Congenital c1 c2 issue

Tagged: cervical foraminal stenosis, odontoid fracture

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Mookie12
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July 17, 2015 at 4:21 pm

Post count: 5

#20031

Hello, Dr. Corenman. After having an MRI and CT scan for a separate issue, it was discovered that my c1 and c2 vertebrae are not connected. It’s likely that they have always been this way, as I’ve had no accidents or injuries that could cause this. I’ve had a set of x-rays done as well, during an initial meeting with a neurosurgeon. We (well, I) decided to “watch and wait”, however, the pain at the base of my skull is increasing, and I’ve had a couple short bouts of dizziness when turning my head to the right while laying down. I’m calling to schedule a follow-up with the neurosurgeon, but in the meantime I’m very nervous about something horrible happening due to this. What would a fusion of these vertebrae entail? I’m scared of doing something about it and scared of doing nothing about it. I have no idea what each day might bring…will my head flop over? I feel ridiculous, but I’ve never had any sort of health problems, and this is a big one. Thank you for any assistance and if you need other information I’m happy to provide it to the best of my ability.

Donald Corenman, MD, DC
Moderator

July 18, 2015 at 11:59 am

Post count: 8660

#20036

The C1 “not being connected” to C2 typically is caused by an injury to the transverse ligament. C1 is a ring shaped vertebra and C2 has a “head” on it (called the odontoid or dens) that touches the inside front of the C1 ring. What keeps these two surfaces together is this transverse ligament. It is uncommon but not rare that this ligament ruptures. It ruptures more commonly in certain conditions (rheumatoid arthritis, downs syndrome among others).

When it ruptures, the C1 vertebra is free to move around and can compress the spinal cord or disrupt the flow of blood from the two vertebral arteries. Needless to say, this is not a good condition and generally, C1 needs to be fused to C2 in order to stabilize this condition.

Since 50% of rotation of your head on your neck comes from C1-2, you will lose some motion. This is the “no” motion that will be partially lost (when you shake your head from side to side).

If you have other problems not related to your transverse ligament (odontoid fracture, dentate ligament tears), the treatment might be the same or differ slightly.

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.

Mookie12
Participant

August 8, 2015 at 3:52 pm

Post count: 5

#20164

Hi again! Is it possible that this issue with my neck can cause other symptoms, like pain in the left arm? It’s not a shooting pain, and it’s not my whole arm. I looked in the electronic records of the x-rays I had done with the neurosurgeon, and not only do I have the C1C2 issue, but I have multi level degenerative disc disease, most prominent at the C4C5. I know that that’s a somewhat normal part of aging (I’m 41), but would that cause the pain in my arm? Or any other sort of pain? The neurosurgeon didn’t mention it when he followed up about the x-rays, so it may not be a cause for concern just yet. Thank you again for any help!

Donald Corenman, MD, DC
Moderator

August 11, 2015 at 7:45 am

Post count: 8660

#20172

Foraminal stenosis (narrowing of the exit nerve hole) is quite common and will cause arm pain. The path of pain depends upon the nerve that is compressed. C5 will only radiate into the upper arm while C8 will cause pain into the hand.

If this pain is impairing, you could consider a nerve block (SNRB). This injection will both diagnose the disorder (see pain diary) as well as potentially treat it (the steroid injected).

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.

Mookie12
Participant

November 30, 2015 at 11:00 am

Post count: 5

#20880

Hello, Dr. Corenman! I recently had a cervical spine MRI and am due for a followup appointment with the neurosurgeon next week, but I was wondering if you might be able to “translate” the findings from the MRI. I tried looking up terms but it just got too confusing! I appreciate any assistance you might be able to give.

Craniocervical Junction: Normal.
Osseous Structures: Again demonstrated is an unfused dens fragment approximately 6 mm distal to C2 body.. There is edema within the surrounding soft tissues at this level. The transverse ligament, anterior and posterior longitudinal ligaments are intact.
There appears to be partial avulsion of the anterior and posterior longitudinal ligaments from base of C2. Soft tissue edema adjacent to dens. Marrow signal is normal.
Spinal Cord: There is a focus of T2/STIR hyperintensity of the cord at the level of the dens.

I understand you are busy yourself, so anything you may be able to tell me to simplify what this is saying would be so helpful.

Thank you!

Mookie12
Participant

December 12, 2015 at 10:00 am

Post count: 5

#21017

Hi again. I’m assuming this got lost in the shuffle. Anyway, I met with my neurosurgeon and am scheduled for surgery in February. I still don’t understand what the MRI results mean, but the official diagnosis is os odontoideum and I also have what he called an “old bruise” on my spinal cord at the exact place where the issue is. Surgery scares me, but just all the unknowns, as I’ve never had surgery where I’ve been completely under anesthesia before. Anyway, just wanted to give the update.
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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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