Delaying Intervention?

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jmc118
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February 11, 2013 at 7:36 am

Post count: 1

#7971

Hello Doctor,

I have had escalating neck pain for 14 months. My family physician referred me to pain management Nov 2012. At that time I had an MRI. Here are the findings…

OSSEOUS STRUCTURES: There is a loss of lordosis and a moderate kyphosis of the lower cervical spine. Prominent disc space narrowing anterior, posterior, and uncovertebral osteophytosis is seen at C5-6 and to a lesser extent C6-7. Severe bilateral foraminal stenosis is present at C5-6. Moderate bilateral foraminal stenosis is present at C6-7.

INTERVERTEBRAL DISCS: There is a right paracentral extruded disc herniation at C4-5. This measures 7mm vertically by 5mm AP by 5mm transversely. This minimally abuts the anterolateral aspect of the cervical cord. A broad based spondylitic disc protrusion is seen at C5-6. This too minmally abuts the ventral aspect of the cervical cord. A shallow central subligamentous protrusion is present at C6-7 which closely approaches the ventral cervical cord.

SPINAL CORD/SPINAL CANAL: The cervical cord has a homogenous appearance. Borderline central canal stenosis is present at C5-6 and C6-7.

IMPRESSION:
1) Severe bilatral foraminal stenosis at C5-6.
2) Moderate bilateral foraminal stenosis at C6-7.
3) 7x5x5mm right paracentral extruded disc herniation at C4-5.
4) Broad based spondylitic disc protrusion at C5-6.
5) Shallow central subligamentous disc protrusion at at C6-7.
6) Borderline central canal stenosis at C5-6 and C6-7.

(Before relating the escalating neck/arm/back symptoms I’d like to mention I have had bilateral releases of the carpal and cubital tunnels (not by endoscopy). Right side in April 2012, and left side in Oct 2012. Other than slight pressure related tenderness at the palm incisions, these surgeries appear to be successful.)

I did receive 2 epidural injections. Nov 2012 at C7.1, and Dec 2012 at C5-6 after three failed attempts to catheter up to C4-5. Relief was minimal and short term.

At the onset of cervical symptoms I was having sporadic shooting/stabbing pain from the neck upwards in front of and behind my rt ear. Occasionally experiencing pain up the back of my head that actually brought tears to my eyes. The back of my rt shoulder blade area has been burning more or less consistently even before the pains up the neck began. The burning also at the top of shoulder area near base of neck. Then pain under both arm pits with radiating burning all the way across the clavicle area and corresponding anterior areas. Dull and sharp pins/needle sensation at base of throat moving up into jaw and sometimes the cheekbone. More prominent on rt side but the more I am using left to relieve the rt, left side symptoms are increasing. There are extremely sharp deep stabbing pains in the right anterior mid upper arm that progress around the elbow, deep into the forearm, and now often also include the wrist area at thumb and forefinger side. The rt arm, posterior shoulder, clavicle area, and back of neck hurt so much I am only getting about 3-4 hours sleep a night and often have to sleep sitting up in a recliner to relieve pressure. There is weakness in the rt arm at elbow, wrist, and when gripping with thumb as evidenced during clinical exam. Middle and ring fingers have no strength when splayed open. Spiking pains originating at the cervical spine are increasing, with the area staying sore 24/7. Sensations in the throat itself as if I can’t swallow properly are beginning to freak me out.

I recently saw an accomplished neurosurgeon at Texas Orthopedic Hospital in Houston, 100 miles from my home. After relating the above I was quite alarmed by his decision to send me home with a steroid pack, Mobic, and an order for PT to include ROM for rt arm and spine stabilization techniques. His clinical exam itself has put me in increased pain for several days so I am very nervous about being able to tolerate PT and doubtful of its necessity at this point.

Truthfully, after being sent home by this neurosurgeon my faith in his treatment plan that leaves me in physical distress is nil, and wondering if I should seek another opinion. I am very concerned about permanent nerve damage to my rt arm.

Your thoughts would be greatly appreciated.

Donald Corenman, MD, DC
Moderator

February 12, 2013 at 9:18 pm

Post count: 8660

#7996

Much regarding your symptoms pivots on your physical examination. If you have significant motor weakness, this would lead more to a surgical diagnosis. If weakness is minimal, conservative measures are the path to take, at least initially.

If you have already failed multiple attempts at conservative measures, then a surgical discussion needs to take place. This requires a careful assessment of your symptoms (neck vs. arm pain), what aggravates and reduces the symptoms (differentiation of disc pain vs. foraminal stenosis-nerve pain). Finally an understanding of what surgery will and will not do for you (a reasonable understanding that you won’t be perfect after surgery but better).

The fact that he did not jump into a surgical discussion is not a bad sign.

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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