Chiropractor's x-rays cervical spine

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Pinales
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January 18, 2012 at 2:01 am

Post count: 18

#5392

A while back I wrote to you about tightness, burning, pressure in the head, neck, face, shoulders. You thought it might be C2/C3 facet joints. That is still uncertain. My question: It was suggested that I visit a chiropractor. He took many tests including temperature scan, a dual scale balance test, and x-rays. He showed me an x-ray of neck flexion where my vertebrae didn’t move at all — the chin touched the chest but the muscles were doing all the work in the forward movement. It was a very strange x-ray. Could this have been unconsciously purposeful on my part? Have you ever seen an x-ray like this? What would cause this to happen? Could this lack of movement in the vertebrae be causing my problems?

He is suggesting 28 sessions.

Thanks for any answers you might be willing to give.

Judith

Donald Corenman, MD, DC
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January 18, 2012 at 2:56 am

Post count: 8660

#5393

From your account of your experience for this chiropractor, his or her particular specialty may not fit with what you need. Temperature differences and a dual balance scale work more with posture deformity which is not your problem. The findings on the X-rays do not make sense to me.

In addition, you do not need to sign up for 28 visits. Chiropractic treatment of 3-5 visits should give you enough knowledge of treatment efficacy. If you don’t improve, then another form of treatment would be in order.

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.

Pinales
Member

January 18, 2012 at 10:00 am

Post count: 18

#5396

Thank you for responding so quickly. It is hard to believe that a busy doctor with a full schedule of patients can care enough to be interested in those who are limited to being online. We are grateful. And I will try to be concise.

Yes, I am a bit lopsided due to a frenetic experiment with “swivel hips” on the trampoline about 25 years ago. The temperature scan was all in the red on the left side and my shoulder, ear etc. are higher on one side than the other. That said, it has never bothered me much and I didn’t think it was so important to mention in conjunction with my head/neck problems. Maybe I was wrong. As for the neck x-ray (I asked for another today), apparently my lordoctic curve is so extreme that my neck never straightens out completely even when my chin is firmly on my chest. Is that so rare or important? (If you are curious to see a cut/paste of the straight head and bent head x-ray, I’d be glad to send them in a document attachment.)

The neurosurgeon whom I am working with has decided to experiment with least invasive procedures first, starting with deep tissue massage. (Previously, he had ordered several nerve blocks, none of which made any difference and prescribed Xanax…ditto). I am sure he will return to the C2/C3 facet joints unless something simpler works. The insurance won’t pay for the massage unless it is done by a physician (gives me cold chills to see another physician), a physical therapist (I’ve been so many times) or a chiropractor. I chose the chiropractor and now he doesn’t want to do the massage. I’m not totally comfortable, but will continue for the moment.
I wish you were closer.

Donald Corenman, MD, DC
Moderator

January 18, 2012 at 11:57 pm

Post count: 8660

#5403

If massage cures your headaches with a short course, that would be a good treatment investment but I am not optomistic that massage will cure you.

I have never seen a cervical spine X-ray that locks the entire neck into lordosis with a flexion X-ray with the chin on the chest. I would say it is impossible to put the chin on the chest without flexion of the neck so there has to be some misinterpretation of the films.

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.

Pinales
Member

January 19, 2012 at 12:20 am

Post count: 18

#5405

Who knows what, if anything will help. When I bend my chin to my chest, the x-ray shows a straightened, but not curved cervical spine. I have no idea how common or not common that is or if it is even relevant.

Right now, the chiropractor is not interested in the massage, so it looks like it won’t be happening.

I’m very unsure what to do.
Thanks for your advice.

Judith

George Etzl
Member

January 19, 2012 at 5:45 am

Post count: 4

#5408

Cervical lordosis can be affected drastically by X-ray positioning. A patient is told to put their chin to their chest. You and I are picturing mandible to sternum where flexion occurs over the entire cervical spine. The flexion is initially at the C0-C1 Level then the remainder of the Cervical spine follows. So the incorrect positioning is performed by having the patient flex having the tip of the mandible is placed toward the top of the sternum. (A maneuver like cervical retraction or turtle stretch.) This causes the majority of flexion to come from CO C1 and maintains lordosis. This is probably a case of incorrect positioning making it perceive a lack of motion. This can occur even without the X-ray technologist or chiropractor having touch the patient by simply using the command “Tuck” your chin into your chest. 8 times out of ten the patient will flex from the upper cervical and not lower cervical. while feeling like they are in “Full” flexion.
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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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