C4-C5 Severe Focal Spinal Stenosis

Tagged: Parsonage Turner syndrome vs. cervical myelopathy

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

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Arq
Participant

June 18, 2018 at 4:33 pm

Post count: 3

#28542

Dear Dr. Corenman,

About three months ago, I started to have instantaneous sharp pain in my left lateral elbow and the thumb of the left hand. The pain then developed into the left lateral upper arm and finally the left shoulder. Now I have constant sharp pain in my whole left (lateral) arm from the shoulder to the thumb, but have no pain at my neck. I have got a MRI scan with the following findings.

FINDINGS:
Posterior fossa: The visualized posterior fossa is unremarkable.

Alignment: There is retrolisthesis of C4 on C5 [grade 1] on the basis of degenerative disc disease.

Vertebral bodies: Normal marrow signal intensity. The vertebral body heights are maintained.

C1/C2 and C2/C3: No significant abnormality.

C3/C4: Mild posterior disc bulge with mild spinal stenosis and no significant neural foraminal narrowing.

C4/ C5: There is degenerative disc disease with loss of disc height and endplate osteophytes. Moderate concentric disc bulge is present. Disc osteophyte complex causes severe focal spinal stenosis with complete effacement of CSF and indentation of the anterior spinal cord. There is associated increased signal within the central spinal cord, asymmetrically more prominent on the left. Severe right and moderate left neural foraminal narrowing.

C5/C6: Mild posterior broad- based disc bulge without spinal stenosis or neural foraminal narrowing.

C6/C7: Small left paracentral disc protrusion without significant spinal stenosis or neural foraminal narrowing.

The paraspinal soft tissues are unremarkable.

IMPRESSION: C4-5 severe focal spinal stenosis due to degenerative disc disease and concentric disc bulge. Increased signal in the central and left spinal cord due to compression and chronic myelopathy.
Additional degenerative disc disease changes as described above.
My family doctor recommends me to see a neuro-surgeon for a likely surgery.

Note that I had a severe flu lasting for over 2 weeks, right before the start of the pain in my left elbow, and I have had no pain at my neck, especially the left side.

I would highly appreciate your advice, would you recommend cervical physiotherapy exercises or surgery or tests for Parsonage Turner syndrome? Looking forward to receiving your reply.

Thanks,

Arq

Arq
Participant

June 19, 2018 at 7:53 am

Post count: 3

#28545

Dr. Corenman,

Correction: My pain is located at the posterior side only of the shoulder, the lateral upper arm and the lateral forearm, as well as the thumb. All are on the left only.

I am eager to know if my pain arises from cervical radiculopathy or from parsonage turner syndrome. Any advice will be greatly appreciated.

Thank you very much,

Arq

Donald Corenman, MD, DC
Moderator

June 23, 2018 at 5:09 am

Post count: 8660

#28582

Your report at C4-5 is concerning “Disc osteophyte complex causes severe focal spinal stenosis with complete effacement of CSF and indentation of the anterior spinal cord. There is associated increased signal within the central spinal cord, asymmetrically more prominent on the left. Severe right and moderate left neural foraminal narrowing”.

This means that you have severe canal narrowing with spinal cord damage (“increased signal within the central spinal cord”) as well as significant nerve exit canal narrowing. I would not hesitate to have surgery. In fact, I would have you in a soft cervical collar now and prevent you from participating in any activities that would put your neck at risk.

Parsonage Turner syndrome is alway possible but with the MRI report of high signal in the spinal cord, don’t play the waiting game. Get you neck fixed soon.

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.

Arq
Participant

June 23, 2018 at 6:54 pm

Post count: 3

#28603

Dear Dr. Corenman,

Many thanks for your kind reply and the valuable advice you gave, which will definitely be helpful to make my decision. I already purchased a soft cervical collar this afternoon and wearing it now. I really appreciate your kindness.

Thanks!

Arq

Donald Corenman, MD, DC
Moderator

June 23, 2018 at 8:58 pm

Post count: 8660

#28605

Please keep us informed of your treatment progress.

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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