Atlantoaxial instability

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KristinaMG
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November 19, 2014 at 12:10 pm

Post count: 2

#11759

Hi. I have had several mris this year due to increasing neck pain and headaches. At 22 I was in a really bad car accident where my airbag deployed with excessive force and hit me in the face (I am short). It broke my nose, messed up my jaw, and gave me painful whiplash. I was in pt and massage and chiropractic and acupuncture for the first few years to achieve pain relief and nothing really worked except massage and muscle relaxers would temporarily take the edge off. At 29 earlier this year my primary doctor ordered an MRI of my head and neck to investigate my severe head and neck pain. My neck kept going out last year and he could feel it. I had an upright MRI of both my head and cspine which revealed a 5mm chiari malformation and a defect at c1/c2. The neurosurgeon then ordered additional mris of my whole back to check for tethered cord and syrinx but thankful I don’t have either one. Generally my mid and lower back feel fine but my neck and back of head have been a major problem ever since that accident. The neurosurgeon also ordered a cine MRI which luckily was normal too and a 3d reconstruction ct which showed instability again at the same spot, c1/c2. I was diagnosed with ehlers danlos syndrome at 26 and have always been naturally hypermobile. Due to my hypermobility, my physical therapist and neurosurgeon believe pt will never fix the instability as they cannot change the structure of the loose ligaments themselves. Is a fusion the best option for long term correction and pain relief? I have tried everything under the sun except spinal injections. Would these be any help from a diagnostic standpoint? I also had mild multilevel disc disease with some compression between all cervical discs and bulging discs at c3,4 and 5. Could these be contributing to the headaches? My ns doesn’t think the headaches are from the chiari given that my cine MRI demonstrated normal flow. Thanks for your help!

Donald Corenman, MD, DC
Moderator

November 19, 2014 at 8:19 pm

Post count: 8660

#11760

Headaches certainly can develop from instability of C1-2. If you have an atlanto-dens interval (ADI) of 5mm or greater, you have instability by definition.

There are no exercises that can help an instability like that. You will probably need a fusion. Make sure that the occiput-C1 level is normal without instability here too.

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.

KristinaMG
Member

November 20, 2014 at 1:16 am

Post count: 2

#11765

I understand I also have instability from the skull all the way to c/3 due to the eds. Would they fuse this all at the same time? What are your thoughts about fixing the chiari? Stabilize the neck through fusion first? There Are a few places like The Chiari Institute in NY that fuse both and fix the chiari at the same time but sadly I’m too sick to travel and I’m in wa state. What is complicating this is I’ve had a low grade fever of 99-100 for the past two months and am currently being treated for chronic sinusitis on a month of antibiotics. Getting a ct of my sinuses as the ent is thinking I may need sinus surgery. I am nervous about that because it’s head surgery under general anesthesia and I read somewhere that that can be dangerous with Atlantoaxial instability. My sinuses don’t bother me too bad on the antibiotics but the head and neck pain leaves me bed bound as movement is excruciating and car rides are the worst. However the ent said neck surgeons prob won’t touch me until my sinusitis is resolved. Any thoughts? Thank you.
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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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