Advice needed AGAIN!!

Tagged: Need your wonderful advice on having you look at these.

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Thompson74
Participant

October 29, 2024 at 8:53 pm

Post count: 7

#36310

Hello Dr C. It is your favorite problem child from Kansas!! I hope all is well in Beautoful Hawaii! You are missed here locally for sure! I can’t trust anyone after getting the quality care from you over those rough 3 years!!🥲. But I’m still here and trying to enjoy my grandbabies and life!

My question is that I am having some problems still with my eating. Darn esophagus. But I had a head and neck MRI done last week to see if my vagus nerve was damaged and the MRI of my neck came back as follows:

MRI CERVICAL SPINE WITHOUT CONTRAST: TECHNIQUE: Multiplanar/multisequence cervical spine protocol without contrast. INDICATION: Neck pain. Cervical radiculopathy. Vagus neuropathy. COMPARISON: Cervical spine radiographs from March 11, 2020

FINDINGS: Skull Base: Mild degenerative changes of the atlanto-occipital articulations. Included Intracranial Structures: Normal
Alignment: Straightening of the normal cervical lordosis. No spondylolisthesis.

Vertebral Bodies: Interbody fusion and posterior fixation hardware at C3-C4. Disc instrumentation at C5-C6. ACDF at C6-C7. Osseous fusion of the C4-C6 vertebral bodies. Vertebral bodies appear normal in height.
Marrow Signal: Expected background marrow signal. No aggressive osseous lesions.

Intervertebral Discs: Marked degenerative endplate changes and disc height loss at C6-C7.
At mild degenerative endplate changes and disc height loss at C7-T1.

Spinal Cord: Artifact in the spinal cord at the C3 and C4 levels.

Prominence of the central canal at the C6-T2 levels without an overt syrinx.

Equivocal focal T2 hyperintensities in the bilateral posterior spinal cord at the C1-C2 level (series 100 image 4), although this appearance may be artifactual.

Paraspinal Soft Tissues: Postsurgical changes of the posterior paraspinal soft tissues.
Individual Levels: C2-C3: Facet arthropathy. No spinal canal or neural foraminal stenosis.
C3-C4: Small dorsal endplate osteophytes. Artifact partially obscures the spinal canal. There appears to be mild spinal canal stenosis. No right neural foraminal stenosis. Artifact nearly completely obscures the left neural foramen.
C4-C5: Artifact partially obscures the spinal canal and nearly completely obscures the left neural foramen. No spinal canal or right neural foraminal stenosis.
C5-C6: Facet arthropathy with partial ankylosis of the facet joints. No spinal canal stenosis. Artifact partially obscures the right neural foramen and obscures the left neural foramen. There appears to be mild right neural foraminal stenosis.
C6-C7: Small disc osteophyte complex. Facet arthropathy. No spinal canal stenosis. Artifact partially obscures the neural foramina. There appears to be mild to moderate bilateral neural foraminal stenosis.
C7-T1: Minimal disc osteophyte complex with dorsal annular fissure. Facet arthropathy. No spinal canal or neural foraminal stenosis.

Of course no KC Dr wants to see me so they have asked me to contact the amazing surgeon that fused me from c3-T1 for his expertise!!!

Thompson74
Participant

October 29, 2024 at 9:00 pm

Post count: 7

#36311

Here is my scan from brain:

MRI BRAIN WITHOUT CONTRAST: TECHNIQUE: Multiplanar, multisequence noncontrast brain protocol. Additional series acquired through the brain stem.

INDICATION: Cranial nerve palsy. Dysautonomia. Esophageal motility disorder. Vagus neuropathy.

COMPARISON: None

FINDINGS: Parenchyma: Multiple FLAIR hyperintense foci in the supratentorial white matter, predominantly in a bifrontal distribution. No mass effect or acute infarct. No hemorrhage. Normal appearance of the brainstem.
Parasellar: Normal appearance of the pituitary gland, suprasellar cistern, and cavernous sinuses.
Extra-axial Collection: None
Ventricular System: Normal. No hydrocephalus.
Major Intracranial Flow Voids: Major vascular flow voids appear patent.
Included Orbits: Normal.
Paranasal Sinuses: No significant mucosal thickening. Included nasal cavity and nasopharynx: Unremarkable.

Tympanomastoid Cavities: Mastoid and petrous air cells are clear.

Osseous Structures and Soft Tissues: Postsurgical and degenerative changes of the imaged cervical spine. Normal appearance of the bilateral jugular foramina.
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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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