c6/7 herniation with atrophy

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joeyl328
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October 30, 2013 at 3:35 am

Post count: 2

#9726

Hello, I have an acute disc herniation at C6/7 (moderate in the MRI report) with left paracentral and left lateral disc protrusion that impinges on the descending left sided nerve root and cause moderate left sided neural formaen stenosis and exiting left nerve root impingement. It has been 8 weeks since the injury. I am taking Gabapentin for nerve pain 3x a day, and Percocet as needed. The pain is now constant but 4/10 sometimes up to 7/10. It began as constant 8/10. I have noticed atrophy in my left forearm and tricep. When I compare to my right, I notice a 1″ difference in circumference in the left forearm compared to the right and a 1.5″ difference in the tricep. I also have noticed some left shoulder instability, when I bring my arms together and push my shoulders back, I feel a “clunking” in the posterior left shoulder. I have tingling in my left index finger and occasionally in my middle finger. I have pain that moves around from posterior shoulder, to the outside elbow to the back of the hand. The worst pain when it is present is just to the middle of the tip of the shoulderblade, in fact that is where the pain began, I can’t sleep on my back and not at all in my bed, so I have been sleeping on my right side on the couch (my wife and I are getting tired of that for sure). I am getting a cortisone injection in a few days and am going to schedule surgery. I am concerned with the atrophy in such a short time and the instability of my shoulder. But when I look up C6/7 (and c7 nerve root), it doesn’t innervate the posterior shoulder, so I am worried about maybe having 2 injuries? The problem started while doing pull-ups 8 weeks ago. So a few questions:
1) what do you think of ADR (I am 36 and healty, 176lbs, no illnesses, don’t smoke)
2)can c6/7 cause these symptoms (shoulder atrophy, tricep atrophy, etc)
3) I have read surgery won’t increase my strength any faster than waiting, but wouldn’t surgery help decrease the atrophy that is currently happening?
4) THANK YOU!!!

joeyl328
Member

October 30, 2013 at 3:44 am

Post count: 2

#9727

one more quick question: If I wasn’t taking gabapentin, would it be safe to assume the “tingles” that I feel in my arm would be more painful than tingles?

Donald Corenman, MD, DC
Moderator

November 17, 2013 at 8:48 pm

Post count: 8660

#9809

You have a left disc hernation at C6-7 that is compressing the exiting nerve root (C7 nerve). You have all the typical symptoms (pain, paresthesias, numbness) and also weakness. The weakness is the one symptom that really concerns me.

The other symptoms can resolve over time but the weakness can be permanent. It is true that cervical nerves recover from weakness better than lumbar nerves and the C7 nerve has a good record of recovery. Nonetheless, if the weakness is significant or atrophy occurs, I give my patients only 6 weeks to see if the nerve will recover without surgery.

If in this 6 week period there is no significant recovery, surgery is recommended to give the nerve the best chance of recovery. Atrophy is a sign of significant compression and would prompt me to consider surgery sooner than later.

If this is a typical disc herniation with good disc height preservation (the disc is not significantly narrowed from years of degeneration), then you would be a candidate for an artificial disc replacement (ADR).

WIthout Gabapentin (Neurontin), generally you would have greater nerve symptoms. This medication sometimes does not help symptoms but there is no way to know unless you stop taking it. For this medication, you cannot stop cold turkey but need to wean down slowly off.

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.

Seth82
Member

May 31, 2014 at 10:08 am

Post count: 1

#10917

Please tell me more abt your situation. I have those exact same symptoms except pain. I don’t hurt very much at all. I’ve had an MRI 7 weeks ago. Have been doing pt and 2 weeks ago my arm shrunk an inch. My doctor has scheduled another MRI for this coming week. I’m very nervous b/c my tricep has shrunk and my left pec is affected too. Any advice you have from your experience would be appreciated. I’m afraid surgery will be in my future and I really don’t want that.
Thank you for your time

Donald Corenman, MD, DC
Moderator

June 10, 2014 at 9:07 pm

Post count: 8660

#11018

Painless atrophy of the upper extremity can originate from a pinch nerve in the cervical spine but there are other syndromes that can also affect this. You cannot put your head in the sand and hope this will go away. You need to seek some medical advice soon. Atrophy is a serious sign and you need to address this.

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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