Cervical Spine: Herniated Disc, Blood Blister

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Barry_T
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February 3, 2012 at 8:51 am

Post count: 3

#5497

Dr. Corenman, I am a 50 year old man with a history of thoracic and lumbar back pain in the last 10 to 15 years. I have also had 2 to 3 years of problems with my neck following a road traffic accident about 30 years ago. I have some relatives with spinal problems brothers, cousins. The physiotherapist diagnosed multiple symptoms of nerve ‘pins and needles’, with feeling of coldness in my right arm with a measured temperature drop of 1-2 deg C between right and left hand. The physiotherapist sent me for a X-ray suspecting that some of the symptoms were attributed to Thoracic Outlet Syndrome. The X-ray indicated a small ‘Cervical Rib’ protrusion. I was then passed on to a consultant who sent me for a investigative MRI. The results from the MRI indicated a herniated disc between C4 and C5, protrusions of vertebrae into the spinal cord region also. He also mentioned that the white area, are pointing to the C4 cervical vertebrae had a ‘blood blister’ contained within it. I asked about my physical symptoms of temperature difference between right and left hand, and didn’t get a response.

I repeatedly asked for more information about the ‘whole’ diagnosis but did not get a response other than he was going to ‘quickly’ forward my case to a neurosurgeon.

I have searched the internet and have found a few references to Thoracic outlet and herniated discs, but I could not find any information on cervical bone blood blisters.

I am getting worried about the whole situation, can you help me please?

Donald Corenman, MD, DC
Moderator

February 3, 2012 at 11:00 am

Post count: 8660

#5498

You have some complaints listed and some conditions listed. Let us first discuss the complaints. Pins and needles in the right arm could be from a compressed nerve in the neck or from thoracic outlet syndrome. Coldness (greater than 1-2 deg C) can be from a condition called RSD or CRPS but that is very rare and most likely, you do not have that.

You note no complaints of pain in your neck or arm or what makes the symptoms worse and/or better. You note no complaints of weakness or of dexterity.

Let us work backwards from the stated conditions. Thoracic outlet syndrome is caused by compression of the nerves in the shoulder (brachial plexus) by the first rib, cervical ribs, the muscles in the side of the neck (scaleni) or the tendon of the pectorals minor. These symptoms would include numbness in the pinky side of the hand and worsening numbness with any overhead work. The hand could get cold when raised up but be of normal temperature when at your side.

The herniated disc at C4-5 would cause pain and numbness into the shoulder but not down the arm below the elbow. The muscle associated with the C5 nerve is the deltoid (lifting the arm up at the shoulder level).

The “blood blister” in the vertebral body of C4 is a new one for me. I would imagine that this individual means a hemangioma of the body of C4 but I cannot be sure about that. In general, hemangiomas of the vertebra are common and benign.

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.

Barry_T
Member

February 3, 2012 at 9:26 pm

Post count: 3

#5499

I visited my general practicioner (GP) today and I have some corrections to the MRI results.

Radiologist report to GP – MRI Spine Cervical: There is a small haemangioma in C5. There is loss of disc height with both disc and osteophyte at C5/6, I think probably more osteophyte than disc but narrowing the exit foramia certaily on the right and possibly on the left. The spinal cord and vertebrae are otherwise normal.

In Response:
My symptoms started after a fall and a ‘partial’ disclocation of the right shoulder December 2010 and Feruary 2011 respectively.

I have pins and needles regularly and some instances of weakness and sensation in my right hand mainly. The symptoms vary day to day but can be over thumb/index finger or ‘pinky’ and the fingers next to it. I have recently had shaking hand/arm and problems with writing. The sensation of cold was checked by myself with a digital temperature probe (accurate to 0.1 deg C); this measured in a seated position.

Apologies for getting the vertebrae numbers wrong!

The symptoms vary day to day and also depending on what I am doing at the time. To start with the symptoms occurred when using a computer mouse and has ‘developed’ into a more irritating problem exacerbated by the ‘coldness’ of my right arm and hand. I aleviate this with heat pads.

Does this help with diagnosis?

Donald Corenman, MD, DC
Moderator

February 4, 2012 at 2:54 am

Post count: 8660

#5500

OK- this makes more sense. The condition of foraminal stenosis of C5-6 (see website for this) would cause compression of the C6 nerve. This radiates pain and paresthesias (pins and needles) down to the thumb side of the hand. Weakness would include biceps (bending the arm at the elbow), wrist extensor (lifting the wrist up opposite side of the palm)- important for grip strength and the thumb muscle.

Foraminal stenosis would become worse with neck extension (bending the head backwards) making the radiating symptoms worse. Temperature is governed by the sympathetic nervous system that does not originate from the neck so the coldness in the hand is not related to the neck.

You could also have carpel tunnel syndrome- very common with using a mouse. I do not have a section written on that so you will have to look it up on the internet.

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.

Barry_T
Member

February 8, 2012 at 1:33 am

Post count: 3

#5522

Dr. Corenman, I am awaiting referral to a neuro-surgeon and unsure about delay in the NHS (UK) system it could be many weeks/months.

Are there any short/long-term effects or damage to the spinal cord with a herniated disc and osteophyte pressing on it; or the symptoms of Thoracic Outlet Syndrome? Should I put pressure the NHS to speed up the referral or go private?

I am trying to ascertain whether the ‘neural’ conditions could be causing other symptoms in my body, such as:
1) One-off Seizure (three years ago), 2) Neck and shoulder pain, 3) Neck graunching, 4) Headaches/Migraines, 5) Dizziness, 6) Violent/Panic waking from sleep trying to get my breath, 7) Choking when eating, 8) Stomach upsets, etc

Donald Corenman, MD, DC
Moderator

February 8, 2012 at 4:17 am

Post count: 8660

#5524

With your National Health Service, I understand the referral wait can be months. The good news is that there is no cord compression that you have reported- only nerve root compression. Nerves are more forgiving than the cord and the waiting time to see a surgeon can be longer. There still is some risk with waiting but the risk is much less than with cord compression.

Seizures would not be associated with nerve compression in the neck. Neck and shoulder pain more likely is related to this nerve compression. Many of the other symptoms are not related to the neck but could be related to anxiety. I am unclear what neck “graunching” is.

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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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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