AtlasBone/Prolotherapy

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biofreeze
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January 3, 2014 at 2:46 pm

Post count: 99

#10042

1.) I was rear ended 3.5 yrs ago and have had exercise intolerance/dizziness/fatigue since the whiplash accident in addition to neck pain/arm pain on left side/left trap where seat belt crossed over. My cervical MRI shows nothing significant. My lumbar MRI shows grade one spondy.

What are you thoughts on atlas orthogonal ?

Can C!-C2 misalignment create syncope from exercise ?

2.) I have read in some of you past postings that you are not a fan of prolotherapy because of the toxicity of the injection. I have a Dr. locally that uses saline/sugar injection and nothing toxic.

Does this change your mind regarding prolotherapy for back or neck pain in order to rebuild ligaments ??

Thank you

Donald Corenman, MD, DC
Moderator

January 3, 2014 at 11:55 pm

Post count: 8660

#10043

Manipulation of occiput/C1 and C1-2 using a drop table is not a good idea. Mobilization is generally OK but a grade five mobilization (an adjustment) has risks that you need to understand. If performed incorrectly or with too much force, there is a risk of injury to the vertebral artery.

C1-2 misalignment should not cause dizziness. Syncope could be from other problems such as metabolic origins (Addison’s disorder or hypothyroidism).

Prolotherapy by definition has to use injurious solutions. Saline (salt solution) or sugar in high concentrations is injurious (fifty times the normal concentration) to tissue. This injury promotes scar tissue which is the theory behind prolotherapy. Prolotherapy causes scar tissue and does not “rebuild” ligaments. Injection around the upper cervical spine in my opinion is too risky to consider this therapy.

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.

biofreeze
Participant

January 6, 2014 at 3:20 pm

Post count: 99

#10075

I have nothing significant that has showed up in my cervical MRI however still experience mucle tightness and pain (feel like a sprain) on left side of deck and trap. I have received many trigger pt massage, botox injection, trigger pt injection but nothing is taking it away.

1.) what is your suggestion on how to proceed ?

2.) Could it be that the upper cervical is not aligned and causing chronic muscle tightness and pain? If so how would you treat ??

(I also have a labral tear in shoulder (left side).

3.) If I were to have prolotherpay in back ad it did create scar tissue like you say, would it then be harder to have TLIF or any back surgery if you need to cut through the scar tissue.

Thank you

Donald Corenman, MD, DC
Moderator

January 8, 2014 at 7:35 pm

Post count: 8660

#10090

There are many times that patients have been told there is “nothing significant” on their MRI when an obvious disorder is present. Make sure you have this MRI reviewed by more than one set of eyes.

If there are no obvious changes, you could have cervical facet syndrome. This disorder typically does not show up on MRI and is diagnosed by facet blocks (see website).

Alignment of the upper cervical spine is normally not a problem but restriction of range of motion can cause upper cervical pain. This disorder is typically related to the facets so we are back to facet syndrome again.

Prolotherapy should not make any surgery much harder unless the solution was injected around the nerve roots as nerve root scar tissue can have an adverse effect on surgery.

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.

biofreeze
Participant

January 9, 2014 at 4:27 pm

Post count: 99

#10097

Very informative – Thank you again.

My cervical MRI was looked at by two very good neurosurgeons. I do have small bulges at c2-c3 and c5-c6 that touch the thecal sac, but no hernaiton. Dr’s told me it was nothing to worry about. One did suggest a steriod injection into c5-c6 but I heard you are not suppose to give steroid injections in neck so I decided to live with the pain and go for regular trigger pt massage.

1.) what is a discogram ?

2.) would it help diagnose pain/stiffness in neck?

3.) A good chiro (NUCCA) told me that C1-C2 – Atlas could be off alignment from whiplash injury and to try to get it straightened out with activator gun or soft adjustment. They want to take x ray and measurements of c1-c2 and then realign accordingly.

I had chiropractic adjustments of upper cervical 3 years ago after the accident and it did help tremendously but I think the force of the adjustment was irritating the pars fracture,disc herniation at L5S1 as I was being adjusted sitting up in a chair. Thoughts ?

what are you thoughts on activator gun to adjust C1-C2 ?

Sorry for all the questions! I kind of feel like I am going around in circles. I don’t want to poke around with injections with the hope they may help. Last epidural I had left me in a lot of pain.

Thank you kindly

John

Donald Corenman, MD, DC
Moderator

January 9, 2014 at 8:27 pm

Post count: 8660

#10100

A discogram is a pre-surgical test to determine if the disc is a pain generator. A positive discogram in light of significant failed therapy and continued non-tolerated neck pain can be an indication for surgery.

Discograms are only used when all other therapies have failed and the pain in intolerable. You are then looking for a surgical solution.

Vertebra do not go “in and out” of alignment. The vertebral motion becomes restricted, sometimes by facet restriction and sometimes by disc stiffness. A manipulation opens the vacuum of the facet joint (hence the “pop”) and increases range of motion.

Activator techniques uses a very soft “touch” to relax the muscles through a reflex but does not manipulate the joint. I am not against the activator technique but think this technique is not extremely effective.

Epidurals should not cause any significant pain. The technique of the injectionist is really the factor in a relatively pain free and successful injection.

Look into facet blocks to determine your pain generator.

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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Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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