CERVICAL SPINE

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DRAGON
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August 3, 2012 at 4:17 am

Post count: 14

#6652

Dear Dr Corenman

I have been known to have cervical spondylosis since 2003. Have had 3 MRI’s and my latest shows ‘early flattening’ of the spinal cord at the affected level with subtle signal change
I was examined in the briefest fashion sat in the chair by the Consultant, a quick tap with the reflex hammer a little sensation testing and that was it. But for a few years I have very brisk reflex in my left leg but not in my right, and in recent times
I have noted my left leg at the hip seems sometimes toi ‘give’ as though the muscle temporarily forgets to hold me up. It ius entirely unpredictable and sporadic and tends not to happen when moving briskly. Aside of this I get sporadic tingling/. numbness in the hands and a snesation of being off balance, plus other issues, for example poor night vision, and difficulty adjusting to a dim environment when entering, and note that in the mornings my pupils stay like pinpricks for a long time even coming back into a semi dark room doesn’t have much or any effect, as well as gettinbg frequent feelings of nausea and fatigue
At times, I have to wonder if I could even have something like MS
but I guess the MRI (albeit of the C spine ) might show evidence pointing to that if it were there

What the GP says is that the problems (C6/C7 ) (also have spondylosis at C5/C6 and some compromise to the nerve roots would not be respo0nsible for the very brisk reflexes. He and Consultants have not shown any interest in that, they say ‘tone’; is normal and when tone is normal brisk reflex doesnt matter, I read however that a large difference between reflexes on each side is pathological They are brisk both sides but probably on the left is twice as brisk

I also think that where signal change is noted at the level of the theca being indented and early flattening of the cord then that is what I understand to be mylopathy and I can expect some impairment of function perhaps ?

I feel my glute muscles are weaker too but they say the C spine wouldnt be responsible for this and they say my lumbar MRI was fine (haven’t had the thoracic spine scanned though
Sometimnes a foot will scuff on the street surface and I almost stumble and my left foot (the side with the much brisker reflex ) will seem to almost slap down most notable at alow pace

If I was to send you my C spine MRI would you look at it and tell me what you think re signal and flattening ? I can email stills from it but that wouldn’t be quite as effective

Anyway I don;t know what you make of thes e points and queries.

Most appreciated

Andrew

DRAGON
Member

August 3, 2012 at 2:31 pm

Post count: 14

#6656

just to be clear it doesnt say signal change, it says subtle increased signal’ sorry for the slight error

Donald Corenman, MD, DC
Moderator

August 6, 2012 at 10:47 pm

Post count: 8660

#6671

Spinal canal narrowing with signal change in the cord is indicative of the beginnings of myelopathy. This causes dysfunction of the spinal cord and is associated with multiple signs and symptoms. Signs are findings on physical examination such as increased reflexes and imbalance with testing. Symptoms of course are what you would complain of. See the section regarding myelopathy on the website for a full explanation of these symptoms.

Not only is myelopathy a concern but acute injury to the cord is also possible. The spinal canal changes in diameter with flexion and extension. Extension or bending the neck backwards narrows the canal even further. This action can cause pinching of the cord and a resultant spine cord injury called a central cord syndrome. The potential for this injury increases with patients involved in activity that can cause falls onto the head. Biking, water and snow skiing, horseback riding among other activities fall into this category.

Normally on physical examination, the reflexes on both sides will be increased with the presence of myelopathy. There are rare presentations of injury to the cord that are only one-sided that can caused asymmetric hyper-reflexia. See Brown-Sequard syndrome of the website to explain this phenomenon.

Some of your symptoms could originate from the lumbar spine.

If you have developed the beginnings of myelopathy, surgery is generally recommended.

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.

DRAGON
Member

August 7, 2012 at 4:17 am

Post count: 14

#6675

Thank you very much
I have also sent a brief message by the form including a link to 3 of my MRI images just to clarify if I am seeing the ‘increased signal’
I did watch your helpful video about reading the scans

Thank you

Donald Corenman, MD, DC
Moderator

August 7, 2012 at 8:58 pm

Post count: 8660

#6681

The images indicate that you have an old injury or severe degenerative disc at C6-7. This creates significant angulation at this level. The good news is that the spinal canal is still capacious in spite of this deformity. There might be some evidence of cord signal changes on one image but this has to be compared to the axial images of the same level to confirm this finding.

Even if there is cord signal change (and I am not sure of this), there is no evidence that the current anatomy of the cervical spine caused this problem. The spinal canal is large and there is no evidence of instability.

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.

DRAGON
Member

August 7, 2012 at 9:10 pm

Post count: 14

#6682

Thank you for looking at the images I guess the thing is for me to be sensible in my activities and posture, and vigilant to any possible changes. I’m glad the spinal canal has plenty of space
I can’t recall any specific injury.
But I presume that as a degenerative condition, at some stage in the future this may produce some problems so all I can do is take as much care as possible and keep my fingers crossed, as well as persuade my primary care doc to schedule a fresh scan every coiuple of years or so
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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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