Cervical Instability C1 C2

Tagged: cervical instability

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Donald Corenman, MD, DC
Moderator

January 8, 2017 at 9:22 am

Post count: 8660

#24092

I’m going to weigh in on the dangers of prolotherapy. This treatment uses a corrosive fluid that causes damage to the structure it is injected in. Injection in the upper neck especially is highly dangerous as if it inadvertently is injected into the spinal canal or vertebral artery, stroke or cord injury can occur. I think prolotherapy is advised for the sacroiliac joint only and only under certain conditions.

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.

ftothelo
Participant

March 3, 2017 at 4:01 am

Post count: 2

#24450

Dear Dr. Corenman,

i’ve also developed an instability between c1 and c2 (not really sure, because of missing diagnose. it just feels i little bit unstable). My doctors think because of overusage according to an atlasassimilation, which was first noticed at age 25 (i’m 29 now). I do not have any of the symptoms, which are usually described by persons with this condition, except a little bit of headaches sometimes and the feeling, that its a little bit unstable under my head. I came across prolotherapy as my doc told me in 2014 about it, tried for the neck, gave up after 3 sessions after i startet research about it – letting someone pinch needles in my neck didn’t feel right at all… Also i’m from germany and prolotherapy isn’t a usual therapy here, i forgot about it.
But now i came across this thread and wondered if you could answer me two questions?
Is it recomended to stretch a neck with istability slightly to release tension in the muscles? Or should i only focus on strenghtening? I’m able to stretch without feeling unstable.
Why do think prolotherapy can be useful to the si joint only?

I’m really escited for your answers.

Thank you and greetings from germany!

Donald Corenman, MD, DC
Moderator

March 3, 2017 at 4:56 am

Post count: 8660

#24451

If you have atlas assimilation, this is a disorder where the atlas failed to separate from the base of the skull. The occipital-atlas articulation (OAA) is fused and this has ramifications for motion. The OAA is responsible for 50% of the flexion/extension motion of the neck (“yes and no” motion) so loss of this joint will increase stress on the lower vertebra. Make sure you don’t have platybasia with the odontoid of C2 protruding into the foramen magnum causing a form of Arnold Chiari syndrome.

Gentile stretching is OK but you have to be careful that you don’t “overstretch” the neck to gain greater range of motion. I am a big fan of strengthening to control abnormal motion so that is the direction I would go in.

Prolotherapy uses a destructive fluid to gain scar tissue. Injected into dangerous areas (the cervical spine comes to mind), this technique can cause damage to sensitive structures such as the spinal cord or vertebral artery. I do not recommend prolotherapy for the neck.

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.

ftothelo
Participant

March 3, 2017 at 5:43 am

Post count: 2

#24456

Thank you for your fast response Dr. Corenman!
My Doc said the MRI’s haven’t shown anything special except the fused facette joints between atlas and occiput and that i dont have to fear chiari.
Great, that you share your experience and knowledge here!

Jasper175
Participant

August 18, 2017 at 6:03 am

Post count: 7

#26002

???
Trying not to freak out now
I, laying on a couch.. progressively through the years it started with the sound of dry breath he and sand paper when turning my head. Of course Doctors near me just give Advil and Creams and recommend PT

Now suddenly I had massive anxiety issues the past 2 years. So a lot of psychosomatic tension added.

While doing Jumping Jacks or felt like my head would skull would pop off the atlas (head lift off my neck$ and clunk back down.
If my heart rate is up while exercising my pulse would clunk through the occipital area (loud pulse pounding top of neck).
Now I have this very weird pain when turn or extend my head.
The pain is chronic now.

X-Ray shows no subluxation other than my curve is not the best. My chiro says my Atlas C1 is locked up.

My ortho or Primary hasn’t approved MRI yet. I wonder if I should request with contrast?

I don’t know if some of this mental anxiety or panic is a result of or the cause of? maybe even the SVT (heart arrhythmia / Tachycardia).

It seems this issue is rare in the book of diagnosis

I don’t know what to do

Rob

Donald Corenman, MD, DC
Moderator

August 18, 2017 at 6:26 am

Post count: 8660

#26009

The noise you hear is typically produced by irregularities the facet sliding surfaces. Normally, the facets are covered with a glistening, perfectly smooth frictionless surfaces of cartilage. As we age, these surfaces become irregular and dried out. When they move against each other, they “catch” and cause the sounds of “sand in the joints”. These sounds are not dangerous if there is no pain. Generally, even with pain, this condition is not dangerous (but painful).

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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