c5-c6 c6-c7 bulges

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DDOMINATOR1
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June 30, 2011 at 10:40 am

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#4677

Hello Dr Corenman. Have to say excellent site and happened to find while searching for neck conditions. I am a very active athletic professional and sustained a mod-severe herniation at levels described subject back in january 2011 as result of what i belive was weight lifting. Initial MRI showed a severe bulge at C6-C7 with central and foraminal encroachment particuliarly on left nn root. C5-C6 somewhat less with left nn root impingement as well As a result of these injuries i began having severe 8/10 neck pain with radiculopathy down left arm into tricepts, extensor and dorsum of hand.This pain exceptionally worse when sitting. I also experienced pain into left pectoral area. Weakness and atrophy developed rather quickly into left tricepts, pectoral, forearm and even latissimus. Being in medical field i quickly made contacts with physician collegues and began a short 5-6 week chiropractic regimen that consisted mainly of light manipulation, traction. Without much relief i contacted my pain mgmt friend and began a round of epidurals x 3 spaced 3 weeks apart. Not much relief there either. Followed up after that with an ortho spine surgeon like yourself who suggested surgery. I purchaced an neck decompression device, inversion table and cervical piece that helps improve lordotic curve. Again, not much relief. I began developing parasthesias approx 6 weeks ago into what seems like C7 dermatome. Again, worse with sitting and laying on side. These can be rather severe and range from “pins and needles’ t oalmost full numbness of extremity. Approx 5 weeks ago i had a PRP injection performed on upper and lower cervical area hoping that this would alleviate some of pain and numbness issues. I also began PT 4 weeks ago twice weekly mainly consisting of stretching, massage and acupuncture. So far i have to say that pain level has somewhat decreased qualitative and quantitative to around a 4/10 but worse again when seated. Parasthesias have seemed to stay same (maybe slightly improved) but worse again with certain positional movements and seating. All around seems a little better 5 1/2 months after initial injury but what concerns me is the continued parasthesias, weakness, and of couse atrophy. My question that i have to you is this:

1. In your medical opinion do parasthesias, weakness and atrophy constitute surgery
2. What if any other modalities should i consider trying to help relieve symptoms
3. Could pain relief possibly be from PRP and / or PT and do you have any experience in this area?
3. Bases on above what would you think my prognosis is? Should i give this some more time? If so how long?

thank you for your time

Donald Corenman, MD, DC
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June 30, 2011 at 9:58 pm

Post count: 8660

#4678

By your description, you have herniations at C5-6 and C6-7 on the left with C6-7 being a larger herniation. These herniations would compress the C6 nerve (C5-6 herniation) and the C7 nerve (C6-7 herniation). Symptoms of a C7 herniation would be shoulder pain that radiates into the middle of the hand, weakness of the triceps, MCP extensors (straightening of bent fingers) and wrist flexion (bending the wrist down). C6 compression symptoms would be shoulder pain radiating into the thumb side of the hand, weakness of the biceps and wrist extension (bending the wrist up and important for grip strength). Neck may or may not be present- it depends upon the tear of the disc itself.

You have already had a very good conservative treatment program with chiropractic, physical therapy, traction and epidural injections.

There are new complaints of paresthesias (pins and needles) down the arm which concern you. Paresthesias are generated from the proprioception portion of the nervous system. This is the system that tells your subconscious brain where your body parts are in space.

Symptoms of paresthesias generally are an indication of nerve root compression and new onset symptoms are slightly concerning. The most concerning symptoms to me however are the generalized weaknesses of the muscles of the arm. This requires some explanation.

There are four nervous system functions carried by one nerve root. These are sensory (compression would cause numbness), noceceptive (compression causes pain), proprioception (compression causes paresthesias) and motor (compression causes weakness). All except the motor are pure sensation type transmitters. The sensory roots can cause these symptoms with only mild compression but the motor portion of the nerve root is much tougher and more compression is required to make it dysfunction.

When weakness develops from motor nerve compression, this means the compression is significant. The motor nerve root does not recover easily after compression and some patients even after decompressive surgery may not recover full motor strength. The nerves that are the most to least sensitive are T1, C8, C5, C7 then C6.

There are four indications for neck surgery, significant motor weakness, spinal cord compression, instability of the vertebra and intolerable pain. You have at least one of the indications.

In my experience, PRP will do nothing for symptoms of nerve compression. Epidural steroid injections are the single most effective treatment for pain but will do nothing for motor weakness. PT is very important for function but will not help motor weakness.

My opinion is that surgery for motor weakness is the best option. In the face of a disc herniation without neck pain, surgical options include ACDF or artificial disc (see website for discussions). Motor weakness with neck pain most likely requires ACDF only. There are no studies regarding how quickly the surgery needs to be performed but in my opinion, the quicker the nerve is decompressed, the better the chance of recovery.

Hope this helps.

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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