Complex situation and really needing some input. Respect your expertise.

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MaryJane12
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August 29, 2016 at 12:43 pm

Post count: 3

#22861

I was recently found to have whats called a ponticulous posticus, which is a ossicification of the arch covering the vertebral artery. I also was born without my posterior communicating arteries. Current symptoms dizziness, blurred vision, vague headaches, neck pain, pain in left shoulder/arm, feeling as though hairs brushing against both arms at times, feeling of instability, occipital pain, spasms, ringing in ears at times, mental fogginess. It began with dizziness a swaying unsteady feeling, headaches, blurred vision (4 years ago). At that time flexion extension x ray was in good alignment, but arthritis DDD present and mild to mod forminal narrowing and bone spurs. I initially saw a ENT that ordered vestibular testing. When the tech put me in the dix-hallpike position it ellicited a similar type dizziness so she stopped and they sent me to a neuro to rule out vertebral insufficiency. (Could the current finding of ponticulous posticus be impinging on the vertebral arteries?) Due to a history of migraines he labeled it that without further testing. The dizziness continued and I started to develop neck pain with terrible trap spasms. I went to cleveland clinic to see an otoneurologist who thought I could have had a viral infection had some point and possible occipital neuralgia. None of his treatments helped. He also thought is could possibly be coming from the neck. I had been waiting to get into a local otoneurologist he first diagnosed me with dystonia. When botox didn’t help he ordered his own vestibular testing. All was normal except the dix-hallpike. When the tech did it I had abnormal nystagmus not the kind seen with crystals in the ear. He said it would be up to the doctor to figure it out. An MRI of the brain he ordered showed
A few punctate periventricular and subcortical white
likely of no clinical significance. They can also be seen with
chronic microvascular disease or demyelination. Clinical correlation
is recommended. No dominant masses are noted.

Here are the findings of the vestibular testing:

Interpretation: Abnormal neurovestibular test battery because of constant (non-paroxysmal)
oblique (rightward & upward beating) nystagmus in the head hanging right position; constant
(non-paroxysmal) mixed rightward beating and counterclockwise torsional nystagmus in the
head hanging left position; and prolonged rightward beating optokinetic after nystagmus.
These findings suggest a nonspecific vestibular disturbance without loss. I see on MY CHART on line he has it list as CENTRAL IN ORIGIN

It took several weeks for me to get the doctor to call me with these results. To be honest this doctor has a very big ego and is very difficult to work with. When he called he rattled off the results and that was it. I wasn’t seen by him for six months. When I saw him he gave me a diagnosis of Mal de debarquement and did not offer any treatment. He just told me let me know when it goes away. He sent me to a neurologist to try to get my muscular issues under control. He started doing trigger point injections, botox, and some occipital blocks. Things got a bit better, but I was still struggling. I do have arthritis in my neck and I was in a recent auto accident which made things much worse. I suffered a concussion in that accident. I just had a recent MRI which showed:

C2-C3: There is no significant disc protrusion, spinal canal stenosis or
neural foraminal narrowing.
C3-C4: There is no significant disc protrusion, spinal canal stenosis or
neural foraminal narrowing.
C4-05: Degenerate disc disease with disc height loss and desiccation
shallow disc osteophyte complex measures 2 mm. No spinal canal stenosis.
Moderate to severe left neural foraminal stenosis secondary to
uncovertebral hypertrophy.
C5-C6: Moderate DDD. Disc osteophyte complex measures 2 mm. No
significant spinal canal stenosis. Mild bilateral neural foraminal
stenosis secondary to uncovertebral hypertrophy.
C6-C7: Mild DDD. Disc osteophyte complex measures 2 mm. No spinal canal
stenosis. Minimal right neural foraminal stenosis secondary to
uncovertebral hypertrophy.
C7-T1: There is no significant disc protrusion, spinal canal stenosis or
neural foraminal narrowing.
IMPRESSION:
Multilevel degenerate spondylosis of cervical spine without high-grade
spinal canal stenosis. Multilevel bilateral neural foraminal stenosis,
including moderate to severe left C4-05 neural foraminal stenosis. Please
see above for level by level description

Flexion Extension X-Ray
Study Result
Impression
1. Anterior subluxation of C3 on C4 during flexion which reduces upon extension.
2. Posterior subluxation of C4 on C5 during extension which reduces upon flexion.
3. Stable slight retropulsion of C5 on C6 during flexion and extension.
4. No acute abnormality by plain film imaging. Disc space narrowing at C4-5 and C5-6.

CT while in ER after accident showed severe left sided neural forminal narrowing C5-6 and multilevel DDD

I had a DMX motion xray that showed: (I know you are not fond of this exam, but since it was done here are the findings)
In the lateral nodding projection movement at the atlanto-occipital articulation is hypermobile. Increased mobility at occipito-atlas joint C0-C1. Hypermobility of C1-2 noted. Damage to the posterior longitudinal ligament is indicated by a widening of the posterior intervertebral disc space at C2-3 and C3-4. Damage to the anterior longitudinal ligament is indicated by a retrolisthesis at C2 on C3, C4 on C5, and C5 on C6 and anterior widening of the intervertebral disc space at C2-3 and C3-4. Damage to the capsular ligament is indicated by gapping of the facet joing at C4-5 on the left and C5-6 on the left. Damage to the capsular ligament is indicated by hypermobility of the facet joint at C4-5 on the left and C5-6 on the left.

I am having a lot of neck pain currently and having to take pain medication. I am a RN and recently had to resign from my position that required a lot of driving due to my limited neck mobility. I find that in order to see I have to turn my whole upper body. It is greatly affecting my quality of life and I am unsure where to go for answers at this point due to so many specialty areas. I am wondering if you feel this is coming from the neck with the flexion extension xray findings and MRI. I would also like to determine if I have damage to the upper cervical spine or just lower.

Thanks
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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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