Can severedisabling neck issues w/ post chiari decompression be helped

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dotari
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September 27, 2012 at 10:10 pm

Post count: 1

#7035

Dr. Corenman,

I am grateful to have found your forum. 14 years ago as a National Product Mgr w/ a fortune 25 company, I was diagnosed w/ Chiari which was highly symptomatic. I have always been a motivated, productive and fitness oriented person. I had a decompression w/ large craniotomy which looks good on MRI in 1998 meaning the Chiari part. I have had severe muscle pain, neck pain and occipital neuralgia since the surgery but could initially do light activities, volunteer, etc. However, 8 years ago, I had a herniated disc and I have been plagued by severe disabling pain ever since.
My husband and I have done everything possible to keep moving forward despite tremendous disabling neck pain and now radiculopathy of right arm which actually improved 8 years ago after the EMG/nerve test but the neck pain by c5/6 did not. (I believe my old MRIs also had a c6/7 herniation which seems to have resolved itself) I have literally done every therapy available some with complications and most providing temporary relief at best. The therapies I have tried include acupuncture, massage, PT, purchasing a swimming pool /a $3000 pilates machine as I am dizzy as well so I can keep legs strong, formal aqua therapy, trigger points, botox injection, Epidural Steroid injection, many medications, high dose prednisone and care at one of the best Headache centers in the country due to the pain/occipital neuralgia and chronic migraine.
I have been unable to work or ever do the activities I enjoy. I have been so afraid of any further surgeries since the Chiari surgery. I have had periods of relative stability, however, they never include things like going to the grocery store as I cannot load and unload and put away groceries without being highly symptomatic. Just doing personal daily care is a true struggle. We have tried to be satisfied that I am here and have a beautiful 19 year old daughter in college. I did fall one year ago and broke my foot from imbalance.
This summer things have gone from severely limited and in pain (hard to aqua job w/ arms weights as arms / wrist weak) to unable to do anything without excruciated neck pain and the right shoulder and arm, hand are now involved including pain in deltoid shoulder and weakness. The neck pain is so bad that I have to talk myself into getting into a daily shower and the arm pain is very bothersome. I had a new MRI in August which reveals foraminal cervical stenosis indenting the thecal sac from a posterior right osteophyte complex. I also think I did something after the MRI as about 2 weeks after, the pain is so searing that we are contemplating what to do. I haven’t had a surgery consult since 2004 when I was told since the arm pain improved I was not a candidate and there was only herniated disc at the time no stenoisis and not much in the way of minimally invasive here in Upstate NY and they advised against a fusion due to risks, etc.
My primary gave me a cortisone shot a few weeks ago and no relief and my neurologist is recommending traction for which I am scheduled for next week. I know there are no easy answers but am wondering because I already have a craniotomy or plate if I am even a candidate for any kind of neck surgery. I read through your boards but do not know if the stenosis is from the facet or uncovertebral joint. I am used to having limited my life to avoid pain but I see so many people from dancers to football players keep moving I keep thinking maybe just maybe there is something out there to help relieve the pain and help me increase my participation in life. I feel I have so much to give and am only 50 years old and I would love not to center my entire life around what I cannot do. Grateful for any advice.

Donald Corenman, MD, DC
Moderator

October 3, 2012 at 4:15 pm

Post count: 8660

#7098

For those who do not know, a Chiari malformation is a condition where the base of the brain “settles” and a portion of the brain protrudes through the foramen magnum, the large hole at the base of the skull. This crowding of the brainstem causes compression and symptoms that are difficult to live with.

The treatment is to enlarge the hole and decompress the brain stem. This typically involves removal of a portion of the first vertebra and occasional fusion of the upper vertebra.

You apparently did reasonably well after this decompression but note a herniated disc some years after the Chiari decompression.

Your current symptoms could be from foraminal stenosis, a disc hernation, some advancement of the Chiari malformation or cervical stenosis. You do need a new MRI, CT scan and a consult with a spine surgeon who specializes in base of the skull surgery. You can call my 888 number and talk to Margaret for a recommendation of which surgeons might be able to help you (I do not perform Chiari surgery).

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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