Cervical Degenerative Disc disease

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slavergne
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November 3, 2011 at 10:14 am

Post count: 1

#5070

I am from Canada and have seen many specialists and doctors in Ottawa, Ontario in regards to my degenerative disc disease of the cervical and lumbar spine condition which started in early 2000 and was diagnosed by an MRI back in 2006 and a more recent one in 2010. I would like to know what can be done to help me aleviate the chronic pain which i have been living with for so many years.

My MRI of October 2010 indicates that the cervical spine at C2-C3 there is no disk protrusion or spinal stenosis. Mild to moderate right neural foraminal narrowing secondary niderate IA cgabges if tge facet joints.
At C3-C4 there is a small broad-based posterior disk osteophyte complex. Small left uncovertebral osteophytes. No disk protrusion, spinal stenosis significant neural foraminal narrowing. There are mildly changes of the facet joints.
At C4-C5 there is a small broad-based posterior disc osteophyte complex greater towards the right. Small right and moderate left uncovertebral osteophytes. There is moderate left neural foraminal narrowing. Mild degree of central spinal stenosis. No disc protrusion.
At C5-C6 there is a small broad-based posterior disc osteophyte complex. Small right and moderate left uncovertebral osteophytes. Mild right and moderate left neural foraminal narrowing. Mild degree of central spine stenosis. No disc protrusion.
At C6-C7 there is a small broad-based posterior disc osteophyte complex. Small to moderate bilateral deep osteophytes. Mild right and moderate left neural foraminal narrowing. Borderline degree of central spinal stenosis.
Moderate multilevel degenerative disc changes with mild multilevel central spinal stenosis. No disc protrusion. Neural foraminal narrowing/OA change of the facet joints as described.
An X-Ray of the cervical spine in June 2010 indicates that there is straightening of the cervical lordosis, probably the result of muscle spasmes. There are degenerative changes from C4 to C7 and with osteophytes and severe narrowing of the C4-C5, C5-C6 and C6-C7 disc spaces. There is mild narrowing of the left C5-C6 invertebral foramen.

I have been in constant pain since 2000 which has now become a chronic pain. I have been off work in 2007 for 3 months due to this condition and again from December 2010 to May 2010 and now progressively returning to work. I have tried physiotherapy in January 2010(the Mckenzie Method) which has not helped as the pain is centralized in the cervical spine and lumbar spine, causing at times nevralgia headaches, numbness in hands (especially the left hand), sore elbows, weakness in arms, sore left buttock and calf, feeling of electric shocks in right hand, neck, trapeze and lumbar area.

I have undergone this last August, three cervical facet cortisone injections and on October 3rd 2011, botox injections in the muscles of the my back for which none has helped or reduced the pain.

My question to you would be to know if I would be a candidate for cervical spine fusion?.

Your advice is greatly appreciated.

Donald Corenman, MD, DC
Moderator

November 4, 2011 at 10:10 pm

Post count: 8660

#5078

You report pain in the cervical spine centrally. The lumbar spine pain most likely is from another source. The upper extremity symptoms seem to be variable. First, which symptoms are worse, the neck or the arms? If the neck, what is the percentage of neck vs. arms? 70/30, 80/20 or? What makes the neck pain worse? Does time of day make a difference? What is the intensity of the pain on a 0-10 scale?

The X-rays can be revealing. You note significant degeneration of C4-7 and straightening of the normal lordosis curve. Straightening of the curve is typical with degenerative change of the discs. The discs are trapezoidal in shape and wear of these discs will straighten the spine.

I will assume that you have already had substantial treatment in the form of physical therapy, chiropractic and other forms like acupuncture and medications. You report that injections have failed to give you relief.

If you have failed everything and the symptoms are disabling, you might be a candidate for a work-up for surgery. First, facet injections might be in order. The cervical facets can generate central neck pain. Temporary relief of your pain with injection of the facets may make you a candidate for ablation of the nerves that send signals from the facets (rhizolysis).

If that procedure gives you no relief, then you might be a candidate for fusion surgery. First, the range of motion of the C4-7 levels on flexion- extension films has to be very limited or there has to be instability present. Some surgeons would then use a test called a discogram to test discs above. This test would have to be negative (no pain generated from the discs above). You would then need a long talk with your surgeon regarding surgery, the expectations, the potential results- both good and bad.

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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