C5-C6 Bilateral foraminal disc bulges

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esreddy
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February 23, 2012 at 8:36 pm

Post count: 2

#5628

I am 39 years old man and working in india. Recently i have a mild pain in my right hand. I have taken MRI and x ray as per the doctor advice. Finally i got this report given below:
C5-C6 Bilateral foraminal disc bulges CAUSING MILD NARROWING
C6-C7 DIFFUSE POSTERIOR DISC BULGE CAUSING MILD THECAL SAC NARROWING
RIGHT D3-D4 FLAVAL HYPERTROPHY (6 MM) CAUSING THECAL SAC IDENTATION

doctor said as of now we cant do anything and do exercises and take care the postures. He said once the pain increases then we will go for surgery. I need your suggestions on this is there any better treatment at this stage, until severe pain comes. Please help me and suggest.

Regards,
Srinivas

Donald Corenman, MD, DC
Moderator

February 23, 2012 at 10:05 pm

Post count: 8660

#5629

Do not jump to conclusions regarding the origin of mild pain in the right hand. The sources of right hand pain include carpel tunnel syndrome, cubital tunnel syndrome, tunnel of Guyon syndrome, thoracic outlet syndrome as well and radiculopathy (pain generated by the neck).

If the origin is from the neck, there are some general questions that can identify the cervical spine as the origin or rule it out. Does the pain increase with neck extension (bending the neck backwards) and become relieved with neck flexion (bending the neck forwards)? Does bending the neck to the side of pain increase the hand pain? Is this pain worse at night? Is the hand pain worse with overhead activity especially if your arms are up but your neck is down (driving a car)?. Do you have any neck pain? Is there pain that radiates from the neck into the shoulder and then down the arm? Does the hand “go to sleep”? Is the pain on one side of the hand or the other or “all over” including the back of the hand?

The MRI report is not specific. What really needs to be identified is if there is significant foraminal stenosis at C6-7. The radiologist comments on thecal sac narrowing but that is not your problem. He would need to comment on foraminal narrowing. As I have said before, using of the terms mild, moderate and severe are in the eye of the beholder. Some radiologists interpret films differently than others.

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.

esreddy
Member

February 24, 2012 at 1:39 pm

Post count: 2

#5638

MRI REPORT:
C5-C6 Bilateral foraminal disc bulges CAUSING MILD NARROWING
C6-C7 DIFFUSE POSTERIOR DISC BULGE CAUSING MILD THECAL SAC NARROWING
RIGHT D3-D4 FLAVAL HYPERTROPHY (6 MM) CAUSING THECAL SAC IDENTATION

Please send me your private email id i will send my mri photos to understand my problem clearly.

If the origin is from the neck, there are some general questions that can identify the cervical spine as the origin or rule it out. Does the pain increase with neck extension (bending the neck backwards) and become relieved with neck flexion (bending the neck forwards)?

Ans: I am not feeling any pain while bending the neck backwards and forward.

Does bending the neck to the side of pain increase the hand pain? Is this pain worse at night?
Ans: No pain if i bend my neck to the side

Is the hand pain worse with overhead activity especially if your arms are up but your neck is down (driving a car)?.
Ans: Driving a car no pain

Do you have any neck pain? Is there pain that radiates from the neck into the shoulder and then down the arm?

Ans: I dont have neck pain. But i feel when i bend forward and backward little bit uneasy.

Does the hand "go to sleep"? Is the pain on one side of the hand or the other or "all over" including the back of the hand?

Ans: My right hand i can lift up and down and rotate there is no problem. If i take my hand towards my left shoulder I am getting pain at arm. It is not physical pain. Inside arm musles are giving pain. But my left hand i stretch towards right shulder. there is no pain.

Donald Corenman, MD, DC
Moderator

February 24, 2012 at 10:45 pm

Post count: 8660

#5645

It does not sound like the pain is originating from your neck. You need a thorough physical examination by an expert in neurological testing to determine where the pain and numbness is originating from. The only way you should consider neck surgery is to have a selective nerve root block (see website) and have two hours of relief of your symptoms.

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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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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