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  • exercise453
    Member
    Post count: 53

    Hello Dr Corenman,

    I can see myself traveling 2000 miles to see you for a diagnosis and have direct questions to determine its possibility and practicality
    and even what you think about it.

    If additional testing is needed are they expedited for someone on the road? How much time do you actually get with Dr Corenman? Do you personally do the history and examination? Can you get a followup visit for the inevitable questions the next day? Can you give an approximate number as to how many cervical surgeries you have performed in the last year? 2 years?

    My concern is that after such a journey one might receive the same rush you could surely get in your own town due to the hectic schedule doctors have, especially elite doctors.

    This response you wrote verbalizes the fear I have versus the desire to get in a room with you for an hour (or two)

    Re: cervical spine and MRI ‘early cord flattening’ 1 month ago #1300
    “Your experience regarding the time taken for physical examination is sad but not unusual. It even happens here with pay for service.”

    Can u you explain and provide any insight for those entertaining a trip to Vail.

    I admire what you are doing…thanks

    Donald Corenman, MD, DC
    Moderator
    Post count: 8378

    Travel to visit the clinic and see me is quite common. We have services to help with accommodations (“Here to help”- call my nurses for contact information) and information regarding transportation.

    The clinic has its own 3.0 Tesla MRI machine and the hospital has a 64 slice CT scanner and another MRI. If diagnostic injections are needs, there are three very well qualified interventionists who can accommodate injections at the last minute.

    Between my PA, Eric Strauch and myself, the typical history, physical examination and explanation of the disorder with viewing of the X-rays and MRI or CT takes about one hour. I never rush a patient as I understand that your knowledge of the disorder takes precedence. If you are coming out for potential surgery, we have to know more about your disorder before your trip.

    I perform between 350-400 surgical procedures a year and one third of those are cervical.

    If you have further questions, please call my nurses Diana and Sarah for further information at (970) 476-1100.

    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.
    exercise453
    Member
    Post count: 53

    Hello again Doc,

    I do not understand the loss of motion with single and double ACDF. So much is trumpeted about motion sparing techniques but you suggest that surgical skill, not choice of surgery is most important. Just what are the motion and other long term consequences of a successful fusion and do the levels matter?….vs posterior.

    What is the importance of a positive, year old and a repeated (current) emg test showing +1 fib and +1 psw at at c4-5 paraspinal, a painful neck level. (posterior disc-osteophyte complex with mild narrowing of the spinal canal and moderate bi-lateral neurofaraminal stenosis). Only one side is symptomatic. The deltoid is smaller than the other side but the shoulder and rotator cuff have suffered earlier traumas. Muscles are strong. Cord is fine. There is more neck than arm pain 70-30. Also when an ACDF relieves the pressure on the canal will the neck pain reduce or vanish?

    The nerve test also was positive at the bicep. Can this be verification of c5 or is c6 positive as well?

    I notice that as the legion of “coren ites” grows our medial jargon improves. Your generosity aside, does it not speak to the state of our medical system or the rampant, earned distrust of their own doctors that has 1000’s turning to Dr C.

    Thanks

    exercise453
    Member
    Post count: 53

    Doc
    Want to add, the smaller gimpy, protected side deltoid injury history is 6 years old. The neck issue from a jogging fall is 5 years old….strength is excellent, tingling, parasthesia is felt

    Donald Corenman, MD, DC
    Moderator
    Post count: 8378

    Positive EMG testing at the paraspinal muscle level is generally not significant unless there is concern about Parsonage Turner syndrome (not your problem). The use of EMG in the cervical spine has applications, but not in your situation. If the nerve test was positive at the biceps, this indicates the C6 nerve is involved.

    If muscles are strong (and you have tested all pertinent muscles), then root compression is not a great concern. 70/30 neck to arm symptoms means that most of the pain is generated by the disc or facet. Have you had a facet block? Facets generally generate about 30% of the neck pain that patients exhibit. If the block is positive, you might be a candidate for a facet rhizotomy.

    If you are looking at surgery, an ACDF is the procedure of choice for neck pain. The surgical levels are generally obvious by X-ray and MRI but if there is some concern for level choice, a discogram by a meticulous injectionist is warranted.

    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.
    exercise453
    Member
    Post count: 53

    Hello again,

    I have had c2-8 rhizotomy. The total effect was minimal. I am 63 and athletic. I suffer from a combination of chronic symptoms and levels stemming from a jogging fall and trauma doing an incline bench press five yeas ago. My appearance belies my age, and functionality belies my pain. Further elaboration on the board would unfairly consume your precious time.

    You say a positive emg at cervical paraspinals is not terribly significant and positive at the bicep involves c6. So I understand, if the bicep (or another muscle) shows the same +1 fib +1 psw as the paraspinal but has full strength, then the root compression affirmed
    by emg is not significant? Muscle strength and function overrule emg at all muscles?

    You say 70-30 more neck pain indicates disc or facet…its not facet. I have posterior disc & spurs (along with lateral) encroaching the canal but no cord compression. Does this mean the neck pain comes from the disc and/or spurs pressing nerves within the canal, not the disc material itself?

    You have mentioned cervical epidurals several times. If they give effective relief for a couple of months in chronic pain management cases how many of these do you consider safe each year in the hands of a board certified anesthesioligist? Are they equally effective for arm pain and neck pain?

    Thanks again doc

    PS (those excellent one liners “the bone is probably intact in your head” in anatomy and motion of the cervical spine and “you can’t ask your mother to stand up straight” in a tv interview, did not escape me)

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