2-3 mm overhang C1 C2

Tagged: Cervical Spondylolisthesis and retrolisthesis

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MaryJane12
Participant

August 29, 2016 at 1:54 pm

Post count: 3

#22862

Ok I have a question my flexion x ray is totally a zig zag as far as my bones lining up. My extension isn’t too bad. I have taken it upon myself to trace over my image and work on my own measurements. One of the issues I am seeing with my new image since my recent auto accident is on the flexion my C2 pushed back from C1 about 3mm. So C2 actually measures 14/16 of an inch and the offset from C1 is almost 3/16 of an inch. Is this a problem or not? C3 and C4 are both pushed back 4/16 of an inch and hang back behind C2 about 4/16 of an inch. Any thoughts as to whether this is a problem. The disc between C4-C5 is do dehydrated and deteriorated and corners have spurs touching it almost looks like it has already fused itself. Could the issue between C1 and C2 be causing my headaches, dizziness, and blurred vision.

Donald Corenman, MD, DC
Moderator

August 29, 2016 at 10:13 pm

Post count: 8660

#22871

The position of the vertebra on top vs the one below is the noted as the direction of “slip”. That is, if the vertebra on top compared to the one underneath has slipped forward, this is called a cervical degenerative spondylolisthesis and is due to the wearing out of the facets in the back of the vertebra.

If however the vertebra on top slips backwards, this is called a degenerative retrolisthesis and is due to a degeneration of the disc with relatively intact facets.

Headaches, dizziness, and blurred vision can be caused by degenerative facets in C1-C4.

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.

MaryJane12
Participant

August 30, 2016 at 7:25 am

Post count: 3

#22873

so how is degenerative facet joints best treated. I do see that characteristic mushroom top on some of mine. There is also wide gapping see on my DMX x ray of the facet joints at C5-6 on the left and C5-6 on the left. I know you are not a big fan of DMX x ray, but since I have had it done here are the finding and I can clearly see it as I watch the video myself.
In the lateral nodding projection movement of the atlanto-occipital articulation is hypermobile (it’s not that great maybe 2mm). Increased mobility at occipito-atlas joint (C0-C1) hypermobility of C1-C2 noted. I do clearly see this.
Damage to the posterior longitudinal ligament is indicated by a widening of the posterior intervertebral disc space at C2-3 and C3-4.
Damage to the anterior longitudinal ligament is indicated in a retrolisthesis at C2 on C3, C4 on C5, and C5 on C6 and anterior widening of the intervertebral disc space at C2-3 and C3-4.
Damage to the capsular ligament is indicated by gapping of the facet joing at C4-C5 on the left and C5-C6 on the left. Very evident to my eye.
Damage to the capsular ligament is indicated by hypermobility of the facet joint at C4-C5 on the left and C5-C6 on the left.
I want to clarify I have had neck spasm for four years, (was a lot of trap spasms prior to accident) but was in a very bad accident (I will make clear it was determined to by my fault so I am not doing this for money, I just want to get better) in mid May. I always wear my seat belt, but was found in the passenger seat. It was a T-bone situation. I suffered a bad concussion, forehead swelling and two huge black eyes, neck on the left side was very sore and looked yellow. For some reason I took pics of it as I laid in my hospital bed I guess to see what it looked like cause it hurt so much. I will disclose that I am a RN so I have a fair amount of knowledge and am trying to piece this all together. My current neuro is a movement specialist. He says my case is complicated. He does botox injections for my migraines and occipital blocks and trigger point injections. He has always steered me against surgery so I feel his thoughts are maybe not unbiased. I am willing to do or go wherever I need to get the treatment indicated if I can pinpoint my real issues.
I am having a lot of pain all throughout the left side of my neck. Dizziness, headaches, blurred vision, ringing in head. I have always had many trigger points. Current also having trouble with concentration. Through the left shoulder center region down the shoulder. Feeling of hairs rubbing against both of my arms and sometimes my face. The feeling in my neck is a pinching feeling currently. It has been confirmed through EMG I have a pinched nerve, but it was not definitive as to location either C4-5 or C5-6. Your reply would be greatly appreciated.

Donald Corenman, MD, DC
Moderator

October 2, 2016 at 3:23 pm

Post count: 8660

#23123

Be very careful in talking about hypermobility of the occiput-C2 complex. It is very over-diagnosed and may not be present when these DMX studies are interpreted.

EMGs are not very helpful in this situation. Unless you have significant nerve root compression, the EMG will not be helpful. If there is no motor weakness (which is diagnosable by careful physical examination), the EMG will be negative as localized pain generators (disc, ligament and facet) will not generate any ascertainable findings on EMG.

You need facet blocks, SNRBs and possible discograms to determine your pain generators.

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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