Complicated Cervical Case

Tagged: Degenerative Disc Disease, facet hypertrophy, foraminal stenosis

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mtn_runner
Participant

May 18, 2017 at 10:08 pm

Post count: 2

#24814

Dr. Corenman,

I have severe foraminal stenosis, facet hypertrophy, and severe disc degeneration from C4-T2 with a bulging disc T1-T2. I also have severe uncovertable joint hypertrophy and an osteophyte complex which abuts the cord at C6-C7, plus numerous anterior bone spurs.
I had debilitating symptoms on the right side – arm, shoulder blade, hand, fingers — which were helped by a posterior laminoforaminotomy in 2015. According to the MRI I still have the severe stenosis on the right side, but it seems to be less symptomatic. However, in the last 9 months, I have had severe symptoms on the left — sharp arm pain, tingling, hand malfunctions, neck stiffness, shoulder blade shooting pain. I’ve had 3 facet injections and 2 epidural spinal injections just to be able to still go to work. I’m now getting aggressive with looking for operative treatment again. I’m very active — mountaineer, mountain biker, ultra runner (and haven’t been able to do any of these activities in almost a year) and depression is getting bad so I need to get this taken care of. My surgeon is talking about a complete neck fusion and I just don’t think that’s the answer considering it is obvious that I am genetically prone to disc degeneration since I have all these problems and am only 39.

I was wondering what you can suggest. I’ve been doing alot of research and I’m wondering about endoscopic foraminotomy to get rid of bone spurs and maybe part of that bulging disk. If fusion is required to reinforce structurally, I’m wondering about interlaminar implants or other devices. I’m willing to go to Europe where they have better hardware and more experience, but I just don’t know what I’m looking for.

Thanks,

Stephanie

Donald Corenman, MD, DC
Moderator

May 19, 2017 at 9:52 am

Post count: 8660

#24815

There are many questions that need to be answered. How bad is your degenerative disc and facet disease? Do you have a localized kyphosis (anterior angulation due to degenerative disc disease)? Do you have a degenerative spondylolisthesis (worn facets causing anterior slip-see website). Do you have instability of any level (more than 3.5mm of forward/backwards motion at any one level on flexion/extension x-rays)?

Is there any specific level worse than any other levels in the way of foraminal stenosis or central stenosis? Does the physical examination note focal compression at any particular nerve root noted by weakness of that motor group (or spinal cord compression with long tract signs and myelopathy-see website).

I’m going to assume that you probably need a reconstruction of your neck and the endoscopic foraminotomies are not going to be enough to repair your neck based upon the very limited information I have. You can determine what range of motion (ROM) you might lose based upon flexion/extension x-rays and measurement of ROM of the specific levels that might be addressed by reconstruction surgery.

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.

mtn_runner
Participant

May 19, 2017 at 10:12 am

Post count: 2

#24817

Reconstruction….lovely.

While I can’t positively answer your questions, I do know that my neck is currently very stable. That always comes out in the “look on the bright side”.

I do have foraminal stenosis worse at some levels than others, however, it’s just a matter of time until the less severe levels become severe. I don’t know exactly how bad the discs have degenerated (percentage wise), the MRI just always says “Severe”.

What would neck reconstruction consist of? I did a google search but it doesn’t tell me too much since most people get it once they have tumors removed. I’m guessing multiple surgeries over multiple years? What would be the least committing way to start out — ie could I attack two of the worst levels first and then see if that holds me over for a few years? The thing that keeps me a little hopeful is that even though the MRI states that the right side is horrible in terms of stenosis and hypertrophy, I don’t have horrible symptoms on the right anymore. Only nagging pains. Finally…who would I see about this since I’m guessing not just any ortho spine person could handle this case?

Thanks for all your advice. Now I have more things to look into. It’s all about figuring out what you don’t know, right?

-Stephanie

Donald Corenman, MD, DC
Moderator

May 19, 2017 at 5:13 pm

Post count: 8660

#24836

To reconstruct the neck, a number of questions have to be answered. Mainly, what structures are causing the most pain by history, physical examination and imaging.

An example is if you might have 50% neck pain and 50% right arm pain. The right arm pain is caused by foraminal stenosis of C5-6 and C6-7 and these discs are collapsed (less than 50% of normal height left) with Modic changes (endplate fractures of the C5-6 and C6-7 vertebral bodies). Most likely the neck pain is generated for the most part from the C5-7 levels. The C4-5 level is “OK” and C7-T1 does not have a significant slip. You would be a candidate for a 2 level ACDF at C5-7. If the discs still had greater than 50% height, you could be a candidate for a two level ADR (artificial disc replacement). This is how the surgical plan is put together.

I know you don’t want a fusion but if the flexion/extension X-ray views note little to no motion at the most significantly degenerative levels, fusion of those levels should not cause diminished range of motion.

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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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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Complicated Cervical Case – anti-fusion