A small syrinx at c4 and c 5 level accidental finding

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somspv
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June 23, 2012 at 2:43 pm

Post count: 2

#6418

QUESTION

Dear Doctor, I have a peculiar problem.Kindly go through this letter patiently and advise me.I was in dialemma and very disturbing. Does this vertigo resulted because of the middle ear problem or from spondylosis?. Or from small syrynx in spinal canal.?

PROBLEM

I am 69 year old male .I have cervical spondylosis from 1995. In December last while i was in bed, i have stretched my hands over my head and stiffened my hands to ward of lethargy. immediately after that when i got up, i felt dizzy and lost balance for the first time in my life.. since i have spondylosis, i immediately taken stugeron 25 mg and then gone to see ortho. He asked me to undergo MRI for cervical spine, since i have spondylosis for many years. Accordingly I ve gone for MRI of the cervical spine.He diagnosed it as postural vertigo (bppv). He asked me to take stugeron twice a day for 10 days and aceproxivon twice for 3 days. Besides this , accidentally , in the MRI he has seen a small syrinx at c4 and c5 level.He said not to worry about this, since it is asymptomatic and as i have never experienced weakness in limbs or pain in head etc. He further told me some elderly people have some abnormality and there is nothing alarming. It takes a long time to expand.He further said that it is most likely a cyst.I took the stugeron and aceproxivon. After that the vertigo lasted for about 16 to 20 days and subsided. In this period I felt spinning of the room while getting up from the chair or bed and also while turning sideways in the bed and while moving . I lost balance while going to the bath room. Again in May this year, I have again in the same position in the bed as in December , resulted again dizziness. Again i took stugeron for about 3 days but it was not subsided. Then on somebodys suggestion i ve gone to an ENT surgeon. He asked me to take Audiometry. Accordingly i took it and it shown 60 % loss in the left ear and 25 % loss in right ear. and apart from this some fluid secretion resulted in the middle ear and i am told that this is preventing the air to pass freely and it is building up the pressure and creating vertigo as my eushtachian tube is somewhat narrow.As such, he suggested me to take vertin 16 mg twice daily , allegra 120 mg one a day and ambrodil syrup thrice daily for 20 days .He further suggested if we implant gromets, the loss of hearing may be improved to some extent and the vertigo may also subside.But he has not given any assurance. Now the vertigo has gone. But at times, when i woke up from sleep in the morning I feel reeling or dizzy ness, particularly when i bend my head to wash my face in sink. I never had any head ache.

MEDICAL HISTORY
My medical history is as under: Had IHD in the year 1977 (T wave inversion in V1 to V6) No complications since then .
Had mild Hypertension in the year 1980 (under control)
Had prediabetes in the year 2010 (IFG) (under control)
Had subclinical hypothyroidsm in 2011
Medicines now being used
Heart * (from the year 1977)

I have been taking Stamlo Beta 50 MG,(since 2006) Ismo 10 mg (since 1996), ASA 50 mg ,(since 191) TG tor 5 mg (since 2006) and glycomet 250 mg (since 2910)

.
mri report
. Early changes of cervical spondyilosis with multiple level changes of degenerative discs, marginal osteophytosis and mild disc bulge is seen at C3/4, C4/5,C5/6,C6/7 discs. No obvious thecal sac indentation/neural foraminal encroachment seen at any level

Mild flateening of contour with slight posterocentral disc bulge is seen at c3/4, c4/5,c5/6 ,c6/7 discs. No obvious thecal sac indentation/neural formainal encroachment seen at any level.
A mall syrinx is seen at c4 and c5 level.

Questions about the two problems

Now i would like to know from you first regarding VERTIGO …1. what are the other effective medicines in curing vertigo? 2.Do i have to take vertin as maintanence dose say 8 mg or 16 mg once day for the rest of my life to prevent vertigo? 3. what are the precautions i have to take when i go into the cold weather and travelling in an a/c compartment. 4.does this vertigo is a combination of middle ear problem and also cervical spondylosis? 5. If so do i have to take stugeron along with the vertin . 6. If so what is the dosage. 7.. How to differentiate the vertigo from spondylosis or from the middle ear problem ?. 8. Can the vertigo be cured permanently or do i have to live with it for the rest of my life? 9.Do i have to keep Vertin always handy? 10. Do I have to wear a cervical collar whenver i have dizziness?11.Do i have a cervical pillow while lying in bed?
Then regarding Syrinx . .1. Whether this syrinx has any bearing over vertigo. 2. Does this syrinx give me any problem at this age of 69 years or will it be dormant. 3.How much time does it take to grow? Already 6 months have passed after taking MRI. I did never have any symptoms through out my life so far. . Kindly advise me, as I wish to hear from you as an expert.Thanking you in advance.

Donald Corenman, MD, DC
Moderator

June 25, 2012 at 4:39 am

Post count: 8660

#6423

Syrinx symptoms depend upon where the syrinx lies. Normal syringomyelia symptoms have to do with numbness, pain and burning in a “shawl like” distribution and syringomyelia can be associated with a condition called “Arnold Chiari syndrome”, See “central cord syndrome” on the website for further information regarding possible symptoms.

Generally, vertigo or the sensation of the room “spinning” is related to the vestibular mechanism or the “inner ear”. I am certainly no expert on this condition. Medications can be quite helpful. There is evidence that in some vertigo patients, otoliths are present. These small “stones” grow in the villi of the inner ear. If they break off and cascade down these hair-like projections, the sensation of falling or room spinning can occur. There are some head positioning maneuvers that can sequester these stones. You will have to consult an ENT specialist for further information.

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.

somspv
Member

June 25, 2012 at 8:09 pm

Post count: 2

#6427

Dear Dr.Corenman,
I thank you very much for your valuable advise.
sincerly
somspv
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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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