Daily upper neck & occiput pain

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Littleshell09
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October 18, 2014 at 9:32 pm

Post count: 7

#11556

Dear Dr Corenman;
First of all, I’d like to take a moment to thank you for your expertise & advice. I had lumbar instability with severe pain & difficulty walking. With a 7 mm slip on dynamic x-rays on flexion & 4 mm on extension I’d found surgery to be an option. I’m so glad I did. The first 3 weeks felt awful but by week 4 I was out walking & week 6, I was up to 3 miles/day. I would have loved to come your way but insurances being what they are…
On to my next issue. I was having the upper cervical pain concurrently with the lumbar pain but since my legs had so much pain went with that first. My post op meds did a wonderful job at treating the neck pain, it was joy to be able to sleep at night! They only offer pain meds for 90 days post operatively, so now I’m back to daily & nearly unrelenting pain in this region. In addition, significant grinding, cracking, crepitus in the C1-2 area with neck movement. Diagnostically, CT scans showed severe degeneration of C1-2 with one radiologist noting concerns with articulation there. The Os had a linear lucency, with sclerotic margins suggestive of non-union or “congenital anomaly” unspecified. I also have a 3mm anterolisthesis of C3 on C4, C5-7 are already fused. The ROM side to side is very limited, while flexion/extension is fair with extension being the most uncomfortable of the two. I do get pain in my R arm. I also feel & hear a “snapping” sensation in my occiput at times & kind of a clunking sensation at the joint. Several times a day the area sounds like stepping on twigs with accompanying discomfort. The pain is the worst at night, and as alluded to earlier gives me a hard time sleepwise. Of NSAIDS, ASA seems to work the best although my history with NSAIDs has led to severe esophagitis/gastritis so I feel a bit concerned taking them for any length of time. So bottom line, what are my options? I use ice/heat, PT, TENS, gentle stretching, acupuncture, meditation, etc. It feels embarrassing to say this, but there are times at night where I literally wish I’d just die. It’s THAT bad. Pain pattern is right sided upper neck, into occiput, radiating into R ear, R jaw & now a throbbing of R neck in general. I’ve been waiting to see Pain Management now for 6 weeks & that’s just to schedule an initial appointment. The sensations I’m feeling & sounds I’m hearing are causing me to feel nervous. If opiate therapy was helpful & I have no history of addiction, why is it so darn hard to have them prescribed? I’ve literally explained that I’m suffering, which isn’t a word I use lightly.
Once again,
Respectfully,
Thank you for your thoughts!

Donald Corenman, MD, DC
Moderator

October 20, 2014 at 12:34 am

Post count: 8660

#11559

C1-2 arthrosis (arthritis or wear of the joint surfaces) is a painful condition that causes base of skull pain and pain that radiates up into the ear region. The pain increases with motion and can wake you up at night.

The diagnosis (and potential management of this disorder) is facet blocks of these joints. A diagnostic block (pain relief for the first three hours) confirms the diagnosis. Hopefully, long term relief can occur with the steroid included in this facet block.

If only temporary relief is noted, a fusion of the C1-2 joint generally will give relief. There might be some loss of range of motion (rotation of the head on the neck) as a consequence of this fusion but the trade-off is pain reduction.

This injection needs to be performed by a skilled and experienced injectionist, not someone who has limited experience with this area as it is technically demanding.

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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