Facet Joint Disorders

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diybob
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December 28, 2012 at 4:48 am

Post count: 6

#7651

Dear Dr. Donald Corenman

For a long time (2 years) I’ve been experiencing neck pain from an injury type whiplash. Along with the neck pain I’ve been experiencing headaches at the base of my skull and other symptoms in my head (ear, face, jaw, eye & dental pain, dizziness, nausea, blurred vision and my worst symptom tinnitus). These symptoms are not present all the time they seem to come at different times but my neck pain at the base of my skull along with my tinnitus is always present. The tinnitus seems to change sound levels and pitch with the amount of neck pain I’m feeling.

The fusions from C3 through C6 have fixed the numbness problems in my hands and arms but have not fixed the symptoms I mention above, tinnitus being the worse.

After my surgeries the MRI and CT scan report states: “C2-C3 There is mild facet Arthropathy, greater on right. Minimal right neural foraminal narrowing is present. The central canal is remarkable. But does not report any major Damage to my facet joints.

I’ve had 2 cervical facet blocks between C2-C3. After a few days my symptoms and pains pretty much go away and my tinnitus becomes tolerable. This relief will only last a short time and I’m back to the pains I’ve described above. I have a C2-C3 Facet Rhizotomy scheduled for Jan 14.

The Pain management doctor thinks that my tinnitus and some of my other symptoms could be coming from C1-C2 Facet Joint.

What would you recommend to repair or relieve the symptoms caused by the Facet Joints between C1-C2 and C2-C3? Is there anything that can be done without major surgery as a permanent fix or possibly a long term relief?

Any help will be much appreciated,
Robert

Donald Corenman, MD, DC
Moderator

December 28, 2012 at 7:14 am

Post count: 8660

#7652

In general, tinnitus does not originate from the cervical spine. The acoustic cranial nerve does not exit the skull. There may be some feedback that can occur from other tracts that drop down below the base of the skull (foramen magnum).

Base of skull neck pain and back of the head headaches commonly do originate from the facets at C1-2, C2-3 and C3-4. Your CT report does note arthropathy (arthritis) of the C2-3 joint and this can cause some of your symptoms. You have a fusion of C3-4, so we can rule out that level as a cause of pain.

Since you have had diagnostic blocks of C2-3 that relieved your pain, the rhizolysis of the facets you have planned is a good next step. That is if you had a good 2-3 hour window of relief immediately after the facet injections (see pain diary).

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.

diybob
Member

December 29, 2012 at 2:03 am

Post count: 6

#7655

Dear Dr. Donald Corenman thanks for the reply and taking the time from your schedule, it’s much appreciated. There are not many doctors who would give this type of service, again thank you. By the way my son has nothing but great admiration for the clinic and Dr. Hawkins who performed surgery on his shoulder, no problems playing baseball since 1997.

Yes, I had good 2-3 hour window relief that lasted for several days and my tinnitus became tolerable, but not completely, this is why I feel there might still be a problem at C1-2.

I’m an engineer type and always seeking a solution and feel necessary to have a plan B. This is my way of coping and living with these crazy pain symptoms.

I’ve read there are only a handful of practitioners having the skills needed to inject at C1-2. If my symptoms are coming from C1-2 is it possible to do a Rhizotomy at this joint to get long term relief?

I have been told there are no nerves at C1-2 facet joint to burn. If this is true and from your experience what can be done at the C1-2 facet joint to get relief?

Thanks again,
Robert

PS I’ll also send you by email information regarding the connection sensory input from the facet joints at C1-C2, and C2-T2 intraspinal pathway from the Tinnitus Research Centre, Wantirna, Australia. This is possible proof of my facet joint injury relation to my tinnitus and vision problems. Please let me know what you think.

Donald Corenman, MD, DC
Moderator

December 31, 2012 at 1:25 am

Post count: 8660

#7658

C1-2 does have pain and sensory nerves and can cause base of skull pain as well as headaches. There is an individual in Denver that I use to inject the C1-2 joint and he is very competent. You can call the office at (970) 476-1100 to get his name and number. I have yet to refer a patient for a C1-2 rhizotomy but under skilled hands, I believe it could be completed.

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.

diybob
Member

December 31, 2012 at 1:54 am

Post count: 6

#7661

Dr. Corenman, thank you for the help. You’ve given me my plan B but I’m hoping the Jan 14th Rhizotomy will do its job and I won’t have to go to plan B.

Happy New Year to you and your family!

Thanks again,
Robert

Donald Corenman, MD, DC
Moderator

December 31, 2012 at 1:57 am

Post count: 8660

#7662

Thank you. Have a great New Year and may next year find you both healthy and happy.

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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