Dizziness, Spams, Arm Pain, Neck Pain, Motion Intolerance

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westie California
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August 21, 2014 at 12:54 pm

Post count: 138

#11317

Hello Dr,

I had a head trauma 10 years ago fell off ladder hitting back of head (12ft). Head imaging (MRA, MRI, CAT Scan)all negative. IAC negative.

MRI- C4/5 Disc Herniation deforming thecal sac with bilateral neural foraminal narrowing, increased conspicuity on extension view and decreased conspicuity on flexion view

C3/4, C5/C6 and C6/7 Disc bulges with C3/4 right neural foraminal narrowing

C2/3 Bilateral neural foraminal narrowing

Cervical spine straightening

T2/3, T3/4,T7/8 and T8/9 Disc herniations deforming thecal sac
T4/5,T5/6 and T6/7 Disc bulges

Surgery:

ACDF with instrumentation C5, C6 OCT 2012

ACDF with instrumentation C3,C4, C7 Aug 2013

Laminectomy C3-C7 with bilateral instrumentation Aug 2013

I am still having headaches, dizziness, left arm pain, lack of range of motion, spams and motion intolerance. I have received nsaids, muscle relaxants, physical therapy, trigger points with no long reliefs. The headaches radiates on one side only. My neurologist ordered an MRI and came back with the following:

1.straightening of the normal lordosis

2.C3 productive changes of the posterior elements mildly impinging the posterior aspect of the spinal cord

3.C3-C4 mild productive changes of the joints of Luschka and facet joint degenerative changes causing mild left neural foraminal narrowing

4. C4-C5 mild productive changes of the joints of Luschka especially on the right

5. C6-C7 mild productive changes of the left facet joint causing mild left neural foraminal narrowing

6. C7-T1 productive changes of the joints of Luschka together with facet joint degenerative changes causing mild left neural foraminal narrowing

My question is what are my options? Thannks

Donald Corenman, MD, DC
Moderator

August 23, 2014 at 12:00 am

Post count: 8660

#11322

Well-falling 12 feet and impacting the back of your head without a skull fracture or brain injury is lucky in itself.

I am confused. You had initially undergone an ACDF at C5-6 and then C3-4 but you reported a disc herniation at C4-5 “deforming thecal sac with bilateral neural foraminal narrowing”. Why were the initial surgeries above and below the level of C4-5 where you had a herniation?

You underwent a laminectomy with posterior fusion at C3-7 after the other two surgeries. Why? Was there central stenosis and cord compression?

Your lack of range of motion develops from two sources. First obviously, you have a fusion of C3-7 which will reduce motion.

Second, I suspect is degenerative facet disease at C2-3 and possibly higher (“C3 productive changes of the posterior elements mildly impinging the posterior aspect of the spinal cord”). I will assume that “productive changes” are bone spurs and bone spurs are indicative of facet degeneration.

Facet degeneration will reduce range of motion also. Careful visualization of the occiput-C1 and C1-2 facets would also be important to look for degenerative changes.

As far as the left arm pain, you have some residual compression of the left C7 and C8 nerves but this is “mild” and with a fusion to C7, the C7 nerve should not be involved. However, the C7-T1 level still moves and nerve pain can be generated from that level.

A selective nerve root block of an individual nerve (see website) will help identify the pain generator. It is a matter of understanding why this nerve is still sensitive to help ameliorate this matter.

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.

westie California
Participant

August 27, 2014 at 11:06 am

Post count: 138

#11351

Thanks could you tell from MRI what is causing dizziness and headaches? My headaches are mostly in back of head on right side (occipital). The left bicep pain comes and goes and worsens if I sit or stand for long period of time.

What are my treatment options if pt and medications don’t work? Thank you very much Dr. Corenman! Have a great night.

Ashley

Donald Corenman, MD, DC
Moderator

August 27, 2014 at 8:58 pm

Post count: 8660

#11352

Headaches have many sources from post-concussive syndrome (hitting your head) to facet arthritis of the upper cervical spine. I cannot begin to tell you the headache source with the limited information available.

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.

westie California
Participant

August 28, 2014 at 10:06 am

Post count: 138

#11358

Last questions Dr and thanks for your time.

What can be done to Luschka and facet joints neural foraminal narrowings and is C3 impinging spinal cord a concern? I appreciate all your help,

Ashley

Donald Corenman, MD, DC
Moderator

August 29, 2014 at 8:53 pm

Post count: 8660

#11361

Anytime the spinal cord does not have adequate room, this is a concern. The vertebral segments are mobile and extension (bending the head backwards) will narrow the spinal canal. A forced extension (impact on the front of the head) can pinch the spinal cord and cause an injury (central cord syndrome-see website).

Foraminal narrowing is not as significant but can also cause radiculopathy (dysfunction of the nerve root). This includes pain, numbness, paresthesias (pins and needles) as well as possible weakness if the nerve root supplies major muscles. The C2-3 level does not supply any major muscles but does turn into the lesser auricular nerve which winds around the ear. Compression of this nerve can cause headaches in this region.

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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