Cervical Instability C1 C2

Tagged: cervical instability

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judith19
Member

November 30, 2014 at 9:35 am

Post count: 5

#11798

hey pete, you can email me if you see this

Donald Corenman, MD, DC
Moderator

November 30, 2014 at 10:11 am

Post count: 8660

#11800

You are correct in that a C1-2 fusion is a somewhat altering experience. However, patients that need this surgery are in danger of becoming paralyzed due to upper neck instability or suffer severe neck pain and headaches due to severe degeneration.

This surgery does not reduce neck range of motion by 80%. You have been hearing false assumptions regarding a C1-2 fusion. The normal C1-2 joint is responsible for 50% of rotation of the cervical spine. A fusion will reduce rotation by 50%. However, many patients who undergo this surgery are already restricted in this motion by disease of this joint.

The statements “being at a drastically higher risk for stroke post surgery” and “not being able to lift more than 20 pounds even after a year of recovery” are not true and a product of lack of understanding of this surgery.

I have a patient now who has currently instability of the C1-2 joint and is at risk of stroke without surgery. The vertebral artery winds around the C1-2 joint and in this individual, when he turns his head, he cuts off the artery and becomes nauseous and dizzy due to the blood loss to the base of the brain. WIthout surgery, he will have a stroke.

I have many patients who lift up to 100 pounds after a C1-2 fusion so your other comment is misinformed.

You are welcomed to use prolotherapy for whatever you so choose as long as you understand the risks vs. rewards. My issue is your misinformation regarding surgery and the risks of prolotherapy in such a dangerous area.

This site is dedicated to correct information. You are obviously free to choose what you wish but you should go into any treatment with realistic information so you can make an informed decision.

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.

patrice
Member

January 7, 2015 at 5:29 am

Post count: 7

#11943

Thank you for this forum, Dr. Corenman. I am a longtime patient at the Steadman Clinic. Dr. LaPrade did a double bundle PCL recon on my knee just 2 years ago and Dr. Steadman saved that same knee years before.

I have been diagnosed with bilateral thoracic outlet syndrome. My symptoms are very severe and have progressed. I was in 3 car accidents within 5 weeks, none my fault, but was doing great and recovering from the knee surgery with a vigorous rehab program. After a forceful chiropractic manipulation of my neck, my world changed within a few hours and that is when I was diagnosed with the TOS. Nothing has been the same since. I have also had left-sided tinnitus as a result and had severe dizziness afterwards for a while. As I struggle to deal with that diagnosis, my PT also told me that I have C1-C2 hyper mobility. Could my tingling lips and tongue along with some of the other symptoms be coming from that? I am confused as my very recent cervical MRI did not show any problems with C1 C2 or the transverse ligaments. I also had recent flexion extension x-rays. I do have some expected degeneration for my age but nothing that alarms doctors or that they see with C1 C2. Is is possible that the alar ligaments are damaged? Can a PT make a clear diagnosis of this condition? I am suffering terribly from the TOS and now wonder what part is coming from the upper cervical instability and how best to address this. I have had multiple neck injuries over the years but was fine and athletic for decades until this occurred. Desperate to understand and move forward with a treatment plan. Thank you! Happy to come see you as well, if appropriate. I travel from Seattle to Vail just to come to the clinic. Thank you!

Donald Corenman, MD, DC
Moderator

January 10, 2015 at 3:28 am

Post count: 8660

#11968

Thoracic outlet syndrome (TOS) is not related to neck origins or instability. Read the section on thoracic outlet syndrome on this website to understand the pathology.

Instability of C1-2 can cause base of the skull pain and headaches but not tinnitis or “tingling lips and tongue”. Instability of C1-2 can cause dizziness.

You cannot determine hypermobility or instability without motion X-rays or a CT scan with the head placed in different positions.

First- work with a therapist who is expert in TOS. You can try brachial plexus injections if this is ineffective. Finally, if nothing else works and symptoms are unacceptable, a surgery to release the thoracic outlet can be effective. I do not do this surgery.

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.

patrice
Member

January 10, 2015 at 4:29 am

Post count: 7

#11971

Thank you so much, Dr. Corenman. I do understand that TOS is impingement of the brachial plexus and unrelated to cervical instability. The scalene muscles and/or cervical ribs can cause issues depending upon whether nerves, veins, and/or arteries are impacted. I will read further on your website. I have extreme electrical sensations and numbness impacting arms, hands shoulders, upper back, neck, and base of skull. Dizziness with movement of head. Overhead activities are impossible.

May I just ask 2 more questions please:
1. How does a doctor determine if further imaging, as you talked about, is required to determine C1 C2 instability?
2. Does Howard Head in Vail have a PT who is excellent with TOS? They were amazing with my knee rehab both times.

Grateful….When you have a moment.

Donald Corenman, MD, DC
Moderator

January 10, 2015 at 6:58 am

Post count: 8660

#11973

Instability is suspected by regular cervical X-rays including flexion/extension views. If symptoms match the suspician of instability on films, that is when the speciality studies are ordered and reviewed.

Howard Head does have very good therapists for TOS but realize that TOS is one of the more difficult disorders to treat through physical therapy.

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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