.
I don’t work out anymore, I don’t run. I have no desire to exercise anymore because the pain is constant and makes me very tired. I used to work out 5 times a week. This is very upsetting for me.
• What do you now do to prevent pain from occurring? Lay down, try not to turn my head or use my forearms to hold things
• What type of work are you involved with? I am a Manager of an automotive group
• Describe your work by its physical demands: Do you have to repeatedly lift, bend and twist? Do you have to sit without position change for long periods of time?
• Are you off of work due to the pain or did you have to change your job position secondary to pain? I sit most of the day at my desk. It has been set up ergonomically.
• How long have you been off work or have changed your position? I work half the time from home now because its easier to get relief and lay down when I need to. Also, I avoid the long drive in because driving isn’t comfortable.
Liability
• Is there liability from another party (motor vehicle accident or workman’s compensation involved)? no
• Have you been injured by another’s fault? no
Previous Consultations or Treatment
• What previous treatment have you had?
• Massage therapy
• Physiotherapy
• Sports therapy
• Osteo-therapist
• Acupuncture
• Chiropractor
• Botox injections in the neck and head
• Prednisone
• Celebrex
• And injections
• Have you seen a chiropractor? yes
• Have you seen a therapist? Yes mentioned above
• How successful or non-successful has that treatment been? None have been successful
• Have you seen a surgeon and if so, what did they say? I saw a neurosurgeon who sent me for injections and said he is thinking about surgery but he doesn’t know what is causing me the pain and that I am a “slippery slope” because of the condition of my spine.
• Did you have previous spine surgery and if so, what procedure? none#35680Topic: advice in reading xrays in forum BACK PAIN |Hi,
I recently had a 3rd xray on my lower lumbar. 2 years ago I was advised to get an L4L5 fusion. I was so afraid of surgery I waited.I recently got another xray and my L4 L5 displacement has gone from 11mm to 17 mm in 2 years. They also say I have levoconvex scoliosis. I’ve read that certain surgeons perform whichever surgery they are most comfortable with. I’m wondering which surgery you feel would be best for my condition.
Here is the report:EXAM: XR Lumbar Spine – Minimum 4 ViewHISTORY:
Back pain
COMPARISON:
11/1/2021
TECHNIQUE:
4 view lumbar spine series.
FINDINGS:
Levoconvex scoliosis of the lumbar spine is demonstrated. There is 17 mm anterolisthesis of L4 on L5. In remain static on flexion-extension views. Previously it had measured 11 mm. Intervertebral disc space narrowing is noted at L4-5 and has progressed since prior study. Facet joint arthropathy is also noted from the levels of L3-S1.Paravertebral soft tissues are unremarkable.
IMPRESSION:
Degenerative spondylolisthesis L4 on 5. Degree of displacement has increased and worsened since prior study.
Thank you for any advice with this.
Sincerely,
Aleta#35670Topic: Inconclusive MRI in forum BACK PAIN |My 80 year old father has been suffering from acute pain. All of his symptoms are consistent with arachnoiditis. The MRI radiologist indicates that the MRI did not show this condition. But his last surgeon indicates he does. Should he have another MRI to confirm or can he proceed under the assumption that he has arachnoiditis? His pain is so intense he has indicated he cannot keep living like this. Any help is appreciated
#35654Topic: Thoughts…Laminoplasty? in forum NECK PAIN |Long story shorter, I have Ehlers Danlos Syndrome, hyper-mobility and have been in pain management for a few years. I try to treat my pain minimalistic with natural supplements on the side for inflammation. In Feb of this year my right arm would go numb off and on. The dr performed a Hoffman reflex test and it was positive. She then sent me for an MRI. After going back and forth with insurance (military) I was able to see a neurosurgeon in April. He sent me for a thoracic MRI. We reviewed the results and surgery details on May 31. He suggested a Laminoplasty on June 15 which is different from his initial thoughts of an ACDF in August. I have only a week to gather my thoughts before my pre op appointment on the 8th. With a shortage of doctors who accept military insurance, I am having to get the procedure done at a military hospital. At this point I am in a lot of pain, so I know something needs to be done, but I don’t have much time to play around. Im curious of your thoughts with ACDF vs Laminoplasty since these are the two he has mentioned. He also mentioned Laminectomy but would prefer a Laminoplasty. I guess I’m wondering what I should expect from a Laminoplasty since I’ve been preparing for an ACDF instead. I’m finding mixed reviews on the Laminoplasty procedure. I want to educate myself as much as I can before going into the procedure. These are my MRI findings:
Impression
1. C5-6 broad-based central disc/osteophyte complex causing severe spinal stenosis and mild spinal cord flattening with minimal spinal cord T2 hyperintensity consistent with myelomalacia versus active spinal cord compression, and moderate/severe bilateral neural foraminal narrowing.
