Cervical Instability C1 C2

Tagged: cervical instability

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Donald Corenman, MD, DC
Moderator

June 20, 2016 at 11:58 am

Post count: 8660

#22431

The Chiropractor comment that the C1-2 joint is loose and that traction may correct this is not correct. If a joint is loose (unlikely in this case but we will go along with this train of thought), traction stretches the joint and should make it looser. Joint arthritis of C1-2 or C2-3 is not uncommon and can cause base of skull pain, headaches that radiate over the back of the head to the forehead or ear and clicking of these upper joints. Individuals with this disorder will complain of noises like “sand in the joints” or popping and clicking with head motion.

Diagnosis is performed with an MRI and CT scan, identification of the problem joint and then a diagnostic cervical facet block of the joint with a pain diary. Successful short term relief identifies the disorder.

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.

Dragonfly
Participant

July 12, 2016 at 4:52 pm

Post count: 6

#22584

Hi,
I’m new to this site and have seen past replies on the same exact thing I’m enduring, I’ve been in prolotherapy now for a few months I’ll be on my fourth session, I have yet to have any real improvement, could you tell me how long it took you before you felt better? I would more then appreciate it, I’ve been diagnosed with ligament laxity and was in a car accident two years ago I’m 32 and disabled this injury completely takes your life. I so hope to hear from you and that you have overcome this!
Andrea

Dragonfly
Participant

July 12, 2016 at 4:57 pm

Post count: 6

#22585

Hi, I’m new to this site and it’s been years now sense your post on your struggle with your neck and back injury. But I read your story and it’s so similar to mine that it brought me to tears. I’m 32 and have been dealing with this injury for over two years. Had DMX MRI’s and have been to the same types of Dr.’s you’ve seen and medications with no real improvements. I’m not able to work it has disabled me and has ruined so much of my life. I so hope you are doing better now, it would mean so much to hear from you, if you finally healed and found treatment or not. I just began prolotherapy in April 2016. Anything you could tell me would mean everything I hope to hear from you.
Andrea

Donald Corenman, MD, DC
Moderator

July 13, 2016 at 9:20 am

Post count: 8660

#22588

Be careful with prolotherapy in the upper cervical spine. The tendons and muscles are immediately adjacent to the nerves and vertebral arteries. The solution injected is designed to create damage which causes fibrosis. Injection in the wrong area can be catastrophic.

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.

Dragonfly
Participant

July 13, 2016 at 12:17 pm

Post count: 6

#22590

What do you suggest? Prolotherapy has been one of the few treatments that can be done. My ligaments in my neck and back have all been over stretched from an accident back in 2014. I’m 32 and completely disabled! Muscle spasms constantly with every movement due to the instability I now withstand. My spine know longer is steady or strong to hold the weight because the ligaments are shot. So my muscles are spasming in order to provide stabilization to my spine. You learn with a injury this severe that everything is attached to the spine, therefore I can not do anything without intense pain. Quality of life is honestly well there’s not a whole lot anymore. I’ve done chiropractic, physical therapy, pain mgmt and osteopathic manipulation.. Almost two years into it they finally found the reasoning for all my pain and the injury I had because of being rear-ended at a stop incoming car was driving at 50mph no brakes applied. I’ve worked all my life up until now, I was healthy weighing 125.. Active nothing was wrong.. Why is this so difficult to detect, treat and diagnose? After seeing so many dr.’s.. All which were treating it as a muscular injury putting my through a cookie cutter auto accident after care… If something is not broken or seen to the naked eye they in fact think your ok…? This has devastated my life and my family. My husband works two jobs seven days a week to provide for us, I’m isolated here at home trying my best to get by, but even the smallest of task is climbing a mountain like brushing my teeth… It completely made sense after I was finally diagnosed, I was explaining and describing the term all along feeling like my spine is going to snap! Instability, can you imagine carrying an elephant on your head? As silly and unrealistic as it sounds. That’s what you feel when you sit , stand, anything! I’ve done facet injections, trigger pointe injections, meds the works! I understand for women this can effect menstrual cycles and pregnancy… That it also effects the central nervous system, I off and in experience pain in my joints in my fingers numbness in my thumb finer nail my index and middle finger and arm, at times it hurts so bad I can’t make a fist.. But honestly when the spasms between my shoulder blades start its shattering and brings you to your knees! It pinches and pounds so hard it worsens to even inhale deep. I’m on fentanyl patch, Vicodin muscle relaxants, anti depressant, and sleep meds. I was on Gavepentin but stopped taking it as advised by my dr because of side effects. With all this being said what is your opinion? Reading other testimonies I know I’m not the only one why are we all suffering? Why is this impossible it seems to treat?
Andrea

John A
Participant

July 13, 2016 at 1:25 pm

Post count: 1

#22591

Hello Dr Corenman,
What is the best way to diagnose c1 instability? and would MRI show this? I have had 3 cervical MRI’s at 3 different clinics/hospitals, I have had neck pain for the past 22 years starting with diagnosis of cervical kyphosis in 1994, got alot better and lived most of those years ok, about 1 and half years ago, I had some jarring to the top of my head from a tree limb that shifted while cutting down, I did not bleed but jarred me really hard, not long after had neck pain, mild herniated disc c6,c7 area, eventually pain eased from that area of c6 and c7,,,,but what still lingers is muscle pain in shoulders and up my neck to the back of my skull, with popping at c1,,I believe I have this instability, can this heal on its own? and would the wrong physical therapy exercises irritate and delay healing? Any advise would be very appreciated.
John
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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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