C7 Spinous Process Fracture Fragment

Tagged: C7 Spinous Process Fracture Fragment (clay shovelers fracture)

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darrenacoo
Participant

November 15, 2017 at 10:46 am

Post count: 4

#26834

Hello Dr. Corneman,

You come very highly recommended from my friends in Grand Junction, and I was hoping to get your opinion.

Recently I had a cycling wreck and fractured my C7 spinous process. Due to some miscommunciation/misunderstanding/etc. I thought I had a fracture of the C7 transverse process and the Angel collar was not an absolute requirement unless I was doing something where there would be a lot of rapid movement, etc. As a result, I did not sleep in it, and I took it off when I was not moving much. With the exception of the normal soreness from the accident, I have felt pretty good. When I went in for my appointment I was hoping to be released from needing the collar, but instead I found it was a spinous process fracture of the C7 and that the fragment had displaced downward and that it was critical I be wearing the Aspen collar 24/7. They asked me to come back in 3 weeks to check my progress. They were hopeful that it would stabilize (I am not experiencing any pain or loss of sensation or lack of strength). My understanding is that the fragment won’t grow back together, but scar/fibrous tissue would hold it in place, if everything goes well. They said that if it didn’t, they would need to look at surgery to remove the fragment and then they would fuse C6,C7,and T1.

I would like your input on their assessment, and I would like to know if there is anything I can be doing to help increase the odds of a non-surgical result.

I REALLY appreciate your time, and I would be happy to come to Vail to get a consult if you think that would be best.

Sincerely,

Darren

Donald Corenman, MD, DC
Moderator

November 17, 2017 at 6:11 am

Post count: 8660

#26845

A C7 spinous process fracture is normally a benign fracture. Years ago when individuals had to shovel coal, just the act of shoveling would commonly break this process off. This fracture was so common, it was called a “clay shovelers fracture” and is still commonly referred to as such today.

There are variants of this fracture that can involve facets which is not so benign so a CT scan is important to review.

I think a collar for two to three weeks is a good idea for comfort. It will be “sore” for 6 weeks and then heal as you noted with fibrous tissue. Generally these do not “reconnect” with bone.

I have never seen a patient that needs a fusion after this fracture due to instability so your information was not accurate about this. I have seen about 40 of these fractures in my career and only one patient needed to have this process removed surgically due to discomfort.

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.

darrenacoo
Participant

November 17, 2017 at 2:43 pm

Post count: 4

#26847

Thank you, Dr. Corenman! That is very encouraging.

Is it possible to have you review the original CT scans and the subsequent Xray and/or see me in person? I would very much like to have a second opinion regarding how concerned I should be about the downward displacement, as well as your thoughts on how strictly I need to follow the 24/7 Aspen collar rule. As I mentioned, I have had no unusual pain, tingling, or numbness, and wearing the Aspen collar 24/7 has made life quite difficult.

Again, thank you for your time. I really appreciate it.

Best,

Darren

Donald Corenman, MD, DC
Moderator

November 17, 2017 at 3:26 pm

Post count: 8660

#26848

Would be happy to see you with your studies. Please call the office for an appointment.

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.

darrenacoo
Participant

November 19, 2017 at 9:23 am

Post count: 4

#26872

Thank you, Dr. Corenman. I left a message with Danica (sp?) and will request copies of my studies early Monday a.m.

If you would prefer to wait to see my studies to reply, I totally understand, but one thing that is pressing on my mind is how concerned I should be about the downward displacement of the fracture since the first CT. As I mentioned, I have not had any unusual pain (actually, I have had very little pain period) which is why wearing the Aspen collar for comfort seems like an ironic phrase to me. :-) That said, I have been wearing it every minute of every day except to change pads until I am given clearance by a neurologist to do otherwise.

I look forward to our appointment! I can be there the first moment you can see me.

Best,

Darren

Donald Corenman, MD, DC
Moderator

November 19, 2017 at 5:58 pm

Post count: 8660

#26876

If you pain is minimal with the collar, this is probably a benign clay shovelers fracture but a perusal of the CT will be helpful to rule out the problem type of fracture.

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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