C2-C3 Dysfunction

Tagged: C2-C3

Viewing 5 posts - 1 through 5 (of 5 total)

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Pete1221
Participant

August 26, 2016 at 9:56 am

Post count: 6

#22846

For over two years ever since I sustained a head impact I have been having many issues. The list of doctors and tests I have had done to help diagnose my issues has been vast.
Very long story short it has been determined that I have dysfunction at the c2-c3 joint as well as the upper cervical area. Doctors at this point feel that my main symptom generator however is C2-C3 and looking to suggest surgery. My question to you is, is fusion possible to C2-c3 only? Is this a anterior surgery? What type of recovery would I be looking at? As I have a family to support. Thanks in advance.

Neonmoon
Participant

August 26, 2016 at 4:31 pm

Post count: 1

#22847

Hello pete1221 I was just told after surgery 2 years ago my c2 and 3 are now bone to bone right under that level is where I had fusion. For me it was a virtually easy surgery I mean I was still off work for about 3 weeks, I just wasn’t in much pain. I guess 2 and 3 were not an issue for me 2 years ago, but now the pain is no fun. But I also have psoriatic arthritis. It too affects the neck, so I’m kind of a mess. My doc said to redo the fusion would be major. So to help you my neck surgery went well, home next day . Just had to take it easy. Good luck to you, by the way I was 58 when I had it done. I’m sure you are younger. Take good care

Donald Corenman, MD, DC
Moderator

August 27, 2016 at 9:24 am

Post count: 8660

#22853

Fusion of the C2-3 level does occur but with reduced frequency. I personally have performed this surgery (except for trauma) only about 20 times as the need to fuse just this level is uncommon. The main reason for fusion of C2-3 is degenerative facet disease that does not respond to other therapies. I don’t think I have ever seen a central canal compression (other than trauma) in my career. This level can be fused from the front or the back. The front will heal faster but the back approach is easier to perform.

To Neonmoon: If C2-3 is the main pain-generating problem, the fusion can be performed with good results.

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.

Pete1221
Participant

September 2, 2016 at 2:49 pm

Post count: 6

#22896

Thank you for your reply doctor. I do understand that the anterior approach for the surgery is riskier and more demanding but the recovery time and pain level afterwards for the posterior approach seems insane. Some people are telling me it could be years to recover(posterior fusion). In all of your years of experience have you come across somebody such as myself with this main problem, I will explain. Most of my symptoms I deal with are smanageable( heart palpitations,tinitus). But my main problem is a feeling of my neck almost collapsing under the weight of my head. This is not all the time but happens a lot when I walk or bend my head forwards or nodd my head, walk on uneven surfaces etc. It is a very hard feeling to describe but when it happens it is a terrible sensation almost makes me feel like I could pass out but I don’t. I have had a lot of diagnostic testing done and there has been some confirmation of issues throughout my cervical spine and upper cervical complex. The odd thing is I lack any real significant pain in my neck, I lack headaches and some of the more common symptoms associated with cervical instability and upper cervical instability. My main driving symptom is this sensation of my neck collapsing and/or my head falling off. I have seen every doctor under the sun and and tried many many treatment modalities but nothing seems to help. Have you come across any patients with similar symptoms in your past experience?? I have one doctor I am dealing with who wants to perform something called invasive cervical traction but I am very hesitant to perform this test as I am not wheelchair-bound severely disabled, however my quality of life and physical limitations are greatly decreased prior to my accident when I was completely healthy and active. Again, I appreciate your insight

Donald Corenman, MD, DC
Moderator

September 3, 2016 at 12:08 pm

Post count: 8660

#22897

Before a fusion of C2-3 is contemplated, there has to be diagnostic tests that indicate this level is the pain generator. These tests might include facet blocks, selective nerve root blocks, possible discograms as well as imaging studies that indicate this is the worst level (isolated disc resorption, degenerative spondylolisthesis, instability, foraminal stenosis, severe kyphosis).

I personally prefer the anterior approach as it heals faster with less problems. For this level, I generally have an ENT surgeon help with the approach as the inferior mandibular nerve is also in this area and injury to it could cause a droop around the mouth (think Silvester Stallone). I recommend an ACDF with autograft as this has the best healing potential. Posterior fusions do work well but need more time to heal, heal with a slightly lower fusion rate and have muscular pain as a higher percentage of the postoperative healing period.

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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