Facet Joint Disorders

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diybob
Member

February 10, 2013 at 12:18 am

Post count: 6

#7954

Dear Dr. Corenman

First of all I want to thank you again for taking the time to talk to me and answering my questions, it much appreciated.

The blocks at C2-C3 had significantly reduced my pains along with my tinnitus, but the Rhizotomy (RF) that was performed on Jan 14th did not help, it actually made some of my symptoms worse and has created new pain symptoms.

Even though the RF did not help and was not effective as the blocks, I firmly believe my problems are coming from the facet joints (I’ll send you my facet block diary via E-mail). I’ve read that Rhizotomy’s are not 100% effective nor are they a permanent solution.

I feel very confident that the causes of my problems are coming from the C2-C3 facet joints. Unfortunately most data recommends a fusion. After 3 fusion surgeries this scenario is not appealing.

I have a few questions:

• Ruling out fusion surgery as an option, what can be done to fix the C2-C3 Facet Joints?

• Is there a minimal evasive way to fix the C2-C3 facet joint and foraminal narrowing as described in my 10-09-2012 MRI?

• I’ve heard of “Endoscopic Facet Debridement”, do you perform this type of surgery?

Best regards,
Bob Pone

Donald Corenman, MD, DC
Moderator

February 11, 2013 at 12:08 am

Post count: 8660

#7967

Cervical arthrosis (C2-3 facet degenerative change) is a disorder that has only three options, injection, rhizotomy or fusion. This would be similar to treatment of a severely arthritic knee except that the knee can have an artificial joint placed (of which there is no good replacement for the facet joints) while the facets can have an RF procedure (of which the knee cannot).

The RF procedure can be repeated and the success rate is operator dependent. Endoscopic facet debridement is a procedure that has not been studied and there is very little room to put a scope in this joint. I would not prescribe it at this time.

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

February 11, 2013 at 1:16 pm

Post count: 6

#7973

Dear Dr. Corenman

Thanks for the reply. I guess I was hoping to hear better news regard my options. I was hoping that you performed some type of endoscopic surgery. The thought of another fusion is a hard pill to swallow.

I don’t know who to turn to anymore, it seems I’ve ran the Doctor gauntlet. I’ve been dealing with this pain for over 2 years. Nothing seems to be working. The RF is a disappointment and to me it’s a hit and miss situation and not a permanent solution.

I’m an active person and it’s hard for me to think that I’ll have to deal with this pain and tinnitus for the rest of my life. For me this will be a devastating life style change. With each fusion I lose mobility and there’s no guarantee it will work. I guess I’m looking for some type of hope or a way out.

I did find a doctor doing minimally invasive surgery in my area. I believe this option is worth considering before choosing fusion. I’d like to get your opinion of this doctor’s surgical Endoscopic Facet Debridement technique.

I’ve searched the internet and have only found a few doctors performing this type of specialized surgery. Spine Centers of America in NJ, Laser Spine Institute in AZ and Coast Spine, Dr. Tony Mork in Newport Beach, CA. Coast Spin is in my area.

Please review the Endoscopic Facet Debridement video link that I sent you via email. Kristin said she will forward them to you and your team.

I respect your opinion and would like to know what you think.

You help is much appreciated.

Thanks,
Robert Pone

Donald Corenman, MD, DC
Moderator

February 11, 2013 at 9:48 pm

Post count: 8660

#7978

If this was my neck, my plan would be this. I would have another RF procedure by an individual who has a great track record as this is the most benign procedure out of all of them.

If not and I was focused on “debridement of the facet” (which I am personally not), I would do my best to find who had the most experience and success rate. The problem is that you will not find these statistics and typically, these individuals might be over-enthusiastic in regards to their results.

I am not sure if this debridement procedure is a benign procedure but if you are looking at a fusion, I don’t think you burn any bridges by having this done (other than the potential complications of this procedure and costs involved).

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

February 11, 2013 at 11:51 pm

Post count: 6

#7979

Thanks Dr. Coreman

My primary doctor thinks it’s too risky and has the same opinion and advice you gave me. But he’s not the one who spends many sleepless nights in pain along with this crazy sound in my head. I can’t go to sleep without my transistor radio in-between stations. I need to hear the static sound because it brings comfort. I need sound all the time. My quality of life is at an all time low. It’s difficult to plan family activities or vacations because I don’t know how I’m going to feel. I think if it was just the pain I could deal with it, but the tinnitus and nausea sometimes are overwhelming. What’s frustrating is how complicated my condition is and doctors don’t have solutions nor know how to treat me, it’s like a mystery novel that has no end. Sorry to complain.

I see my orthopedic surgeon next week and will explain your concerns, advice and consult with him about the debridement procedure. I guess from there I’ll make a decision.

I live in Orange County, CA could you recommend a RF doctor who has a great track record? In the meantime I’ll search. Any tips on searching for a good RF doctor?

Thanks again for your time and replies.

Best regards,
Robert Pone

PS Dr. Coreman you are very unique and I applaud you for giving time in helping people. You’re a good guy.

Donald Corenman, MD, DC
Moderator

February 12, 2013 at 1:18 am

Post count: 8660

#7982

Remember that tinnitus generally does not originate from the upper cervical spine so do not depend upon relief of this noise if you undergo any upper cervical spine procedures.

There is a syndrome that is very rare and involves the tunnel that the vertebral artery runs in. This bony tunnel can become narrowed with degenerative bone spurs and can compress the artery withi the tunnel with certain neck motions. I doubt you have this but you can ask your specialists about it.

I do not know the interventialists out there and I am sure that there is no universal way to determine who is “good”. You might call our referral line (888) and we cna give you some names to call to ask for referrals.

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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