Donald Corenman, MD, DC

First to the gentleman that has calf motor weakness. You do not make it clear as to the reason for your initial surgery. Did you have calf weakness prior to your surgery or did you develop weakness after surgery? It sounds like you have an S1 radiculopathy now and I assume that you had surgery for a herniated disc at L5-S1.

If this is a new onset weakness, I would lobby your surgeon for a new MRI. New onset weakness after surgery is of some concern and I would want to make sure there is nothing that occurred to re-compress the nerve (new hernation or hematoma).

Nerve healing is a big subject and I just finished writing a three page explanation regarding how nerves heal. This will be imbedded on the website in the next couple of weeks. Look for it under “Conditions”/”Nerve Injuries and Recovery”.

A nerve injury takes some time to heal but after one year (with some exceptions), the nerve generally will not recover. There are many ways to adapt to motor weakness. That subject is worthy of a book by itself.

Dr. Corenman

You have had 6 months of lower back pain from what sounds like multilevel lumbar degenerative disc disease (DDD). Obviously, i have not reviewed your films so I am speaking generally. Lower back pain from DDD is not generally dangerous. Yes, it is quite painful but will not paralyze you or cause you to be in a wheelchair.

Rehabilitation is the cornerstone for recovery. The discs will never become normal but there are many individuals (including me) who have DDD and have no symptoms. The question is how do you join that club?

I am a fan of Pilates rehabilitation for core strength. This will take as much as three months before good symptom relief can occur. Medications are also important. You cannot take NSAIDs (like me). There are other medications such as membrane stabilizers, non-narcotic pain killers and SSRIs which can be helpful.

I am not pushing my consumer’s book but there are details in that book that can be very helpful to you.

Surgery for lower back pain is only for those patients who have had this pain for some time, failed conservative measures and are candidates for surgery. A surgical work-up is necessary to determine if you are a candidate. Some patients are candidates and some are not.

Dr. Corenman

You have a number of problems going on at once. Let’s break them down to simpler elements to allow some basic understanding.

The HLA B-27 is a genetic marker that makes you more susceptible to autoimmune phenomenon that can affect the musculoskeletal system. That is, you might have your own immune system attack your spine causing pain, stiffness and aching. Have you been diagnosed with a disorder called Ankylosing Spondylitis?

The pain in your neck and right shoulder/arm/hand more likely than not is not related to an autoimmune phenomenon. You have a disc herniation at C6-7 that is compressing the right C7 nerve root. This can cause neck pain that radiates into the shoulder, arm and hand, especially into the middle fingers. Sound familiar?

You have what I like to refer to as CNS or “crappy neck syndrome”. You have four consecutive discs in your neck that are degenerative. The upper three discs bulge and efface the thecal sac, the sack of water (CSF) that surrounds the spinal cord. By your description, other than at C6-7, these bulges do not compress the spinal cord. These upper discs can cause local neck pain but should not cause arm pain if they do not press on the nerve roots.

What is the percentage of neck pain vs. shoulder and arm pain? This makes a big difference in prognosis. If you have mainly neck pain (let’s say 70%) and only 30% shoulder and arm pain, surgery for the C6-7 level will probably only give you 40-50% total relief as the neck pain is most likely caused by all the problem discs. Fixing one disc will only relieve about 20% of your neck pain (about 1/4th of 70%) and should eliminate most of your arm pain (the remaining 30% due to arm pain for a total sum of about 50%)

If we turn the numbers around and assume you have 30% neck pain and 70% arm pain, then you can speculate that you should have a total of 80% relief of pain (1/4 of 30% is about 10% and then add elimination of the 70% of arm pain for a total of 80%).

There are some bold assumptions made with that prognosis but that is the general thought process for relief of pain by surgery.

Grinding and popping in the neck is normally related to the facets. Normally, noises made by the neck are not painful but if you do have pain, degenerative facets could cause this. Do you have a degenerative spondylolisthesis on your flexion/extension X-rays (see website for explanation)? If the facets do generate pain, these can be diagnosed by facet blocks and possibly pain reduction could come from rhizotomies (see website).

Visual disturbances, ringing in the ears and trigeminal neuralgia are all mediated by intracranial processes and are not my specialty. You would have to consult a neurologist for information on those processes.

An elevated white count could originate from many different processes. If you have an elevation from your autoimmune process, this elevation should be able to be ruled out as an infection by the appropriate specialist (rheumatologist or hematologist). This should hopefully clear the way for surgery (most likely an ACDF) at C6-7.

Dr. Corenman