Flexion and Extension X-RAY results !!

Tagged: cervical degenerative spondylolisthesis due to disc wear below

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appleannie
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July 6, 2017 at 10:54 am

Post count: 129

#25428

Hello Dr. Corenman, I had a Flexion and ExtensionX-ray done in 2015 here’s what radiologist report said:

Impression/ Findings:Stable unchanged Kyphosis at the lower cervical level. Mild Anterolisthesis at C4-C5 that demonstrates mild increase upon Flexion and decrease upon extension indicating slight instability. Stable Degenerative changes C4-T1 with disc space narrowing, Endplate Sclerosis, and Osteophytosis.Stable mild left neural foraminal narrowing at C4-C5.

Dr. Corenman here’s my recent Flexion and Extension x-ray results I just had done in 2017 here’s what the radiologist report said:

Impression/Findings: Unchanged Kyphosis curvature at the lower cervical spine. Unchanged Grade 1 Anterolisthesis of C4 on C5 which is slightly more prominent on Flexion.Severe spondylotic changes of the cervical spine most notable at C4-C5, C5-6 and C6-7,where there is anterior and posterior Osteophytosis. Stable Moderate/Advanced left neural foraminal narrowing at C4-C5.

Dr.Corenman I had bad neck injury from a fall down a flight of stairs in 1988 and pulled the ligaments away from the vertebraes at C4-C5 level and a compression fracture at C5-6 level and had to wear a Halo brace for three months.Dr.Corenman when the spine doctor who was treating me in 1988 took the Halo off me and told me that I’m going to have mild to moderate instability at my C4-C5 level for the rest of my life because my Ligaments at that level healed crooked. Dr.Corenman do you think the results above are from the injury that I had back in 1988 ?? Could you please explain these results for me. Thank You !!

Donald Corenman, MD, DC
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July 6, 2017 at 1:02 pm

Post count: 8660

#25429

You have a typical degenerative spondylolisthesis below the C5-7 levels where you probably have multilevel disc resorption. See both https://neckandback.com/conditions/degenerative-spondylolisthesis-cervical/ and https://neckandback.com/conditions/isolated-disc-resorption-cervical-spine-idr/ to understand this condition.

Whether you have to do something about this depends upon your symptoms. Do you have any significant pain or dysfunction?

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.

appleannie
Participant

July 6, 2017 at 1:37 pm

Post count: 129

#25430

Dr.Corenman, Yes I do have aching pain in my neck area that goes along my shoulder blades also I been having spasms in my neck area to.My orthopedic spine doctor I seen said that the Autofusion I have at C5-6 LEVEL will help to stabilize my cervical spine at C4-5 level and the neurosurgeon spine specialist I seen said that the Autofusion I have at C5-6 LEVEL is nothing but severe arthritis and it won’t stabilize my cervical spine at C4-5 level if I was in a car accident or have another bad fall. What is Endplate sclerosis ?? What is Facet arthropathy ??

Thank You !!

Donald Corenman, MD, DC
Moderator

July 8, 2017 at 6:36 am

Post count: 8660

#25440

I would most likely agree with the neurosurgeon. It is very rare that a disc space will fuse but very common that the disc erodes away and ends up bone-on-bone. The loss of disc at C5-6 will not help the C4-5 level but load it even more and is most likely increased the wear of the C4-5 facets.

Your question of endplate sclerosis is answered by the section on IDR (This delayed pain is caused by fractures that occur within the vertebral body in small structural web-like bones called the trabecula. These tiny bones are like a honeycomb inside the vertebra that reinforces the walls. The trabecula are normally protected by the shock absorption capacity of the disc). When the disc no longer absorbs shock, the bone endplates of the vertebra absorb more force than they are designed to handle. They subsequently develop overt and stress fractures. Wolfe’s law states that bone that suffers undo stress will form more bone. Hence, the endplates become thicker (sclerosis).

The slip at C4-5 could not occur without facet arthropathy, a fancy way to say facet arthritis.

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.

appleannie
Participant

July 9, 2017 at 9:35 am

Post count: 129

#25463

Hello Dr.Corenman, I been having alot of tightness feeling in my cervical spine area when I bending over to pick up something or look up to the ceiling. Dr.Corenman I know I have alot of Arthritis in my cervical spine could that be causing the tightness feeling ??

Thank You !!

Donald Corenman, MD, DC
Moderator

July 9, 2017 at 9:54 am

Post count: 8660

#25464

Typically, the “tightness felling” in the neck is caused 70% by disc pain and 30% by facet pain. I would assume that the combination of IDR of discs C5-6 and C6-7 along with the degenerative spondylolisthesis of C4-5 are causing your symptoms.

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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