Reversal of normal c-spine curvature & many more spine issues

Tagged: Sick & tired of being miserable!

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TammyFP
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December 31, 2016 at 8:50 pm

Post count: 1

#24038

Hello, I have a reversal of c-spine curve that shows on both an MRI & CT that were done 4 yrs apart. I had severe neck pain with a herniated disc at c6-7 during my 20’s. I underwent a battery of facet blocks, injections with a long needle (positioned under x-ray) through the front of my neck/throat as well as c-spine epidurals, occipital nerve & other trigger point injections & years of physical therapy that included iontophoresis, ultra sound, heat, stretching, traction & exercises. I became pain free for about a year & a half then I was in a horrific mva (t-boned) that blew out my SI joint & caused bulging disc at l4-5 & l5-6 which resolved after 6 months of PT. My SI, however, kept slipping out periodically after, initially, healing so I had SI nerve blocks done with PT for another 3 months a year after it, initially resolved. I had two more serious (total loss) mva’s after being t-boned in 2005. One in 2008 & another in 2012. The one in 2008 took out the bottom of my vehicle & from that moment on the pain in my left foot (which I had previously after being t-boned but it stopped after the discs resolved) never left/stopped. The accident in 2012 was another total loss (of my vehicle) when I was hit from behind by a truck while I was stopped at a red light. With that accident my seatbelt broke one of my “true ribs” on the left side. When I went to ER the doctor told me that my SI joint was “bone on bone.” I had just moved & hadn’t set up a primary doctor or anything &, since the accident happened 2 wks to the day after relocating – the ER was my only doctor. When I went in the day of the wreck I presented with severe headache & lower back/leg pain. The idiots at the ER only x-rayed my low back (that when I was told SI bone on bone) but they didn’t x-ray my neck or do any study for headache. After having had recurrent kidney stones/infections in left kidney prior to relocating, when I was having severe pain in mid-back on left side I went to ER thinking it was my kidney. I told them to x-ray my neck because I was still having severe headaches. They x-rayed my t-spine & found broken rib but didn’t x-ray c-spine so I went back 2 days later with headache, they x-ray c-spine & told me it was “clear.” By this time I had a doctor who referred me to a pain clinic. That doc ordered an MRI of my c & t-spine. The c-spine showed the abnormal curvature (that my chiropractor found back in 2005 after my t-bone accident) as well as some issues with my t-spine. Although I had told the pain doctor I had severe low back, left leg & foot pain he didn’t order the l-spine to be scanned when he ordered MRI of c & t-spine. Since it took 3 ER visits to get my entire spine x-rayed & then the MRI was ordered, my PIP from auto insurance was exhausted, which prevented me from getting any PT (I didn’t have private insurance at that time). So I was given narcotic pain relievers until I got on medicaid & went to a doctor requesting subutex to get off the oxy. Well, I got off subutex after a couple months, but y low back/si joint pain, leg & foot pain continued off & on causing me to go on & off oxy for years. My neck hadn’t been giving me much problem (at least none that I could feel through the oxycodone). That is, until I fell this past July, hitting my head & jacking up my already messed up neck again. I have been off work for 3 months on medical leave. I fell at home so it’s not a work related nor an auto related injury. Since I hadn’t had any issues for several years concerning neck pain & have been treated for low back sciatic pain only the ER ordered a CT of my head & neck when I went to ER after my fall. The CT showed the abnormal curvature that the MRI in 2012 showed. The CT, also, noted a moderate right c2-c3 & c5-c6 facet degeneration. It showed a moderate anterior disc space degeneration at c6-c7 as well (which is where I had the herniation/facet issues back in my 20’s (1990’s) but had resolved. I have been on oxycodone, fentanyl patches, oxymorphone, oxycontin & such so long that my tolerance was through the roof. I was anticipating getting one of those neuro-stimulator implants in my low back prior to my fall, but found out that doesn’t resolve low back & sciatic pain entirely anyway. I wanted to pursue getting the I-Fuse implant to fix my SI joint because that bone on bone contact is continually causing me to not be able to bear weight & because I can’t walk swiftly or slowly for very long due to the bone slipping and grinding as well as my foot killing me I have gone from 120 to 180 pounds since 2008’s accident. I am a train wreck & because of my opioid tolerance I got back on the subutex along with a butrans patch (same drug, I know) & have undergone more trigger point injections at occipital nerves & shoulders again. I want to know what I can do to permanently fix my lower back/si joint as well as my c-spine problems so that I can be done with the “chronic pain” management doctors, narcotics (subutex/butrans isn’t controlling pain as well as opioids – only stopping withdrawals) & injections. I want to be done with this drama. I’m only 48 yo & I have at least 20 years of working left in my life & I’m tired of not being able to perform adl’s on regular basis/being on medical leave from the first job I’ve had since 2012 accident. I’m too young to live the rest of my life in “chronic pain clinic” where they NEVER prescribe strong enough or large enough quantity to keep me out of pain from one month to the next. My tolerance is too high & it freaks the doctors out to prescribe what my tolerance requires to keep me out of pain – that’s no way to live. I want a solution. I’m tired of band-aids. Please help me.

Donald Corenman, MD, DC
Moderator

January 4, 2017 at 9:40 pm

Post count: 8660

#24043

You have made a mention of a number of things I would like to address. First comment “When I went to ER the doctor told me that my SI joint was “bone on bone”, this is difficult to interpret on an X-ray and the ER is probably not the place to make that diagnosis. SI joints rarely cause pain (3-6%).

“The CT showed the abnormal curvature that the MRI in 2012 showed. The CT, also, noted a moderate right c2-c3 & c5-c6 facet degeneration. It showed a moderate anterior disc space degeneration at c6-c7 as well (which is where I had the herniation/facet issues back in my 20’s (1990’s) but had resolved”. Neck pain can occur from a number of structures including the facets, discs, instability and even nerve compression. The reversal of the normal lordosis may be a factor but there are many patients I have with reversals and no pain. You need a careful step by step evaluation of your neck.

You note; “I have been on oxycodone, fentanyl patches, oxymorphone, oxycontin & such so long that my tolerance was through the roof, too young to live the rest of my life in “chronic pain clinic” where they NEVER prescribe strong enough or large enough quantity to keep me out of pain from one month to the next. My tolerance is too high & it freaks the doctors out to prescribe what my tolerance requires to keep me out of pain”.

Unfortunately, you are habituated to narcotics and this is a real problem and hurtle for treatment. Chronic high dose narcotics changes pain perception and sensitizes the brain to pain over some months to years. You will need to get off narcotics to get to the real sources of your pain. This will be the biggest challenge to you as the side effects of withdrawal initially hypersensitive the brain and body to pain so you think initially you are going in the wrong direction. It can take as much as three months to get off and the withdrawal symptoms will make you think I am crazy for suggesting that you get off these medications.

Unfortunately, your “being on medical leave from the first job I’ve had since 2012 accident” also intensifies this dilemma as you have no co-workers to help you and little direction without demands that working responsibilities entail. I would first see if you can get into a rehab program and substitute other non-narcotic mediations for the narcotics. You will need a schedule to follow to get of these medications and a support group of therapists to help with the hard times.

Once off narcotics, you can then go through a work-up program of SNRBs, possible facet blocks and maybe even discograms to determine your pain generators (of course along with a thorough physical examination). A surgical plan then can be generated.

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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