Bulged disc/osteophyte complex c5-c6

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tlav86
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October 14, 2014 at 12:58 pm

Post count: 5

#11519

Hi Dr. Corenman

14 weeks ago i had pain in my shoulder, which was misdiagnosed as bursitis. I was given anti inflammatory drugs to treat this. It got to feeling much better and the pain has subsided. However the symptoms seamed to have changed to significant muscle weakness in my left arm, mainly in my grip strength. I also have intermittent tingling in my pointer finger and thumb. I have got a CT scan with these findings…

TECHNIQUE: IV contrast enhanced CT cervical spine, from C3 to Tl,

with sagittal and coronal reformats.

FINDINGS:

Mild degenerative arthropathy is noted, with intervertebral disc

height loss at Tl-2.

No cervical spine fractures are identified.

There axe no paraspinal or epidural collections.

C3-4: Mild central disc protrusion with no significant spinal canal or neural foraminal narrowing.
C4-5: No significant spinal canal or neural foraminal narrowing.
C5-6: Disc osteophyte complex with mild symmetric disc bulge, which produces mild bilateral neural foraminal narrowing and effacement of the anterior CSF space. The spinal canal is narrowed to 8 mm at this level.
C6-7: Mild central disc protrusion, with no significant neural foraminal or spinal canal narrowing.
C7-Tl: No spinal canal or neural foraminal narrowing.

Limited evaluation of the apices is clear.

IMPRESSION:
Mild degenerative arthropathy, worst at C5-6, where a disc osteophyte
complex produces mild bilateral neural foraminal narrowing and mild
spinal canal stenosis. Further characterization with MRI is
recommended if surgery is considered.

I have since seen a surgeon who recommended a disc replacement surgery at c5-c6 with an mri before the surgery to clarify, if a few more months of conservative treatment did not help my symptons. The muscle weakness being the biggest of my concerns. I have been doing physical therapy with neck traction and have been on anti inflammatories for months now.

Wondering your opinions on this and the disc replacement surgery itself. wondering what quality of life would be like after a surgery like that. I am 28 years old, love to run, snowbaord, and hike. very active, very scared to have these problems so young…

thanks for your time.

Donald Corenman, MD, DC
Moderator

October 14, 2014 at 9:00 pm

Post count: 8660

#11521

You need a thorough physical examination to point out what nerve is compressed. Grip strength can be the C8 nerve (somewhat rare) but the C6 nerve can occasionally have this effect. See the section on this website “symptoms of cervical nerve injuries” to understand what these nerve root symptoms can cause.

“Intermittent tingling in my pointer finger and thumb” is typically the C6 nerve which might fit with your CT scan findings. I am unclear why the CT scan was performed as an MRI is a much better tool for discovering the cause of nerve compression and there is no radiation used.

A CT scan by itself (without a myelogram-the dye injected in the CSF space) is not a good tool to determine what is occurring in the canal or the nerve root exit zone. I assume you have a C^ nerve compression problem and you should consider an MRI and then a SNRB (selective nerve root block-see website).

It is my opinion that an artificial disc is not useful where there is central canal stenosis (narrowing of the central canal compressing the spinal cord). In this situation, you want to stop motion of this segment as extension (bending the head backwards) can put the cord in jeopardy if the artificial disc allows too much motion. An ACDF (see website) is a much procedure for this situation.

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.

tlav86
Member

October 14, 2014 at 11:58 pm

Post count: 5

#11522

I’m actually in canada. I went to emergency to get help on a diagnosis, this is where the ct scan was done. I met with the surgeon afterwards and he just examined the results I had already got. I’m interested in other types of care to such as microdiscectomy or cortison shots? (Not sure if that’s exactly what they are) but I’m concerned about the quick move to pull the whole disc… Can you not simply trim it and see how that works? If it is in fact this nerve are that is affecting me…

Thanks for your quick response

tlav86
Member

October 14, 2014 at 11:59 pm

Post count: 5

#11523

Also what kinda of results can you expect with a fusion or disc replacement relating to lifestyle? Will I be limited?

Donald Corenman, MD, DC
Moderator

October 15, 2014 at 10:36 pm

Post count: 8660

#11528

First, the diagnosis is not absolute with just a CT scan. In my opinion, you need an MRI or a CT myelogram to determine the source of your pain. I understand you are in Canada but there should be certain standards that are held for imaging in Cananda that would allow for an MRI.

If this is a disc herniation (a soft jelly mass compressing the nerve root), the treatment could be different. An ACDF, and artificial disc replacement (ADR) or a posterior foraminotomy could be considered. Each surgery had advantages and drawbacks.

If this is a bone spur compressing the root, the choices are ACDF or ADR. If there is also significant disc height loss or central canal narrowing (stenosis), the choice is only an ACDF.

A one level ACDF or ADR will not cramp your lifestyle (think Peyton Manning of the Denver Broncos). You would have no restrictions in my practice.

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.

tlav86
Member

October 16, 2014 at 1:00 am

Post count: 5

#11530

Thanks again for your help and opinions. I’m finding this whole injury and process of getting the best and right help available to be very difficult. I will search out the best way to get an MRI. Is there anyway possible to have send you my MRI and have you take a look at it without me having to make the trip down there? Or is that pointless?
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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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