Define disc and spine issues

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Tara
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September 28, 2011 at 7:30 am

Post count: 6

#4947

Hi Dr.

I am trying this website, I found your information on youtube and have now ordered your book.

I am trying to find insite and help with my neck pain. I have had neck pain for many many years. In 2008 it got progressively worse. When i raised my arms above my shoulders i collapsed in excruiating pain. Xrays and CT scan to not reveal or determine cause.
MRI : C4 C5 – minimal disc bulge,no ventral stenosis,minimal bilateral foramininal narrowing seen secndary to uncontreebral hypertrophy
C5-C6 -there is a small central and right paracentral broad based disc protusin. Mild right paracentral stenosis is seen with mild mass effect on the antero right lateral aspect of the cord. Minimal right forimal narrowing is seen secondary to uncontrvertebral joint hypertrophy. No left forminal narrowing.

Have done Chiro and Physio for past 3 years. Had a relapse in January 2011 when my left side went numb and I fell. Doctor did xray and then asked if I was depressed… So i have been just working thrugh the pain.

May 2011 i slipped on a floor in a bathroom when the toilet leaked at a hotel i was staying at.

Since this time i have had excrutiating neck pain, xray showed : cervcal Kyphisis centered at the level C5 with mild degenrative disc change at C4-5 and C 5-6 . No fracture/dislocation. The oblique views show no foraminal stenosis.
If patient shows clinica findings of nerve root impingement then MRi should be dne for follow up.
My doctor has ordered MRI scheduled October 2,2011.
My summer has been very difficult and i have not been able to carry on with my daily activities. My left arm has had extreme pain , tingling pins and needles, when i sleep a certain way,range of motion in my neck is difficult to bend backwards, turn to the left. Sitting for long periods makes it worse.

Can you please advise me as to the proper questins i should ask my doctor when i meet to review my MRI results? I am supposed to have an EMG, will this show or help determine another issue.
I’m sure you have been witness to many patients having longterm pain. Could the above issues be the cause of this severe pain. I am currently on medicine that helps reduce it and rates from a 8/9 pain to a 7/8 depending n the day. I am told i can no longer use ibuprofen/acetIminphen due to long term effects on my body.
Thank you for your advice and answers to my questins.

Donald Corenman, MD, DC
Moderator

September 28, 2011 at 8:56 pm

Post count: 8660

#4950

You report neck pain for many years that has increased in intensity. You then report an injury fall after your “left side went numb and I fell”. Your report significant pain and paresthesias (pins and needles) in your left arm and you cannot bend your head backwards or to the left.

You have an older MRI that notes cervical kyphosis at C4-6 with degenerative disc disease at those levels. You have “minimal” foraminal stenosis at C4-5 bilaterally and a broad based bulge at C5-6 with minimal right and no left foraminal stenosis.

To let you know, kyphosis normally goes hand in hand with degenerative changes. Your symptoms can be generated by your neck. Some individuals have very sensitive pain component nervous systems and these tears in the disc wall can cause local neck pain. The left arm symptoms are harder to understand as the old MRI report does not note significant nerve compression (foraminal compression) but if the arm symptoms are of more recent vintage, a new MRI might reveal newer anatomic changes. I am also reluctant to read an MRI report and accept the conclusions at face value.

The fall from left sided numbness does not fit well with a neck origin unless the numbness was only in your arm and your arm gave out when you grabbed something to prevent the fall. Numbness in your leg would not fit with your neck disorder.

You need a good spine specialist to look you over and figure this out.

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.

Tara
Member

October 4, 2011 at 2:29 am

Post count: 6

#4969

Dear Dr Coreman

Thank you for your reply. The doctor i met with at my clinic has ordered an MRI. I have completed that and am awaiting the results. I am not sure what level of care I wil recieve regrading my neck pain from this physician, as I do not thik he fully undestands the pain I suffer daily. My physio therapistsrecommendation wasto discuss with my doctor the possibility of taking sometime away from my job to help reducethe inflamation and get my neck to the proper postural position as it is in the forwrd position now t reduce pain. My doctors answer was t increase the amount of medicatn im currently taking which makes me feel slow.
I feel a family physician may not have the time available or level of expertise to help me deal with this issue. I am not sure how to ask for a referral to a specialist. If I do ask please provide me with your recomendationa :

I do currently have a neurologist I see for my migraines
We do have Orthopedic specilaists. But im not sure if there are spine specilalists.

Thank you once again for reviewing my questins. I appreciate all the great information you have provided on this site. It is sometimes hard to explain how painful my neck is especialy if the MRI shows disc bulge/ protusins again. I feel I will have to contnue to just suffer.

Donald Corenman, MD, DC
Moderator

October 4, 2011 at 10:03 pm

Post count: 8660

#4971

It is a possibility that your new MRI may shed some light on your pain generators. If you do not have a spine surgeon you can consult, look for a PM&R doctor that specializes in spine treatment.

Good luck.

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.

Tara
Member

October 19, 2011 at 1:03 pm

Post count: 6

#5019

Dear Dr Corenman,

Thank you for your replies to my inquiries.

I have received a copy of my results

There are early degenerTive changes with large bulging disc at C5 C6 abutting central aspect of the cord and pssibly causing compression of the right nerve root.there is moderate narrowing ot the neural foreman.

I am still waiting for a call from my doctor to discuss the results. The clinic has said he woukd phone if he feels the need to follow up.

Can you please explain what the follow up on the above reading means to my health and what questions i should be asking. The MRI was well over 3 weeks ago and no response my doctor yet.
Thank you

Donald Corenman, MD, DC
Moderator

October 19, 2011 at 10:11 pm

Post count: 8660

#5025

The MRI findings of compression of the right C6 nerve root and possibly the central cord can lead to arm pain and/or symptoms of myelopathy. Please read the website under cervical radiculopathy (arm pain) and myelopathy (spinal cord compression) to see if any of those symptoms would fit with what you are experiencing currently.

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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