Whiplash/Post Concussion Syndrome

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john123
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July 24, 2012 at 3:38 pm

Post count: 30

#6581

Dr. Corenman:

I was rear ended in a MVA 2 years ago. Pre-existing bi-lateral pars fracture. Grade 1 spondylothesis with annual tear, disc herniation at same level L5,S1.

Soft tissue damage left side of neck where seat belt crossed chest. disc bulge c2/c3, c5/c6 – minor

no real back pain after the car accident, but was unable to exercise due to PCS (my back flared up about 4-5 months after accident) I now wear a rigid back brace every day for support; I can hardly walk without it, but with it I feel ok….

When PCS symptoms go away for a few weeks, I continue to try some light walking for 4-5 minutes and have continued to have PCS set backs. ie. fatigue, difficulty concentrating, headaches, photsenstitivity, throbbing/pressure in head, sensitivity to impact/walking stiff neck.

I seem to be able to walk ok through grocery store with a cart wearing brace. Standing straight up without brace on, I feel like my heel of my foot is smashing the ground when I walk.

I believe if I can walk/exercise again I can rebuild my back.

I get relief from PCS symptoms with consistent, medical, trigger point massage but never permanent relief and not enough to get walking again. I hvae chronic muscle tightness left shoulder blade and neck.

1.) Are PCS symptoms generated from back, neck, head ?

2.) Do I treat neck or back first?

3.) I did see a chiro for neck which helped, but symptoms PCS reappear? Is there a specific Chiro that I should look for if at at all?

Thank you

Donald Corenman, MD, DC
Moderator

July 24, 2012 at 8:31 pm

Post count: 8660

#6583

Post concussion syndrome is separate and distinct from spine injury but both can occur in the same accident. Post concussion syndrome (PCS) is considered a shearing injury of the brain components (nerves and surrounding supporting tissues) that causes brain dysfunction. Normally, the symptoms are as you note and typically resolve after some time. If they do not resolve, a visit with a neuropsychologist or psychiatrist would be in order.

I am not a fan of full time brace wear. This device may stabilize your spine but at the expense of muscle deconditioning. A thorough rehabilitation program would be a better investment.

Your neck pain could be from injury to the spinal structures. You are now two years out from this injury with significant symptoms and I think you need a consultation with a spine surgeon and a neuropsychologist.

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.

john123
Member

July 31, 2012 at 11:24 am

Post count: 30

#6633

Thank you for the reply. I have consulted with neurosurgeon who have recommended ALIF for spondy.

Neurologist – said that concussion symptoms are mimics from muscle spasm and stiffness in neck, which makes sense after seeing what some NHL players have gone through. I usually have no headaches or memory problems.

Neuropsych has recommended further imaging which may or may not show anything.

How do you explain being able to walk perfectly fine leaning over a grocery cart at a store with the brace on vs generating symptoms walking straight up with the brace off??

Thank you

Donald Corenman, MD, DC
Moderator

August 1, 2012 at 12:24 am

Post count: 8660

#6640

Walking using a shopping cart causes you to flex at your lower back and support some of your torso weight on the cart itself. This has two effects. One, of course is that the spine is partially unloaded (less stress loading on the spine). Less load on the spine reduces compression and shear forces which reduces pain.

The other action that forward flexion produces is opening of the central canal and foramen as well at loading anterior structures and reducing load on posterior structures. If the painful structures are posterior (pars fractures or facets), forward bending reduces stress on them. If there is stenosis (narrowing) of the central canal or foramen, this action will also open the channels that transmit the nerves.

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.

john123
Member

August 3, 2012 at 10:07 am

Post count: 30

#6655

Thank you, this makes more sense.

If I am walking upright, without brace on, walking heal to toe instead of bent over – wouldn’t the spine be then fully loaded?

If my back muscles are very atrophied and spondylothesis is mobile, could it create enough inflammation to generate headaches, dizziness, from impact from walking ?

At this point I don’t know what direction to go in ?

Perhaps I should try another form of exercise? Any suggestions?

Donald Corenman, MD, DC
Moderator

August 6, 2012 at 10:54 pm

Post count: 8660

#6672

The spine is fully loaded whenever you are upright or even bent forward as long as you are not using aids to walk (cane, walker or shopping cart). Without the use of aids, the portion of the spine that is loaded changes with different positions. When fully upright, there is approximately 30% load on the facets and 70% on the discs in the lower back. If you bend forward, the load increases on the discs and decreases on the facets. Visa versa if you extend backwards.

Dizziness and headaches are not associated with the lower back. However, increased pain can be associated with these symptoms. Post-concussion syndrome is highly associated with dizziness and headaches.

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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