Surgery candidate?

Tagged: Cervical spine canal stenosis and cord signal change

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Heathry76
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December 30, 2017 at 7:38 am

Post count: 16

#27178

Dear Dr. Corenman,
This is my first time using anything like this to ask a medical question but I’m curious. I’ve had a C5 C6 herniation since 2006 from a sports injury. It’s always been central herniation with mild canal narrowing and severe bilateral forminia stenosis. Over the years I’ve competed in heavy contact sports and have managed this using chiropractic and massage along with strength training. In 2016 I started to notice it getting worse causing me to quit contact sports. It settled down and I went along with my life. In 2017 after a year of cycling 4-6 days a week it got worse and hasn’t stopped for 1 year. Now, after PT failed miserably I’m consulting a neurosurgeon. My MRI shows DJD, disc height loss with unconvertebral osteophyte, posterior osteophyte ridge, left paracrntral disc herniation resulting in severe narrowing of the foramina bilaterally. There is mild canal narrowing with partial effacement of the ventral subarachnoid space. There is a small focus of amorphous T2 hyperintense signal in the cord at c5 that could reflect myelopathic signal change. The cord appears slightly asymmetric in caliber, appearing slightly smaller on the left as compared to the right.
With that said, I have thoracic canal stenosis with cord remodeling without cord signal change and L5 canal stenosis with subarticular crowding. I can deal with this conservatively but my neck has taken me out of all sports, causes massive chronic inflammation if I try to do sports or even sleep, and my neck movement is pretty much horrible. I’m an athlete and this has taken me from working out 6 days a week down to nothing. I see neurosurgeon next week. My first surgery consult they did not want to do the surgery because I had symptoms also in my ribs and lower back and they did not have MRI of those areas. Now I do, and I hope that my case makes more sense now. I only expect my neck to regain movement and stop being inflammed from the osteophyte that’s rubbing up against my tissues and causing inflammation and probably irritating my cord. What do you think? I know the risks of surgery, the pros and cons long term and I’m willing to take the chance to regain my life.

Donald Corenman, MD, DC
Moderator

December 30, 2017 at 10:27 am

Post count: 8660

#27180

You have what appears to be significant canal stenosis with cord injury and myelomalacia (spinal cord narrowing due to nerve tract dropout). This is associated with severe foramina narrowing causing nerve root compression (and I bet arm symptoms-see https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/ and look at C6 nerve involvement).

Unfortunately, this problem will not get any better with non-surgical attention. You also have a very worrisome sign in cord signal change. This indicates cord injury and regrettably, this cord injury is generally painless. Injury to the cord causes balance and fine motor skill loss with occasional paresthesias (pins and needles) as well as an occasional electrical shock down the arms and spine (L’hermittes sign) with neck extension. As you probably now know, cycling causes neck extension and can aggravate this problem unless you adapt your bike to the “beach cruiser” position.

You probably need an ACDF of this level sooner than later. See https://neckandback.com/treatments/anterior-cervical-decompression-and-fusion-acdf/. The L5 level stenosis generally is not dangerous unless you have developed motor weakness revealed by a physical examination or see https://neckandback.com/conditions/home-testing-for-leg-weakness/. I cannot comment on the thoracic canal stenosis without viewing your images but generally, due to the ribs stabilizing the thoracic spine, these areas are more stable than cervical stenosis.

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.

Heathry76
Participant

December 30, 2017 at 11:24 am

Post count: 16

#27181

Thank you for your insight. I hope they decide to do the ACDF. Since my reflexes are normal and I’m not falling over they did not see the urgency for surgery during the first consult. I had also not been working out for 2 months and was on Prednisone so I told the surgeon I thought I may be improving. Then PT happened and it caused big problems. They gave me more Prednisone which wears off then I’m back feeling crappy again. I have heaviness that comes over me when im standing but feels less crappy if I lie down. After PT I got hit with muscle spasms in my legs thst were ridiculous. My sports life I’m afraid is done unless they fix the area because even swimming aggravates it. Swimming has always been a safe backup sport. Surgery of course is a last resort and at this point I see no other option. My chiropractor even could not help me and sent me to a Neuro. So, thanks again for your insight. I think it’s a great service to the community and its appreciated. When or if I get back to cycling I do plan on raising my stem, but probably not beach cruiser level. Hopefully if they fix me and I strengthen myself and do PT to help support these areas. I think my other unjuries in t spine and l spine with improve once I can start exercising again. My neck strayed this snowball effect of crappiness. Best regards and Happy New Year!!

Donald Corenman, MD, DC
Moderator

December 30, 2017 at 12:35 pm

Post count: 8660

#27182

Once your neck is fixed, you will be able to bike again.

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.

Heathry76
Participant

January 1, 2018 at 5:37 pm

Post count: 16

#27187

Dr Corenman,
I had one more question regarding thoracic herniations. I’ve had the injury likely for years T7-T8 but recently had to get an MRI after an incident at PT which landed me in the ER with chest pain and trembling legs. It’s a central disc protrusion noted as small and remodels the left ventral aspect of the cord without underlying signal change. I wasn’t worried until recently because it’s been 3 weeks since the PT mishap and I still can’t stand up straight for longer than 15 minutes ish. I was,in PT for my neck, so I was pretty bummed about this. I have to sit in a recliner, can’t even sit in chair. I don’t have pain, just immense pressure, heaviness in my back, pelvis, abdomen and legs. It’s weird. I guess I’ll find out this week at the neurosurgeon but it’s worrisome. Ive never had this type of weird pressure and weighted feeling ever in my life. All my back injuries were always successfully treated by a chiropractor so visiting a surgeon is new and its because this is now a whole new level of injury. By the way, I herniated T7-T8 doing butterfly sprints with flippers, or at least thats what took it from slightly bothersome to debilitating. I was healing until PT basically made it worse. I’m still hoping an injection will solve this thoracic issue.

Donald Corenman, MD, DC
Moderator

January 2, 2018 at 1:38 pm

Post count: 8660

#27191

Chest pain can occur from upper thoracic nerve compressions but also from C4 nerve compression (the C4 nerve covers the anterior chest wall to the nipple line). Mid thoracic disc herniations typically cause pain that radiates in a band downwards as the thoracic nerves radiate from the spinal origin down about 5 inches from the originating vertebra. T7 ends right below the bottom of the zyphoid in where you would call the stomach area.

I would say the inability to stand upright might be from your lumbar spine.

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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