Cervical and Thoracic Questions

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jewelz
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January 14, 2014 at 1:29 am

Post count: 4

#10142

I have been in severe pain in head, neck and thoracic for 7 years, in a wheelchair due to weakness and pain for 6 years. I have most recent mri report and wondering how urgent it is for me to see a neurosurgeon. (My pain mgmt dr. said to find surgeon asap) I am having trouble finding on that will help. Here are my main concerns: My recent Cervical MRI is worse this year than last. It shows low lying cerebellar tonsils 3-4 mm below foramen magnum greater on right than left (on last year mri was only 2 mm), loss of cervical lordosis (neck completely straight, no curve left), osteophyte complex C4-C6, flattening dural sac C5/6, intervertebral disc dessication throughout cervical with mild loss of disc height worst at c5/c6. Central, focal, and posterior annular tearing C4-C7, and cervical area is narrow. I also have increased CSF pressure in head & can’t extend my head or look up due to compression on vertebral arteries. Severe migraines often, frequent visual problems: spots, flashing lights & blurry. dizzyness, constant air-flow noise in ears (always), weakness, numbness comes and goes in all extremities, blood pressure drops too low when lying down, arrhythmias, and other symptoms. In addition to that, I have bone spurs/degeneration through cervical & thoracic, severely degenerated thoracic, lower thoracic discs are nearly gone, scoliosis and kyphosis (pain dr. said that is due to thoracic deg.) I was in bad accident (head, neck & back injuries) years ago, but only had chiropractic and PT, no surgeries yet. Can you tell me if any of these are urgent, and what is the most urgent (neck or thoracic) and what is “flattening of anterior dural sac”? THanks so much for your help.

Donald Corenman, MD, DC
Moderator

January 16, 2014 at 3:28 am

Post count: 8660

#10152

According to the MRI, you have Arnold Chiari syndrome. The cerebellar tonsils are structures on either side of the cerebellum that are normally tucked up and away in the back region (posterior fossa) of the cranium (skull). When these structures descend into the foramen magnum (the hole at the base of the skull that the spinal cord exits), the tonsils squeeze the medulla oblongata and spinal cord. This compression causes damage to these structures

In your case, Arnold Chiari syndrome needs to be addressed based upon your symptoms. There are a number of surgeries that can accomplish this task. I do not perform this type of surgery but there are a number of “skull base” specialists that do. You can do an internet search for their names.

You do have degenerative changes in the cervical spine but there is not an overt report of spinal cord compression in this report. Flattening of the anterior dural sac is not an issue. The spinal cord is in the dural sac and the sac is normally almost twice the diameter of the spinal cord. Flattening of the sac without cord compression is not harmful.

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.

jewelz
Member

January 17, 2014 at 6:50 am

Post count: 4

#10169

Dr. Corenman,
Thank you very much for your reply and the helpful information.
It makes sense that the chiari is accounting for many of my symptoms. I have another question for you, I found that the closest neurosurgeon to me that does that chiari surgery is 4 hours away, and with my thoracic pain (extremely severe) it is very hard for me to ride in a car for even short distance, also financially it is impossible for me at this time to get that surgery.
So I am wondering if you could give me your opinion about if this can continue to progress (the chiari did worsen already in just one year, from 2012-2013).
Can you tell me if it usually continues to progress and how urgent it may be for me to get that surgery, like could it result in anything like paralalysis or brain function problems, etc.?
I wonder if it progressed due to the high CSF in head. Can you let me know your opinion on me waiting to get this taken care of, or if it is more urgent, that I should not wait? The migraines and other symptoms are horrible, I just wish I was in a position to be able to get the surgery done.
I really appreciate your thoughts on this and any advice you can give me.
Thank you again.

Donald Corenman, MD, DC
Moderator

January 19, 2014 at 7:46 am

Post count: 8660

#10186

Based upon your symptoms, this is not something that should wait. You could look at these new local insurance exchanges (Obamacare) as the new laws dictate that you cannot be excluded for preexisting problems.

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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