Cervical Laminoplasty scheduled for August 21st. Would love feedback

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Nancy183
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August 14, 2014 at 1:40 am

Post count: 2

#11282

Good morning, Doctor!

A cervical laminoplasty has been recommended to me regarding the MRI report below. Please be advised that I do not have pain. At times, RARELY, I have some mild discomfort, say from working out or from being tired. I was in an auto accident three years ago and wound up with herniated discs. I only went back to a neurologist because very periodically I was awaking during the middle of the night with head/neck spasms/tremors. I thought perhaps I had developed Parkinson’s or MS.
I welcome your feedback. I am a young 47, fairly fit, slim woman. I prefer natural alternatives, perhaps massage, bikram yoga, etc.

Comparison: MRI cervical spine
Findings:
ALIGNMENT: The alignment is normal. Unchanged slight kyphosis.
VERTEBRAL BODIES AND BONE MARROW: Vertebral bodies are normal in height. Bone marrow is normal in signal without evidence of edema or marrow replacing lesion.
DISCS PACESM: Mild narrowing at C4-5 and moderate narrowing at C5-6 and C 6-7.
coRD: There is no focal signal abnormality of the cervical cord. There is flattening of the cord at C5-6 and C 6-7 due to spinal stenosis.
CRANIOCERVICAL JUNCTION: Unremarkable.
Evaluation of individual levels demonstrates:
C2-3: No central canal or neural foraminal narrowing.
C3-4: Small broad-based central disc protrusion producing mild central canal narrowing No neural foraminal narrowing Unchanged from prior exam.
c4-5: Moderate sized broad-based central disc protrusion obliterating the anterior subarachnoid space producing moderate central canal narrowing and mildly indenting the spinal cord. This represents interval progression. No significant neural foraminanl narrowing.
c5-6: Large irregular diffused disc protrusion more prominent on the right side, producing moderate to severe central canal stenosis and flattening the spinal cord. This produces no significant change. There is unchanged bilateral uncovevertebral osteophytosis producing severe right neuroforaminal stenosis and mild to moderate left neuroforaminal stenosis.
C6-7: Diffuse disc protrusion more prominent on the right, producing moderate to severe central canal narrowing and flattening the spinal cord. This appears unchanged. There is bilateral uncovertebral osteophytosis producing severe right neuroforaminal narrowing and mild left neural from narrowing..
c7-Tl: No central canal or neural foraminal narrowing.

IMPRESSION:
MULTILEVEL DEGENERATIVE DISK DISEASE AND MODERATE SPONDYLOSIS.
MODERATE TO SEVERE CENTRAL CANAL STENOSIS AT C5-6 AND C6-7 UNCHANGED.
MILD INTERVAL PROGRESSION OF DISK PROTRUSION AT C4-5 PRODUCING MODERATE CANAL NARROWING.

Donald Corenman, MD, DC
Moderator

August 18, 2014 at 2:23 am

Post count: 8660

#11285

You have significant cervical stenosis. This is a narrowing of the spinal canal due to bone spur and disc bulges. You report no symptoms of myelopathy (see that section on the website for further understanding) which is very good.

Your intermittent neck pain is most likely due to the degenerative changes in the cervical spine that led to the cord compression.

The problem with living with this disorder is the potential for a fall causing a spinal cord injury (central cord syndrome-see website). The spinal canal narrows significantly with head extension. A fall and blow to the front of the head can pinch the cord and cause an injury. If you do not participate in sports that put the neck in jeopardy (mtn biking, skiing, horseback riding, etc), then your risk of injury is lower.

If the narrowing is progressive (which is not uncommon with this disorder), then your cord is at risk for myelopathy. This is a slow developmental process.

The question then comes down to activity selection and risk acceptance. If you understand the risk and do not participate in potential head impact activities, you can try to live with this disorder. If not, you have some surgical choices depending upon your MRI and X-ray findings. This would include an ACDF or a laminoplasty (see website for descriptions of both.

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.

Nancy183
Member

September 5, 2014 at 7:45 am

Post count: 2

#11383

Dear Dr. Corenman:

Thank you for your response and for the abundance of information on your website. It is very helpful and educational.

In your reply to me you said, “The spinal canal narrows significantly with head extension.”

I have been hearing this alot about head extension and that head extension is not good for us.

Head extension is a common move in yoga and it is my understanding that yoga is a very benficial practice for our spine.

Do you have any opinions on this?

~Nancy

Donald Corenman, MD, DC
Moderator

September 5, 2014 at 10:31 pm

Post count: 8660

#11385

Extension of the cervical spine is not a “one size fits all” type of activity. The same goes for yoga.

If you do not have cervical foraminal stenosis or central stenosis (see website), then extension is a perfectly good exercise to perform and should be part of a stretching program. If however you have either of the above two disorders, extension should be limited. Extension narrows the spinal and nerve root canals and can aggravate these two conditions.

Yoga in a perfectly healthy spine is a fine program to participate in. However, if the subject has a degenerative lumbar scoliosis, degenerative spondylolisthesis or lumbar stenosis, there are certain exercises that need to be avoided.

In a degenerative lumbar scoliosis, the spine should be more rigid to prevent the continued progression of the scoliosis. Yoga mobilizes the spine and this could lead to a faster progression of this scoliosis.

The same goes for a degenerative spondylolisthesis. Mobilization of the spine could lead to instability and worsening of this condition. A stiffer spine in this condition will lead to less symptoms and progression.

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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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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