2. C4-5 mild broad-based central disc/osteophyte complex, severe spinal stenosis, mild spinal cord flattening without spinal cord signal abnormality, and mild/moderate bilateral neural foraminal narrowing.
3. T2-3 mild right paracentral disc herniation causing right lateral recess narrowing, incompletely evaluated on this cervical spine MR.Narrative
MR CERVICAL SPINE, WITHOUT CONTRASTIndication: M54.2: Cervicalgia. Neck and bilateral shoulder pain.
Comparison: CR cervical spine, 7/5/2019.
Technique: Multi-planar T1, T2, and STIR weighted MR images of the cervical spine were obtained without gadolinium.
Findings: There is mild motion artifact. There is mild asymmetric soft tissue density at the left vallecula without definite mass. There is mild reversal of the normal cervical lordosis. There is disc space narrowing and endplate sclerosis at C5-6, and mild disc space narrowing and uncinate spurring at C4-5 and C3-4. No suspicious bone lesion is seen. There is no Chiari malformation. At T2-3 there is a mild right paracentral disc herniation causing right lateral recess narrowing, incompletely evaluated on this cervical spine MR. At C5-6, there is a mild broad-based central bilateral foraminal disc/osteophyte complex, severe spinal stenosis and mild spinal cord flattening with minimal spinal cord T2 hyperintensity, and moderate/severe bilateral neural foraminal narrowing. At C4-5, there is a mild central disc/osteophyte complex, severe spinal stenosis, mild spinal cord flattening without spinal cord signal abnormality, and mild/moderate bilateral neural foraminal narrowing left greater than right. There is no other evidence of cervical disc herniation, spinal stenosis, neural foraminal narrowing, or cervical spinal cord abnormality.
#35626Topic: Kyphosis causing lower body problems in forum GENERAL |HISTORY:
Hello Sir, I’ve had back surgery after it was found my backbone was melting(part of D12, L1 and L2) due to Pott’s spine. Total 3 surgeries were done, one of back where it was about to break and they used plate and wire to support my back in 2007 and 2 other to surgeries were of my stomach from where pus was drained around 1.5 liters. My 4th surgery was done in 2010 because my back implant had started causing infection so they had to remove implants. Now my d12, l1 and have completely fused.
PROBLEMS:
1. From several years I’ve been suffering from constipation which is still increasing. I had consulted gastro doctors. They have performed several procedures such as colonoscopy, anorectal manometry, barium defecography, biofeedback, etc but none of them helped or found anything.
2. I have to use some power while emptying my bladder. Procedures done by uro doctors were urine culture, abdomen ultrasound, uroflowmetry, rgu/mcu xray, uds. Doctor diagnosed nurogenic bladder as it was found that bladderneck is not opening properly.
3. Minor jolt like in left leg, some part of left leg skin sensation is gone. Waist pain most of the time and sometimes its unbearable and Kyphosis. Doctors gave some medicines like zosert 50, anxit 0.25, etc. He also advised me to do spinal extension exercises 3 reps, 3 times per day. Until now nothing had helped. Doctor also said spine fixation surgery is not a guarantee that it will fix my problem since nothing conclusive was found in mri so I’m still waiting for medicines to work.
MRI REPORT Impression:
“1. Complete fusion of the D12, L1 and L2 vertebral bodies resulting in a gibbus deformity and causing indentation over the conus medullaris as described.
2. Mild disc bulges at L4-L5 and L5-S1 as described.”Please share your review regarding my case. Also if surgery is required please tell what will be the best way to do it.
Thanks#35609 In reply to: Severe Intervertebral Foraminal – Neck |I’m unclear what the loop means (“small Vertebral Artery Loop Formation”). I have seen this reporting on many brain MRIs (“partially confluent bilateral cerebral subcortical and periventricular white matter T2 hyperintensities, probably secondary to small vessel disease”) and have always been told by radiologists to ignore it.
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. -
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