direct cord contact relevant within cervical spine

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justenough
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October 1, 2014 at 1:12 pm

Post count: 12

#11492

I am editing this message as the board doesn’t accommodate the image file, and I sent the images to your email instead and received a response from your assistant that you will be looking over them as time allows, and understand how busy you are and the amazing service you provide to all of us. you are a remarkable Doctor & surgeon….I think they broke the mold after you !

Donald Corenman, MD, DC
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October 13, 2014 at 8:00 am

Post count: 8660

#11515

Your symptoms could certainly be from myelopathy but this disorder requires significant cord compression.

Your notation “my last MRI before this one showed the C5-6 disc actually slightly indenting the spinal cord and in this more recent MRI of my neck- I do not see the disc actually touching, yet the spinal cord is more pushed in now then it was last year” is difficult to understand. You might have a more deformed spinal cord from instability of this level. Flexion/extension X-rays would be helpful to rule this in or out.

There are other disorder that can cause imbalance including “inner ear” disorders, metabolic disorder and other (MS, etc..).

If you do have myelopathy, a physical examination would demonstrate long tract signe (hyperreflexia, clonus, Hoffman’s sign, Positive Rhombergs sign among others). You need to see a good spine surgeon for these symptoms.

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.

justenough
Member

October 13, 2014 at 1:06 pm

Post count: 12

#11517

“Your notation “my last MRI before this one showed the C5-6 disc actually slightly indenting the spinal cord and in this more recent MRI of my neck- I do not see the disc actually touching, yet the spinal cord is more pushed in now then it was last year” is difficult to understand.”

The cervical spine images on the MRI from last December ( not the recent one you viewed ) showed the C5-6 Disc actually making contact with the spinal cord at that level, and the cord itself was slightly indented.

This recent Cervical spine MRI that you were able to view does not show the C5-6 region making actual contact with the spinal cord in that area, however, the spinal cord at C5-6 region looks more deformed / compressed NOW, then it did in last December, and yet the recent images ( the ones you viewed ) do not show the C5-6 disc making contact with the cord.

I just wondered how the spinal cord could look so much more / indented compressed NOW in recent films with no actual cord contact. I hope I explained well.

“If you do have myelopathy, a physical examination would demonstrate long tract signe (hyperreflexia, clonus, Hoffman’s sign, Positive Rhombergs sign among others). You need to see a good spine surgeon for these symptoms.”

I do have hyperreflexia ( no clonus in the feet, but my hands and fingers shale when my wrists are bent – whatever that is? I do not have hoffman’s sign, but a side note- my Father has myelopthy and does not have babinski, or hoffman’s sign ) I definitely have positive rhombergs sign- and also feel vibration, electricity like feeling and weakness in arms and legs. ( I don’t know what that could mean, or where its from- and I understand I could have disequilibrium from inner ear- I also want to mention- a long with this recent cervical spine MRI you viewed, I had thoracic and lumbar spine as well……the Lumbar dictated report said:

Findings:
Thoracolumbar dextroscoliosis is demonstrated. Vertebrae have normal height and marrow signal.

T12-L1 level: Disc herniation extends superiorly from the disc space posterior to the T12 vertebra over a distance of 2.1 cm, seen in sagittal T1 #5/11 consistent with large extrusion of the disc
herniation indenting the anterior thecal sac producing mild central stenosis.

Axial slices are not available through this level.

L1-2, L2-3, L3-4 levels: No herniated nucleus pulposus or significant central spinal canal stenosis.

The neural foramina appear essentially patent. The facets appear unremarkable.

L4-5 level: Loss of disc hydration. Disc bulge effaces ventral epidural fat indenting the anterior thecal sac. Posterolateral disc bulge in combination with facet arthropathy narrows the neural
foramina.

L5-S1 level: Disc bulge effaces ventral epidural fat. Facet arthropathy is noted bilaterally. Neural foramina are patent.
The conus medullaris and paraspinal tissues appear unremarkable.

The cervical spine dictated report said:

Findings:
There is upper cervical dextroscoliosis and cervicothoracic levoscoliosis.

Vertebrae have normal height and marrow signal.

C2-3, C3-4 levels: No herniated nucleus pulposus or significant central spinal canal stenosis. The
neural foramina appear essentially patent. The facets appear unremarkable.

C4-5 level: Posterocentral disc herniation indents the anterior thecal sac extending across the disc space over a distance of approximately 8 mm, seen in sagittal T1 image #8/13. Neural foramina are
patent bilaterally.

C5-6 level: Broad based disc bulge indents the anterior thecal sac producing mild central stenosis and cord deformity. Hypertrophic facets and ligamentum flava indent the posterolateral thecal sac.
Neural foramina are patent.

C6-7 level: Diffuse circumferential disc bulge indents the anterior thecal sac. Neural foramina are
patent.

C7-T1 level: No herniated nucleus pulposus or significant central spinal canal stenosis. The neural
foramina appear essentially patent. The facets appear unremarkable.
The cord signal, posterior fossa structures and paraspinal tissues appear normal

I wish I could get a flex- extension MRI of the cervical spine- because I do feel there is an instability there- but I’m afraid to ask for one……” the neurologist I was seeing who did the EMG’S which were abnormal – the EMG’s he performed himself. he said the upper extremities showed chronic C5-6 radiculopathy…

The lower extremtities showed L5-S1 chronic radiculopathy ( that EMG was before the T12-L1 disc issue as shown in the recent MRI I added the report to here above ) also it showed periphreal neuropathy.

I also wish someone would measure in mm the C5- 6 regions and the stenosis at that level…….I have a plastic mm measuring device and if I knew what points to measure I would …..thank you so much for any further info.
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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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