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  • AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7481
    in reply to: Chronic neck pain #32586

    SPECT-CT are an older test that uses technecium 99 to tag bone uptake in fast reproducing bone. This test still has some value but has been supplanted by the MRI STIR images which yield similar information. A negative test (no uptake) means this is probably not a bone problem.

    You stated; “His view was that if the issue was facet or even disc related, something would show on this test. The test did not show any abnormal uptake in the cervical spine”. He is correct but only with regards to bone involvement. If the disc was torn, the facet capsule was injured or the nerve was compressed, there might be no uptake.

    The pain generator apparently has yet to be determined.

    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.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7481

    “A question about nerve budding. does exercise encourages this process? i.e the more you try to activate those dormant muscle cells the more chance they can bud with a nearby active cell”? Yes.

    “If we are talking about some axonal damage with the myelin sheath still intact does the distance (from l5) plays a role in this situation”? I would assume distance on the sensory side also matters logically but I have never seen a paper on this subject.

    You could have a tarsal tunnel syndrome along with the prior radiculopathy. It would be unusual but nonetheless, a possibility. See https://www.neckandback.com/conditions/tarsal-tunnel-syndrome/

    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.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7481

    The surgery would depend upon the deformity (degree of your thoracic increased curve) and the pain generator. A sagittal standing scoliogram X-ray would be one of the keys for the need to treat. If you are talking about one or two levels only, then there is “dealer’s choice” in surgical approach. If you need a long construct, then the posterior approach is the one to choose.

    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.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7481

    If you can’t hold yourself upright on your right side with a heel raise (up on your “tippy toe”), then you do have some motor weakness and that L5-S1 right sided HNP is causing motor dysfunction. It is my opinion that with motor weakness, surgery is indicated to decompress the root sooner than later. You can wait if you so choose but I find that decompression of the root performed sooner has a better outcome.

    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.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7481

    Insurance companies have a convoluted rules system whereby the exact same disorder in one company’s eyes is a surgical repair and the next company will not allow surgery. This denial of surgery is even found with substantial failure of conservative measures and significant impairment of your daily activities. Even between adjusters in the same company (physicians whom have the ability to say yes or no to surgery), opinions can differ.

    What this particular insurance company is referring to is “instability” which is a trigger to allow fusion. If a vertebra slips 3mm or more, it is considered unstable and generally, surgery is allowed. Since this is an anonymous site, I can’t identify who you are (and you can’t put an identifier on this site). I can answer your question generally. Yes, some individuals can stabilize their vertebral slip with muscle contraction, preventing the slip from reaching 3mm. I see this all the time when the patient is under anesthesia and a nonexistent or minimal slip becomes much greater (due to the patient being unconscious and unable to engage the “core” muscles).

    Now it would be unreasonable to place every patient denied surgery under anesthesia just to prove instability. Also most patients who really do need surgery don’t have instability so that would be a fool’s errand. We simply have to work with the adjuster and appeal this decision unless you can change your insurance company which is no small effort on your part.

    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.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7481

    If you have a hyperkyphosis and you have severe debilitating pain and you have failed all other treatments, you might consider a thoracic corrective fusion but I say that with great reluctance. The instrumentation necessary to allow a fusion can be adjusted to fit your current hardware which is not generally hard to do.

    You however would have a spine that was fused essentially from your mid neck all the way to the sacrum which is something I don’t recommend. You can try extension exercises and stretching over a Swiss ball as well as facet blocks. Try to stay away from a thoracic fusion if you can.

    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.
Viewing 6 posts - 7 through 12 (of 7,480 total)