Cervical pain

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exercise453
Member

July 24, 2014 at 2:13 am

Post count: 53

#11203

Hi Doc,
I anticipate c2-c3 and c3-c4 facet blocks next month. My current PM Doc will not burn the c-2 medial branch because he feels it is too risky but he has no problem pulsing the c-2 level and will do so if the blocks provide the significant relief. He would then burn the nerves below. I do believe this board certified, long time PM doc is both experienced and skilled. Yet some doctors will burn the c-2 level without hesitation. After all the frustrating obstacles from the insurance companies it is depressing choosing between what might be a less effective method or the revolting chore of starting over with another Doc. Also top doctors I would definitely switch to are either not on the network or perform what is done as an in office procedure in expensive surgical centers.

Is there anything at all that makes the radiofrequency burning of the c2-medial branch more risky than those below in your opinion???

Would you recommend waiting and finding a Doc that will burn the c-2 level or would you go ahead with what I have now.???

As always
thanks Doc

Donald Corenman, MD, DC
Moderator

July 24, 2014 at 8:02 pm

Post count: 8660

#11212

I cannot comment on this physician and his choice of pulsed “disruption” vs. an actual rhizolysis. I can tell you that pulsed disruption is probably less effective but safer than rhizotomy. Possibly this individual had a problematic experience earlier in his career and wants to stay away from C2. I do know many docs who have no hesitation with rhizotomy of the medial branch of C2.

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.

kristina76
Participant

October 17, 2014 at 12:26 am

Post count: 8

#11544

Hi Dr. Corenman,

Somehow I missed your response to my last post from a few months ago. Sorry about that!

I haven’t had much relief from facet injections into C2-3, C3-4 (except for one time), but I can tell that they are hitting an area of pain for me when the needle goes in and I have all the symptoms of facet pain- cracking, tenderness to palpation over facets, degeneration on x-rays, can’t turn my head, headaches, severe spasms, etc.. I can literally feel the facets grinding on each other.

Any thoughts on why I may not be responding optimally? I know it’s not disc pain or severe instability. Have you seen anyone who did well with rhizotomy even if they have not responded as expected with the injections?

I had asked you previously about the benefit of Cat Scans. Coming from a surgical stand point, if I were to consider a minimally invasive procedure at some point, would it be of benefit to have a Cat Scan to see if there are bone spurs rubbing on nerves, or foraminal stenosis, or should that have already shown up adequately on my x-rays and MRI?

Is there a minimally invasive surgeon that you could recommend that is close to Mass? I’m having a hard time finding one that isn’t a long distance away. It would be good to have someone thoroughly look at my tests and give me their opinion. Do you ever look at exams and give a consult over phone/email?

Help!! ;)

Thank you,

Kristina

Donald Corenman, MD, DC
Moderator

October 21, 2014 at 12:35 am

Post count: 8660

#11570

The results from facet injections are “diagnostic and therapeutic”. This means that two different substances are injected, a numbing agent like Lidocaine and a therapeutic agent like Kenalog (a steroid).

The first three hours should have given you good temporary relief if the injection was placed in the correct location. This is the diagnostic portion of the injection. Good relief for three hours confirms the diagnosis of facet syndrome. If this is the case but you did not gain longer term relief (the therapeutic reaction), the diagnosis is still confirmed but these injection will not manage your symptoms.

If that is the case, you are still a candidate for rhizotomies.

There are occasional situations where the facets are highly degenerative but the injections yield no relief. This is where the facets are so deformed due to wear, there is bone pain present. Bone pain might not yield relief from these injections. This is where a CT scan can be valuable. The CT will indicate significant bony damage to the facets.

Forget “minimally invasive” surgeons as this is a catchword that really means nothing. You need a great, experienced surgeon for this disorder, not a “minimally invasive” one.

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.

exercise453
Member

October 24, 2014 at 7:31 am

Post count: 53

#11581

Doc Did not understand one thing in your last answer to Kristina76 just above.

If the cervical facet block yields only minimal to mild relief over the next three hours and a CT scan shows “significant bony damage to the facets” does that mean go ahead and have the rhizotomy or do not have the rhizotomy.

Thanks as always

Donald Corenman, MD, DC
Moderator

October 24, 2014 at 10:24 pm

Post count: 8660

#11582

If there is good temporary relief from the facet blocks (about three hours), then the patient is a candidate for a rhizotomy. There are insurance companies that require relief from intracapsular facet blocks and medial branch blocks (numbing the actual nerve but not entering the facet capsule) before they will approve a rhizotomy.

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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