westie California

Dear Dr. Corenman,

I hope all is well and that you and family are safe and healthy. My situation continues with no improvement and a follow-up with a physiatrist that I’ve seen a couple of years ago, mentioned that a big part of my problem is with lack of decompression of cervical foraminal nerves. My orthopedic surgeon stated to me that my nerves are not severely compressed so they can be ruled out as pain generators, however pain management disagrees. Pain management position is you “shouldn’t have severe compression after decompressive surgeries and that a well known reason for post surgical pain is inadequate decompression of cervical nerves which can irritate these nerves and cause symptoms”.

We went over my scans again and he is very confident that indeed my source of pain is lack of decompression, there’s a solid fusion from C3-T1. I wanted to get your input, a “surgeon’s view” on this, does this make sense that one does not need severe compression after decompressive ACDF’s, Laminectomies, Facetectomies and Foraminotomies in order to have pain? Thanks in advance

Hello Dr. Corenman,

I was making sure before focusing 100% on a nerve stimulator that there’s nothing else I’m overlooking? Before my last surgery, my thoracic MRI noted a herniation at T3/T4 (see below). Is there anything in this report that can cause base of neck pain, muscle spasms, headaches, etc.? If there is should a diagnostic block be in store to rule out if this is the source of pain? Thank you

T1/T2 disc space level, postsurgical changes are noted. Posterior stabilization rod is noted with paired transpedicular fixation screws transversing the T1 and T2 vertebral bodies. No evidence of herniated disc or sideline thecal sac deformity . Loss of disc signal is noted with preservation of disc space height.

T2/3, disc herniation is noted deforming the thecal sac with bilateral paracentral components, Loss of disc signal is noted with partial loss of disc space height.

T3/4, disc herniation is noted deforming the thecal sac with bilateral paracentral components, Loss of disc signal is noted with partial loss of disc space height.

T4/5, left paracentral disc herniation is noted deforming the thecal sac. Loss of disc space height and signal is noted with mild disc degeneration.

T5/6, disc bulge is noted with paracentral orientation deforming the thecal sac. Loss of disc space height and signal is noted compatible with mild disc degeneration.

T6/7, disc bulge is noted with paracentral orientation deforming the thecal sac. Loss of disc space height and signal is noted compatible with mild disc degeneration.

T7/8, disc herniation is noted deforming the thecal sac with bilateral paracentral components.Loss of disc space height and signal is noted compatible with mild disc degeneration.

T8/9, disc herniation is noted deforming the thecal sac with bilateral paracentral components.Loss of disc space height and signal is noted compatible with mild disc degeneration.

T9/10, right paracentral disc herniation is noted deforming the thecal sac. Loss of disc space height and signal is noted with mild disc degeneration.

T11/12, disc bulge is noted deforming the thecal sac. Loss of disc space height and signal is noted compatible with mild disc degeneration.

These extruded disc exert extradural pressure. Ventral dural tube subarachnoid space is impacted upon and deformed. Spinal cord surface is also encroached, without resulting in flattening.

Central canal integrity is partially compromised. Persistent thoracic multilevel discopathy noted

Good afternoon Dr. Corenman,

Just brain storming, as you know last procedure performed extended fusion to T2-T3 due to degenerative spondylolisthesis. My concern is at T3-4 level, the same condition exist and I was wondering if this level can be causing my continued base of neck, shoulder, muscle spasms, etc. pain? If so, should a diagnostic block be performed with pain diary to evaluate if source of pain? Also, if source of pain, can an RFA address, I’m not really looking into having another fusion surgery? thanks a million!!!!