Can I Avoid Surgery?

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BellieKiss1
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November 8, 2012 at 10:45 am

Post count: 4

#7363

I recently had an MRI due to severe pain in the front and back of my shoulder, in my biceps, elbows and tingling and numbness in my fingers. Can you please look at the findings and let me know if you believe there are any remaining options aside from surgery? I had a steroid injection about 3 weeks ago, and continue to have all of the same pain issues. (I sent an email not fully understanding the forum, so I hope that I am not causing you double work – sorry.) I am scheduled to meet with an Orthopedic Surgeon on the 19th of Nov. and just want to make sure that I have considered all options and consulted another Spine Surgeon.

The findings of my MRI are: Sagittal scans demonstrate progressive disc space narrowing, uncinate hypertrophy and Modic type II endplate changes at C6-7 associated with a diffuse grade 1-2 bulging disc producing a mild spinal stenosis. There is interval appearance of diffuse grade 1 bulging disc and right lateral recess grade 2 disc protrusion at C4-5 without significant spinal stenosis. Remaining discs are normal in appearance for age. Mild multilevel facet disease is present. Loss or lordosis of the cervical spine is again appreciated.

Spinal cord and bone marrow signal unremarkable. Alignment is otherwise normal. Visualized posterior fossa unremarkable. Oblique sagittal foraminal scans demonstrate u ncinate hypertrophy and facet disease producing moderate to sever right and moderate left foraminal stenoses at C6-7. A right lateral recess grade 2 disc protrusion is present at C4-5 without significant foraminal stenosis. Moderate facet disease is noted at T2-3 producing a moderate left T2-3 foraminal stenosis.

BellieKiss1
Member

November 11, 2012 at 12:20 pm

Post count: 4

#7372

Hi Dr. Corenman. Thank you so much for your time. I thought that it might be helpful if I included the breakdown on the mri for the individual discs. Have a wonderful weekend, and thank you for your input and for providing this amazing forum! Warmly, Kellie

Axial scans performed C2-T1:
C2-3: Mild facet disease present. Disc unremarkable for age w/o stenosis.
C3-4: Normal for age without stenosis.
C4-5: Diffuse grade 1 bulging ddisc is associated with a right laateral recess grade 2 disc protrusion w/o significant stenosis.
C5-6: A shallow right paracentral grade 1 disc protrusion is present without neural compromise or stenosis.
C6-7: Diffuse grade 1 bulging disc and moderate uncinate hypertrophy produces a mile spinal and moderate severe bilateral foraminal stenoses wwith residual central AP canal diamter of 8.5mm.
C7-T1: Normal for age w/o stenosis.

IMPRESSION:
1. Progressive degenerative disc and uncinate disease at C6-7 producing mild pspinal and moderate to severe bilateral foraminal stenoses as described.
2. Interval appearance of diffuse grade 1-2 bulging disc and right lateral recess grade 2 disc protrusion at C4-5 w/o significant stenosis.
3. Shallow right paracentral grade 1 disc protrusion at C5-6 w/o neural compromise or stenosis.
4. Moderate facet disease at T2-3 producing foraminal stenosis as described.

I have a few questions…I hope you don’t mind.

1) I am experiencing loss of ‘strength’ in my right hand. It almost seems as if it just isn’t responding. If feels dull (no harsh pain). Is feels unresponsive and it scares me. I am accustomed to the pain, but this is a new thing. Is this something to be worried about prior to my appt. on the 19th.

2) I don’t know if it is possible for this to be related to my neck problems – but over the last month or so, I have also experienced some pains in my legs; particularly the outside of my thighs. I notice it at night, when I am trying to sleep. Is there any way that this is associated? I have long term back injuries but haven’t suffered from that in over a year.

Thank you again.

Donald Corenman, MD, DC
Moderator

November 12, 2012 at 3:20 am

Post count: 8660

#7376

Your MRI notes significant neuroforaminal narrowing at C6-7. This is the exit zone for the nerve root of C7. Compression of this root will cause pain and numbness that radiates into the middle of the hand and weakness of arm and some hand muscles. Mild spinal stenosis or mild narrowing of the canal the spinal cord occupies should not cause cord dysfunction. The other levels will not cause spinal cord or nerve root problems.

Since the main problem looks to be nerve root related, it most likely does not appear that you need to move up your appointment, The leg pain should not be related to your neck.

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.

BellieKiss1
Member

November 13, 2012 at 8:12 am

Post count: 4

#7387

Dear Dr. Corenman,
Thank you so much for the reply. Would you mind telling me what you feel is my best course of action based upon my MRI results. My Dr. Indicated that we need to take out discs on 4-5, 5-6 and put in spacers, fusion on both sides and installation of a plate. He will discuss this with me on the 19th. This information was conveyed in a call following his PAs reading of my results. Thank you again for your knowledge and assistance – and this amazing forum!

Donald Corenman, MD, DC
Moderator

November 13, 2012 at 6:08 pm

Post count: 8660

#7394

I am confused by the surgeon’s recommendation. Your worst level in the cervical spine seems to be the C6-7 level by report. I am unclear as to why the surgeon suggests an ACDF of the C4-5 and C5-6 levels. Maybe the physical examination honed in on the levels above or the radiologist’s interpretation of the images is different than the surgeon’s interpretation.

Did you undergo a complete physical examination with testing of all the upper extremity muscle groups? The biceps, triceps, deltoid, wrist and hand muscles as well as arm internal rotation (tennis forehand) and external rotation (tennis backhand) muscles? Was sensation tested as well as reflexes?

When you say the surgeon wants to do perform fusion “on both sides”, do you mean both a front incision for the ACDF and an incision on the back of the neck too?

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.

BellieKiss1
Member

November 14, 2012 at 7:55 am

Post count: 4

#7401

They performed all of the tests in office prior to referring me for my MRI. I am not really clear on why we didn’t address 6-7. I go in on the 19th for a comprehensive discussion about surgery suggestions. I agree – but I believe it is my lack of understanding. (I was on an online Skype class and was not at my best while he was conveying information). But I wrote down what I heard at the time. Can I Send you my actual MRI And ask what you would recommend i do based upon findings. I have lost significant strength in my arms, right side predominantly. I have horrible nerve pain and tingling and loss of strength. I don’t know about the fusion conversation….yikes! I had never thought of the front and back entry…..help. ;D. I sure appreciate your time and input.
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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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