C4-5 Stenosis

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Millstone
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January 7, 2015 at 7:21 am

Post count: 2

#11945

Hello Doctor,

I’ve read many of your threads and have been impressed with your knowledge, the gentleness in your responses and just the basic way you seem to care!

I have some questions regarding a recent MRI (taken 12/24/2014), and hope it will be acceptable to ask a few questions, let’s just say I am a little frighten as to what comes next! My appointment with my Orthopedic Cervical Doctor is on Jan. 16th.

In 2008 I had Anterior Cervical Fusion of C5 through C7. I’ve had problems with pain and discomfort since that period. The one thing that it did eliminate was the severe pain in my left arm! So, needless to say, my disks above the fusion point are a mess! Especially C4-C5.

Current MRI:

Basically C1-C4; there is mild to moderate degenerative facet arthropathy and slight anterolisthesis of C2 and C3. Also, there is mild spurring.

C4-C5: Marked degenerative disc space narrowing with moderate spurring and mild to moderate spinal canal stenosis. Possible slight flattening of the spinal cord. No T2 hyperintensity in the cord. There is severe foraminal stenosis on the right and milder on the left.

This is the result of a MRI taken in 10/13/2013:

C4-5: Moderate disc degeneration. There is a diffuse posterior spur and disc and short pedicles. There is mild moderate stenosis of the central canal. There is asymmetric overgrowth the right facet uncovertebral joint with moderate right foraminal stenosis. Mild left foraminal stenosis.

Finally, on 12/24/2014 MRI, the C7-T1 has mild facet arthropathy on the left.

No evidence of disc herniation or mass.

Ok, now that I’ve bored you to death, my symptoms are numerous;

Weakness, dumbness, pain in both arms, hands and shoulders.

Weakness, dumbness, spastic muscles in the right leg, along with clumsiness of footing, let’s just say I’ve fallen a few times. Vertigo,dizziness.

Extreme pain in the back of neck, loss of feeling in chin and at times sharp shooting needle like pain that goes into my left eye! Also, things don’t taste the same! Extreme migraine headaches. Complete exhaustion! My daily activities are basically nothing!

I could go on, but I’m sure you’ve seen this before, only one other thing, at times, I have a hard time breathing! Never any problems in the past. And yes, there are bladder issues!

So, what I’m I looking at? I do not want anymore fusions, can’t do steroid injections because of my Bi-polar 1 disorder! Can’t take pain medication because it makes me violently ill. Would love to think that a disk replacement in Europe might help, sense the FDA hasn’t approved a disk replacement above a fusion point here in US! Will that make any difference? Also, what about “Laminoplasty Multi-level? I’ve also heard of something called “The TOPS System” by Premia Spine, currently being utilized for the Lumbar Spine. Any chance for Cervical?

Any help would appreciated! I so don’t want to make a mistake!

My highest regards

PS: I am a 51 old female, sorry for not including that.

Donald Corenman, MD, DC
Moderator

January 9, 2015 at 10:55 pm

Post count: 8660

#11962

First, you have to look at the cervial spine anatomy and see if it matches the current symptoms. I hope you have a solid fusion of C5-7 as a non-solid fusion adds more questions to the diagnosis.

C2-4 have degenerative spondylolisthesis. This condition can cause upper neck pain and headaches. C4-5 has central stenosis and bilateral foraminal stenosis-right greater than left.

Look up the section under “cervical radiculopathy” and “cervical stenosis/myelopathy” to understand what the C4-5 level can cause. Then look at the section under “symptoms of cervical nerve injuries” and focus on the C5 nerve root to get a picture of the potential symptoms this nerve can cause.

Disc replacements work well in the right circumstances but I am not a fan of these with the disorder of central stenosis. Laminoplasty is contraindicated in the presence of degenerative spondylolisthesis.

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.

Millstone
Member

January 10, 2015 at 2:45 am

Post count: 2

#11967

I would like to sincerely say thank you for responding to my many questions!
I have followed your instructions and read up on all the things you have mentioned.

That being said, I will wait to see what my doctor recommends on the 16th, I may be calling you for a 2nd opinion (which I would be supplying you with all CT and MRI discs and associated paperwork), I have no problems coming out to Colorado.

Until, such time, thank you again!

My highest regards!

Donald Corenman, MD, DC
Moderator

January 11, 2015 at 1:10 am

Post count: 8660

#11983

Thank you

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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