Cervical Instability C1 C2

Tagged: cervical instability

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frog37
Member

November 3, 2011 at 5:13 am

Post count: 6

#5069

Dr. Corenman M.D., D.C.,

I have cervical instability at C1-C2. I had a C-Spine CT Scan, C-Spine MRI, but the tests do not show the instability. I had a Digital Motion X-Ray (DMX) done in mid July 2011. The DMX shows the damage in my neck. My whole neck is affected but the worst area in my neck is C1-C2. I have a significant overhang of C1 on C2 on both the left and right side on the lateral bending view on my DMX. My neck accident happened over a year ago (14 months ago). My condition has deteriorated over the last 14 months with the treatments I have tried.

Treatments I have tried:
-Chiropractic
-Acupuncture
-Tens Unit
-Massage
-Physical Therapy
-Traction
-Rest
-Ice
-Soft Collar/Hard Collar
-Muscle Relaxants, Ibuprofen, Pain Medicines

My Symptoms:

-Pain under skull left side. Neck pain back of neck and under the skull

-Head feels heavy

-Blurry vision, flashes of light in eyes, black veils and spots in both eyes especially when I lay down.

-Dizziness, nausea

-Loss of balance when trying to walk. The soft collar helps with the balance if I wear it.

-I get a lump in the back of my throat on the left side that comes and goes and I get muscle spasms behind my throat and just below my ear next to the jaw bone on the left side. The muscle spasms comes and goes.

-Grinding, popping, clunking sounds under my skull and in my neck

-Right after my accident my head would drop and tilt to the right. Now my head drops/tilts to the left and I can feel my C1 get locked under my skull on the left side. Then it will unlock again. My whole neck especially C1, C2, C3 is constantly locking and unlocking on the left side of my neck. I can feel my C1 moving around especially when I ride in the car even with a neck brace on. My eyes will go blurry when ridding in the car just from the vibration and bumps in the road.

-Tender scalp pain on top of the back of my head on the left and right side.

-Right ear pain, pulling feel, popping, pressure

-My lips and tip of my tongue would only go numb when I lay down but now my lips, tip of my tongue and both hands are staying numb and tingling feeling. I am scared this numbness I am feeling will not go away.

I have no quality of life. I do not want surgery but something has to fix/stabilize my neck I want my life back.

Can over stretched cervical ligaments at C1-C2 heal? I would appreciate any advice you could provide me on ligaments that are completely stretched in the neck at C1-C2. My C2 also slips forward and backward on my DMX.

I appreciate any insight you could provide me.

Thank you for your time.

Donald Corenman, MD, DC
Moderator

November 3, 2011 at 9:12 pm

Post count: 8660

#5072

Instability at C1-2 occurs from a tear of the transverse ligament which holds the odontoid process of C2 against the front of the ring of C1. Pain can still occur if that ligament is intact from degeneration of the facets of C1-2 just like arthritis can occur at the hip or knee joints. A degenerative joint would not however cause instability but decreased motion at the site. If your C2 “slips forward and backwards” on the DMX- and there is more than 3.5mm of slip, an MRI of the transverse ligament is recommended to make sure this structure is not injured.

DMX or fluoroscopic X-rays are generally not recommended with diagnosing instability as the dose exposure to X-ray is significant and the information can be gained by standard positional X-rays with much less X-ray exposure.

Your symptoms appear to originate from multiple structures. Hopefully you have had a good evaluation by a neurologist.

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.

frog37
Member

November 4, 2011 at 12:52 am

Post count: 6

#5073

Before my accident I was fine. I was never in any pain in my back or neck, I never had headaches, I traveled 100% for my job as a Senior consultant. I played volleyball, I exercised daily, I did yoga, swimming at least 3x a week. I was very active. I have been never married, no children. I was enjoying my life. I went jet skiing in August 2010. I was on the back of the jet ski when the accident happened. We were racing another jet ski going over 60mph (dumb I know) and I had my head turned far over my right shoulder to look back to see where the other jet ski was. There was a stump sticking up out of the water and driver hit the brakes turned the jet ski sharp to miss the stump and jerked my neck forward and backward with my head turned to the right looking over my shoulder. I was thrown off the jet ski and hit the water very hard with my head. It was like hitting concrete. The pain was instant in my neck. At the hospital the CT scan did show rotation in my cervical neck and the doctor said I had a sprained neck and to seek treatment.

I am under the understanding that the DMX produces 2,700 x-ray images with the same amount of radiation as a standard x-ray machine, which gives you 6 static x-rays.

I was told that a static x-ray evaluates only 2 of the 22 major ligaments of the cervical spine. The only two ligaments the flexion/extension x-rays detect are the anterior and posterior longitudinal ligaments. I was told a AP open mouth lateral bending static x-ray is difficult to capture to see the C1 sliding right or left.

I was informed that the ligaments that are not diagnosed during static X-Rays are the following cervical ligaments.
• Right and left alar ligaments
• Right and left accessory ligaments
• Transverse ligament
• Five right capsular ligaments
• Five left capsular ligaments
• Five interspinous ligaments

Here are my report findings from my DMX:

Damage to the posterior longitudinal ligament is indicated by an anterolisthesis at C2 on C3 and C3 on C4.

