ADR C6-7 level

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drjay
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January 10, 2012 at 9:11 am

Post count: 5

#5330

Hello Dr. Corenman,
I’m a 41 year-old healthy male, dentist by profession. No history of trauma/ accidents, other than broken collar bone at age 9 and 17. No meds, reasonably fit. I’d like to practice for another 25 years.
I’ve recently been diagnosed w/ degeneration at the C4-5, 5-6, 6-7 levels– anterior and posterior spurring, straightening of the cervical spine. Review of MRI by Neurologist here in Rapid City, SD shows neural compression at C5-6, 6-7 levels. Spur is larger at C6-7 on the left, but compression at C5-6 as well. Nerve root compression with C6, C7 radiculopathy with arm weakness, significant triceps weakness (I observe this, and have slight numbness, tingling of left index finger)ie. difficult for me to dry my hair with a towel with my left arm. Cervical diskectomy and fusion has been recommended at C5-6, 6-7 levels.
I’m interested in Disk Replacement at C6-7 level.
Symptoms began out of nowhere in early Nov., 2011. UL back pain radiating to triceps/ forearm area. This pain was constant thru Dec. 5th or so. Then suddenly no pain thru Dec. 18th or so. Dec. 12th I had a select nerve root injection

drjay
Member

January 10, 2012 at 9:15 am

Post count: 5

#5331

even though I had no pain at that time. Pain re-appeared around Dec. 18 thru the end of Dec. Pain disappeared again early Jan, although weakness in triceps has worsened.
I currently have no pain, unlimited range of motion. MRI was taken here in Rapid City on Nov. 28. I’m interested in 3rd opinion on disk replacement if weakness progresses. I’ve contacted PHX Mayo and they say they no longer place artificial disks. This makes me wonder?
Please give me your take on this, I’m happy to send MRI.
Thanks,
deleted

drjay
Member

January 10, 2012 at 9:19 am

Post count: 5

#5332

PS, 2nd opinion was orthopedic surgeon in Rapid who has recommended PT and time. ALso, I had an epidural injection in late Dec– again I had no pain at that time, so time line above is a little off–Pain disappeared late Dec.

Donald Corenman, MD, DC
Moderator

January 11, 2012 at 3:20 am

Post count: 8660

#5335

According to your complaints, with triceps weakness and paresthesias of the index finger, it sound like you have compression of the C7 nerve root. Compression of the C7 nerve root appears to be caused by spur formation from degenerative disc disease (see website under the section “cervical radiculopathy” for further explanation).

You also have some degenerative changes at the C5-6 level but apparently no symptoms at that level. I assume a thorough physical examination revealed no weakness of the biceps or wrist extensors.

If your main complaint is weakness and paresthesias with no significant neck pain, then an artificial disc replacement could be a good solution for your C6-7 level. This surgery allows decompression of the uncovertebral joint spur (see website) and still maintains motion of the segment to reduce the stress on the degenerative segment above.

I don’t know how long these artificial discs will last. They may last your lifetime or only 10 years. The research is still being compiled. The other question is whether the allowance of motion at a degenerative segment will allow recurrent spurs to form but I think that is unlikely.

The good news is that if these artificial discs fail- in general, it is not surgically hard to revise them into a fusion. I have revised quite a few (they were surgically implanted elsewhere for the wrong reasons) with very good results.

Getting back to your problem, the main question is if you should undergo surgery? That is quite a discussion by itself. In my opinion, any patient that has undergone conservative care and continues with upper extremity weakness that interferes with occupation or lifestyle should consider surgery. There is no guarantee that you will regain good useful motor strength even with surgery but surgery gives the nerve the best chance to recover.

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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