Chronic neurogenic changes

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Madoak
Participant

December 8, 2017 at 2:50 am

Post count: 5

#27003

Dear Sir,
I am a 53 year old woman from the UK who had a c5/6 fusion in 2013. I have slowly lost functional strength in my right hand and have confirmed rhomboid muscle palsy due to an ‘unknown’ dorsal scapula dysfunction. This makes it very difficult for me to hold up my head. I have quite severe upper back pain. The question is, I was told categorically that the loose screws in my neck (all) and the complete lack of fusion is nothing to do with my deteriorating condition. Would the lack of fusion etcetera be anything to do with this do you think? My G.P. has basically told me to get over it; however, I continue to deteriorate. I also have bouts of difficulty with swallowing (almost as if I’m having a stroke) and speaking also. I have chronic neurogenic changes on EMG but on repeat stimulation only (it does not show on single fibre). This is in the entire back area of my right back and shoulder and also in my hand. I look forward to any insight you can give me.
Yours truly

Donald Corenman, MD, DC
Moderator

December 9, 2017 at 5:01 am

Post count: 8660

#27004

There are many disorders that can cause your symptoms. One obviously would be the C5-6 pseudoarthrosis (“loose screws in my neck (all) and the complete lack of fusion”) as this level with a pseudo can cause spur formation that can recompress the C6 nerve and cause hand dysfunction. The loose screws can cause esophageal irritation and dysphagia (swallowing difficulties). See https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/ to understand what a C6 nerve can cause.

Also, there are syndromes that can cause muscle weakness like Parsonage Turner Syndrome (https://neckandback.com/conditions/parsonage-turner-syndrome-neck/) and some of the intrinsic nerve disorders but I would first focus on the pseudoarthrosis.

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.

Madoak
Participant

December 13, 2017 at 12:56 am

Post count: 5

#27038

Thank you so much for your response – it was very helpful and Inhave just had a CT scan. Hopefully now we can see the extent of the problem.

Donald Corenman, MD, DC
Moderator

December 16, 2017 at 10:31 pm

Post count: 8660

#27072

Please keep own contact to let the forum know follow-up.

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.

Madoak
Participant

January 17, 2018 at 2:38 am

Post count: 5

#27334

Hello Dr Corenam, this is an upadate of my current situation. I am due to see a neurosurgeon tomorrow to discuss the ct scan of my neck (loose screws and failure to fuse). In the meantime my previous orthopedic doctor asked to see the scan and came up with the following:
“…(there is) a halo around the screws in the more cranial vertebral body with asymmetry of the cervical disc replacement and lateral osteophytes on the left side. The problem is how to understand the relationship between this possible failure to fuse and therefore inter-segmental instability with pain from a focal lesion around the scapula, which, I cannot demonstrate.”
I think what is baffling the doctors is that all my symptoms are on, and always have been, on the right side, now resulting in a practically useless right hand, immovable right shoulder and therefore difficulty holding my head up. I have been tested for myasthenia and am negative. I had no health issues prior to my accident. I have a very high pain threshold and am more concerned about the neurological deficits as opposed to the pain, as these have a greater impact on my life. A thoracic surgeon is prepared to do an investigative procedure of the brachial plexus in February to determine whether the intitial symptoms were caused by thoracic outlet syndrome. I do have electromyography demonstrated by a pre-ganglionic lesion affecting the cervical myotomes. Perhaps now two problems? Thoracic outlet plus segmental instability caused by failure to fuse? Very hard to know how to approach the interview with the neurosurgeon tomorrow. Do you have any views on the above? Regards. Laila

Donald Corenman, MD, DC
Moderator

January 19, 2018 at 8:42 am

Post count: 8660

#27351

“A thoracic surgeon is prepared to do an investigative procedure of the brachial plexus in February to determine whether the intitial symptoms were caused by thoracic outlet syndrome”. This statement worries me. Is there a definite diagnosis of thoracic outlet syndrome or is this an “exploratory procedure” which draws a red flag?

Your next statement indicates a lack of a correct diagnosis (“all my symptoms are on, and always have been, on the right side, now resulting in a practically useless right hand, immovable right shoulder and therefore difficulty holding my head up”). A consultation with a careful, thorough neurologist would be the next step.

Diagnostic blocks (SNRB or TFESI) would be indicated to look for pain sources.

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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