Damage to the anterior longitudinal ligament is indicated by a retrolisthesis at C2 on C3, C3 on C4, and C4 on C5.

Damage to the capsular ligament is indicated by gapping of the facet joint at C5-C6 right.

Damage to the capsular ligament is indicated by intervertebral foraminal encroachment of the facet joint at C5-C6 on the right.

Damage to the alar and accessory ligaments is indicated by an overhang of the lateral mass of C1 bilaterally.

Note: The term “Damage” as used in this report concerning any ligament represents a ligamentous laxity or instability due to excess stretching or tearing, and is therefore painful, progressive, and permanent.

My cervical MRI was done in September 2011. The report findings of my cervical MRI showed normal but did state the following:

-Thinning of the tectorial membrane.
-Increased signal of the alar ligaments.
-Retrolisthesis of the right lateral mass of C1 relative to the lateral mass of C2.
-Moderate disc space narrowing at C5-6.
-At C4-5 disc bulge with central 1 to 2 mm protrusion.
-At C5-6 disc bulge with left central 2mm protusion.

A neurologist recommended I see a surgeon.
5 Chiropractors (evaluations) recommended I see a surgeon.

I have seen 4 neurosugeons since the end of September 2011. I have been trying all the conservative treatments first. I have not seen an orthopedic surgeon yet.

1. The first neurosurgeon said PT and pain management.

2. The second neurosurgeon said psychiatry and wrote a prescription for bungee jumping and said there was nothing wrong with me and that I need to get back to work. I had to move back home to live my parents since I been injured and he said he cannot believe I would put this burden on my parents and I am just wanting attention (unbelievable).

3. The third neurosurgeon said pain management and he does not do surgery on stretched ligaments.

4. The fourth neurosurgeon said he is not comfortable doing C1-2 fusions in cases of stretched ligaments. He is only comfortable doing C1-2 fusions in cases of immediate trauma, dislocation, fracture, etc.

I do not like to take medications. I’ve always been very health conscious. I am very sensitive to medications and I do not like the way they make me feel. Pain management is not going to fix my bones.

How do I get help? What do you recommend?

Thank you for your advise and time. It is greatly appreciated.

Donald Corenman, MD, DC
Moderator

November 4, 2011 at 9:42 pm

Post count: 8660

#5077

Unfortunately, your information regarding the radiation from DMX machine is wrong. Each picture from the machine is about the same amount of radiation from one standard image. Based upon your statistics, you have had 2700 images of your neck at one sitting.

X-rays are not static if performed at the endpoints of motion. For example, the lateral flexion and extension X-rays of the neck will show the endpoints of motion of each vertebra with the respective position. If you compare these endpoints of motion with the neutral lateral film, you gain the knowledge of pathological motion.

DMX in my opinion will substantially over-diagnose many problems that are really normal variants. I assume that the surgeons you have seen also know this and in general, no one wants to perform surgery simply on the findings of the DMX.

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.

HaloHelp
Member

August 13, 2012 at 4:12 am

Post count: 6

#6742

Hi,

I am about to try something called Prolotherapy for my loose ligaments in my C1-C2 area. I have similar problems as you do and it can only help and it’s been known to work.

I don’t want the surgery either, and the prognosis is honestly horrific from what I’ve read. So check it out and look for Prolotherapy, the doctor in Oak Park, IL is one of the top in the country and you can put a search in Youtube to find more specifically on Prolotherapy for c1-c2 instability :) Be sure that if you get it done that it’s done with “comprehensive treatment” meaning, not just a handful of injections…but a slew of them where the whole area is covered well enough to treat everything–some fail because not enough was covered.

I am hopeful it works for me and I just found out about it myself…I can’t wait to try it :) It’s all about getting the ligaments to repair themselves and create stability, causing them to get tight again!!! A dream come true for me.

Even where I read negative articles about prolotherapy, the people who had it done attacked the article writer…so I would say there is something to this…I wish you luck and I know your pain…you are not alone :)

And I’ve had doctors say the craziest things to me too that they should be ashamed to even dare to say to another human being…I read where a doctor said you were seeking attention…I swear…I don’t know where their heads are at sometimes!

~Halo

Donald Corenman, MD, DC
Moderator

August 13, 2012 at 7:07 pm

Post count: 8660

#6747

The diagnosis has to be made beyond a shadow of a doubt prior to a drastic step like prolotherapy. You must make sure you are absolutely sure of your diagnosis. Weakness of the C1-2 ligaments is generally only found in patients with Down’s syndrome or Ehlers Danlos disorder.

Remember that prolotherapy is essentially a destructive procedure where a toxic chemical is injected into the area being treated. This chemical is designed to cause injury and the healing with scar tissue (which is rigid and contracts). This is what the prolotherapist is after. This injected chemical can injure structures and the C1-2 area is full of structures that when injured can cause devastating consequences.

You should look long and hard about this. I would not recommend it.

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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