C5-C6 Protrusion

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MikeMorris18
Member

March 19, 2013 at 1:28 am

Post count: 11

#8217

Hi Dr Corenman,

First off many thanks for your great site and forum. You are providing a wonderful service for us.

I am a 39 year old male. I recently had a series of neck xrays and mri completed.

This was due to my orthopedic wanting to check my neck for the pain that I currently endure between my right shoulder and neck. It is a constant burning, aching pain. Not a the back of the shoulder but along the path from neck to A/c joint.

I have a partially torn rotator cuff (supra) and arthritis in the A/c joint and impingement. They will go in shave some clavicle, clean up the A/c Joint and stitch the tear. Pretty standard stuff.

I tried over 30 sessions of physio for the shoulder and two cortisone injections. The sessions did nothing and the cortisone provide relief for about 3 weeks at a time. The whole process has been over 15 months.

The conclusions of the neck MRI are as follows (excuse the layman’s translation as the MRI result is in Spanish) straightening of the lordosis cervical, degenerative changes of uncovertebal C5-C6 (uncoartrosis), associated with a posterior/medial disk protrusion of a large area, that causes decrease in size between lateral recesses.

As I explained before, my pain is between the neck and right shoulder, nowhere else.

Having read a large number of people’s comments here I do not feel I have anything to worry about as I have no pain like my fellow contributors seem to have.

That being said I just thought I would ask you for your general thoughts about these results.

One last thing have looked around on Google and your webpage and YouTube videos. My frontal X-ray shows my neck and it is a bit like straightening out letter S, I repeat not the sagittal plane view, the frontal plane. There are also no visible spaces between the clavicles.

I can’t find a similar anywhere on Google or your webpage. Not sure if that is also relevant.

Thanks again for your time and for the extremely long-winded message which is probably a lot to do about nothing!!

Best wishes and have a great day!

Mike

Donald Corenman, MD, DC
Moderator

March 19, 2013 at 6:36 pm

Post count: 8660

#8219

The pain you experience could be from either the rotator cuff or the cervical nerve root compression. You do not note on the MRI report what side the uncovertebral joint spur and herniation are on so I will assume it is on the side of your pain.

The best way to determine which disorder is causing your symptoms is with nerve and joint blocks while keeping a pain diary (see website). These injections are just like a gum injection at a dentist office that numbs the nerve in the jaw. After this dentist’s injection, the jaw goes numb for about three hours and the dentist can happily drill away without causing any pain to you. He or she has successfully blocked the sensory nerve to the jaw so pain transmission stops.

The same process occurs with a selective nerve root block (SNRB) in the neck and with a sub-bursal injection in your shoulder. Keep a pain diary to determine which block relieves what pain. Only be concerned for the first three hours after the injection and nothing further (the steroid injected can have pain relieving effects that are not specific).

The “straightened S curve” in the front to back X-ray of your neck demonstrates asymmetric wear of the discs. This is not uncommon and by itself is not cause for concern.

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.

MikeMorris18
Member

March 19, 2013 at 7:12 pm

Post count: 11

#8220

Many thanks Dr Corenman for your very fast reply. It is greatly appreciated.

Unfortunately in my MRI it did not stipulate which side the uncoartrosis was on either. Was presuming both.

Have previously had two cortisone type injections for the right shoulder, six months apart. Both times, the burning pain disappeared for about 15 days. As you point out on your article about SNRB, the nerves do love steroids!!

I will ask my orthopedic, when I see him on the 5th of April, for the SNRB diagnostic. When I have these results I will let you know their findings.

Sincerely hoping it is just the shoulder!!

In the meantime I presume that I continue with my day to day life normally, a friend suggested I visit an osteopath. I personally am not so sure on that as I think would like to wait until I have the return visit with the orthopedic.

Thanks again for your time and efforts, you are most generous to offer your time and incredible expertise for us in this manner!

Have a great day!

Donald Corenman, MD, DC
Moderator

March 25, 2013 at 3:44 am

Post count: 8660

#8252

An osteopath uses manipulation along with medications and injections. You can try treatment guided by an osteopath but I think it would be in your best interest to have a diagnosis first. Your response that shoulder injections gave you relief is an indication of the shoulder as the pain generator. Did you get complete relief for a short period of time?

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.

MikeMorris18
Member

March 25, 2013 at 4:18 am

Post count: 11

#8255

Once again Dr. Corenman I sincerely indebted to you for your replies.

I am holding off on the osteopath until the 5th of April, when I see my orthopedic. From there we will make some decisions.

In response to your question about complete pain relief from the injections, the relief would have about 90% for approx. 15 days. After that period the pain returned completely within about 48-72 hours.

As said previously I believe and sincerely hope that is the shoulder!!

On a side note, I showed my cervical Xrays and MRI to my neighbour who is a GP (not sure if in America you use that term, sorry, General Practioner) He said he has seen worse and he has seen better!

He sent me to get a Lumbar Xray, after he inspected the images and did a quick physical study of my back and neck, which I did on Friday past.

From my layman’s eyes the Lumbar seems fine if not fantastic. I have flat-back syndrome, in the lateral view my lumbar is completely perpendicular (I presume that is why my neighbour sent me) and some significant disc degeneration at T11-T12, T12-L1. Am basing the significant comment on comparing to other Lumbar Xrays that I have found on Mr Google! So it could very well be moderate in some people’s eyes. But I am 39 so degeneration is too be expected.

I have no real significant pain in the lower back. I feel I am just like everybody else, getting older!!

I will take those Lumber Xrays with me as well when I see the orthopedic.

Just to give an outline of my pain levels. I have FAI cam/pincer in both hips. I have both labrums torn with articular damage. Have seen 3 orthopedics (all three have worked and presented with your colleague Dr Phillipon) and they all want to operate. I am holding off as that pain is about 2 out of 10. My shoulder/neck pain is a 7. Lower back I would put at 3.

Sorry for the extremely long-winded message.

Hope that it makes some sense!

Once again my sincerest thanks for taking the time to provide this wonderful service.

We are so very fortunate to have a doctor of your standing provide this for us. Please know that we greatly appreciate it.

Donald Corenman, MD, DC
Moderator

March 25, 2013 at 10:44 am

Post count: 8660

#8265

If you received 90% pain relief in the first three hours, then you could blame 90% of your pain on the shoulder. If the pain relief took one to two days before you noticed it, this might be from the steroid effect of the injections. Only the first three hours is diagnostic to determine if the injected structure is causing pain.

Many people have CNS (crappy neck syndrome) and have no to minimal pain only.

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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