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in reply to: Facet Joints #27424
Dr Corenman,
I just noticed that C7/T1 has a 6mm peek cage. So i’m not sure how the MRI show a bulging disc at this level and what test would confirm this level is a pain generator? Any thoughts would be really helpful!
in reply to: Facet Joints #27423Hello Dr Corenman,
As always thank you for your informative replies. The last CT scan shows a solid fusion, however according to my new Physical Medicine & Rehabilitation doctor, her assessment is after six spine surgeries there are remaining problems that she can see after a neurological and physical exams, review of my scans and nerve conduction/EMG test. The following are things in her opinion that are causing issues:
1)C4, C5, and C6 remaining nerve root compression – will cause shoulder and arm pain
2)C7/T1 Disc bulge will cause neck pain and muscle spasms
3)C2/C3 disc bulge causing headaches
In addition cervical kyphosis, scar tissue, degenerative changes, and facet sclerosis, will compound the above issues. Her question is how do we move forward to address my pain generators? She opposes facet blocks and ablations since in her opinion should not cause any significant pain.
Dr Corenman you mentioned in the past “SNRB” and Discogram. I suspect going forward a C4, C5 and C6 SNRB is the way to go and a Discogram on C7/T1? Thanks
in reply to: Facet Joints #272601)2012 surgery I noticed improvement in both biceps pain upon awakening, however the neck pain was severe. After a couple of months the arm pain came back. The neck pain kept progressing.
2)2013 two procedure’s – The first surgery left arm pain went away and right stayed. The second procedure was the worst, left hospital after 10 days in an ambulance, went to subacute facility for seven weeks. I was unable to ambulate. The doctor mentioned a dura tear and after patching it started to leak again. My headaches worsened and i was in a wheel chair for 4 weeks, then transitioned to walker, then cane. Physical therapy was performed five days a week for a couple of hours a day. Started to have base of the neck pain – neck meets shoulders and radiation of pain into the top of my shoulders. Also having cracking and popping noises from the base of my neck.
3)2014 procedure – neck pain worsening starting to get more severe muscle spasms, left arm pain improves with rest, right side no improvement. Started to notice pain in fingers, forearms, tingling sensation.
4)2015 procedure- neck pain improves with rest, worst when sitting and standing. Both biceps pain becomes unbearable when going for walks.
5)2017 procedure -symptoms every time I go for walks and sitting causes my pain level at the base of my neck, arms, and shoulder blades to become unbearable, headaches, arm pain, dizziness, fingers tingling both hands, triceps hurt, forearms, numbness weakness in arms, I also noticed my gait has worsen. I awaken during nights like i slept on my arms, feels like they went to sleep. looking up causes base of skull both side extreme pain. The base of neck is by far the worst.
Hope this helps.
in reply to: Facet Joints #27256Dr Corenman the following are the surgeries performed with dates:
October 2012
ACDF – C4-C5, C5- C6
Diagnosis:herniated disc, nerve root compression, spinal cord compression, cervical radiculopathy, cervical spondylosis
Symptoms : neck pain, arm pain, headaches, dizziness
August 2013 —two procedures
ACDF C3-C4, C6-C7
Bilateral decompressive laminectomy with fusion C3, C4, C5, C6, C7 – right dural tear
Diagnosis : degenerative disc disease, cervical spondylosis, herniated disc, cervical nerve root compression, radiculogpthy
Symptoms : neck pain, arm pain, headaches, dizziness
November 2014
left C6-C7 foraminotomy
Diagnosis: left radiculopathy
Symptoms : neck pain, arm pain, headaches, dizziness
August 2015
ACDF C7-T1-placement of cage
diagnosis cervical radiculathypathy and anterior subluxation
Symptoms : neck pain, arm pain, headaches, dizziness
January 2017
Posterior cervical laminectomy with foraminctomies, medial facetectomies at C5-C6, C6-C7, and C7-T1
posterior segmental instrumentation C5, C6, C7, T1 and T2Diagnosis :evidence of residual foramina stenosis and kyphosis at C7-T1 and psuedoarthrosis C7-T1
Thank you
in reply to: Facet Joints #27254Happy New Year Dr Corenman,
I had a second opinion with an endoscopic spine surgeon and was told that the risk reward is bad. The normal anotomy of the spine is gone, and an endoscopic procedure can’t be done because the instruments would not have space to navigate.
The surgeon also noted “there is a boat load of scar tissue”, and did not feel a diagnostic SNRB-selective nerve root block would work because the medication would not reach the nerves (would follow the path of scar tissues). In addition he mentioned that there is no disc space at C5 and C6. I was told the best of luck and he is sorry. My question to you is I understand endoscopic spine surgery is out however:
I have continued nerve pain after cervical fusion, foraminotomies,laminectomy, and medial facetectomies. My CT scan demonstrates solid fusion, My MRI and EMG confirms continued foraminal stenosis.I’m told I have kyphosis of cervical thoracic spine.The recent X-rays show Lordosis between C2 and T2 with a measurement of 4.
How does one proceed? It appears the foramina stenosis and the lack of disc space is the root of my problems? Any help would be appreciated. Thanks
in reply to: Facet Joints #26318Good morning Dr Corenman,
I received the update from shoulder MRI’s:
Left shoulder: type 2 acromion process noted. There is a tiny focus of abnormal high signal seen near the insertion of the conjoined fibers of the supraspinatus and infraspinatus tendons on the lateral humeral head/greater tuberosity suggestive of a tiny insertional rim rent type tear.
Right shoulder :type 2 acromion process noted. There is mild subcortical cystic degenerative changes seen on the anterior and posterior lateral humeral head near the insertion of the subscapularis and infraspinatus tendons.
The question is can the above shoulder disorders (rotator cuff syndrome and others) can mimic nerve pain from the neck?
Thanks
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