C5-C6 stenosis and leg tingling

Tagged: lumbar stenosis, Myelopathy

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skark
Participant

May 27, 2015 at 4:52 am

Post count: 7

#19535

Hello.
I have (3 months now) right foot tingling and left palm tingling (all day except at night). Last month i have developed also a burning sensation in both of my legs (from knee upwards to the thigh).Symptoms in leg and palm started simultaneously but palms are now much better (occasional numbness only).I have also hypperflexia in legs.
I had an MRI in head (for multiple sclerosis) which was negative. During these months or paresthesias I have no pain but in previous years i had occasional cervical pain (which i then attributed to motorbike and cold….)
Then another MRI in Cervical spine showed stenosis c4-c5 11mm, c5-c6 9mm with no apparent spinal cord compression (but with severe stenosis to the front sub-arachnoid space).
I am scheduled for a thoracic spine MRI on Saturday…
Can these symptoms stem from my cervical stenosis? Is this stenosis mild or severe? Neurologist and Orthopedic says mild but neurologist says it can cause my legs issues also…

Donald Corenman, MD, DC
Moderator

May 27, 2015 at 6:59 pm

Post count: 8660

#19546

Stenosis can cause spinal cord compression. This can in turn cause myelopathy or dysfunction of the cord. This can cause strange paresthesias (pins and needles sensations) in the arms and legs.

Part of the diagnosis of myelopathy is the physical examination findings such as hyperreflexia, clonus and Hoffman’s sign as well as balance tests. Do you have any positive tests like that?

The canal diameter is one variable for myelopathy. The entire volume of the canal is important as well as the deformity of the cord. These two factors are identified by experience and training and cannot easily be measured. 9mm is narrow and could be related to myelopathy.

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.

skark
Participant

May 28, 2015 at 12:24 am

Post count: 7

#19555

Thank you Mr. Corenamn for your prompt response.
I did some balance tests and i was ok (i dont know anything about hoffman’s sign). Neurologist said I have increased tendon reflexes but all other physical examinations were ok (sense of cold/hot, sense of a needle through various parts of body, balance with closed eyes, walking/running, walking with front side of foot, with back side).
Both Neurologist and Orthopedic are certain that I have nothing like myelopathy.
So you actually imply that without myelopathy and clear pressure of the cord those symptoms cannot start from my cervical segment?
I also feel my feet heavy (apart from tingling). I walk for 30minutes and is like having walked for hours…
I wake up from bed better but getting worse through the day. Also a burning sensation from knees up the thighs…Hands are ok except from occasional numbness in palms (not all day)
If my cervical spine does not justify thoese I am truly worried about MS…

Donald Corenman, MD, DC
Moderator

May 28, 2015 at 2:27 pm

Post count: 8660

#19567

Patients who have myelopathy at the very beginning might not have long tract signs but that is unusual. The bowel and bladder symptoms typically occur as a later onset in the process of this disorder. These symptoms do not normally show up until long tract signs are found.

“Heavy feeling feet” can originate from myelopathy but many other disorders like lumbar stenosis or peripheral neuropathy (see website) can also cause these symptoms.

Don’t forget that compression of the cord in the thoracic spine can cause leg symptoms without any arm 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.

skark
Participant

June 2, 2015 at 12:33 am

Post count: 7

#19636

Thoracic MRI with IVC came out clear.

From the physical examination the only thing the doctor noted was increased tendon reflexes (hypperflexia?).
Is this a long tract sign?
I have no balance issues.
I feel burning inside my thighs, and tingling in right foot. Also some days i feel my feet heavy (I walk a stair and is like having climbed ten floors).Also numbness in the hands (but not all day).
Dont know what to do next….
My neurologist initially stated its probably from the stenosis but he is keeping me in Ladose medicine also….

Donald Corenman, MD, DC
Moderator

June 2, 2015 at 5:16 pm

Post count: 8660

#19754

Long tract signs include hyperreflexia along with imbalance (can be found with a positive Rhomberg’s test, walking test, triangle test, adiadochokinesis test), Hoffman’s sign, clonus along with unusual patterns of numbness.

Just hyperreflexia without any other symptoms or signs can typically be ignored as some individuals simply have “natural” increased reflexes.

Lumbar stenosis will cause all the above symptoms but increased reflexes.

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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