Flexion and Extension X-RAY results !!

Tagged: cervical degenerative spondylolisthesis due to disc wear below

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appleannie
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July 13, 2017 at 12:26 pm

Post count: 129

#25525

Hello Dr.corenman, I was told by my Orthopedic spine Specialist that I’M not “Unstable” at my C4-5 level anymore because of the Auto fusion That I have at C5-6 level so I asked him if it’s okay to see a Chiropractor for adjustments and he told me yes.Dr. Corenman so I made an appointment with the Chiropractor and after he examed me,he would not do any adjustments on me and this is what he said in his Report:

There are residual effects that this patient will incur over time do to the ligament laxity damage that was directly related to the trauma on 8/09/1988. The Anterior Longitudinal ligament (ALL) and with the Posterior Longitudinal ligament (PLL) in the cervical spine have a primary responsibility to stabilize the Anterior and Posterior movement of the vertebrae.Since both the (ALL) and the (PLL) are damaged there is excessive Translation and Angulation which can be viewed in the Biomechanical Report which was analyzed on 6/28/2017 from cervical stress views which were taken on 6/09/2017. These two parameters are measured through an analysis called lines. of measuration which objectively isolates and quantifies ligament laxity in stress views (Flexion/Extension).

Lateral Cervical Spine:
There’s a Spondylolisthesis at C4-5.Interruption of George’s line at C2-3,C3-4,C4-5,and C5-6 during the lateral stress views (flexion/Extension) are indicative of Ligamemtous Instability.

Cervical study: Alteration of motion segment

:The Angular motion segment integrity appears to be compromised and Ratable at C3-4, C4-5 and C5-6.

:The The Translational motion segment integrity appears to be compromised and Ratable at C4-5.

IMPRESSIONS:

1) Cervical motion study (C2-C7) indicates Angular motion segment integrity change at C3-4,C4-5 and C5-6. The impairment of the cervical region is due to Ratable loss of motion segment integrity and is Ratable at 23% for cervical spine (AMA Guides,sixth Edition) This patient’s digital analysis reveals loss of motion integrity in Flexion at C3-4=30.45, C4-5=29.39, and C5-6=11.77 and in Extension at C3-4=21.72, and C5-6- 16.10(Calculated Angulation) degrees yielding an impairment estimate based on plain film forensic at 23% whole person.
Cervical motion study (C2-C7) indicates Translational motion segment integrity change at C4-5.The impairment of the cervical region is due to Ratable loss of motion segment integrity and is Ratable at 23% for the cervical spine (AMA Guides edition) This patient digital analysis revals loss of motion integrity at C4-5=4.04mm (total Translation)

2) Ligamemtous Instability is suggested in the cervical spine.

3) Interruptions of George’s line at C2-3, C4-5,and C5-6 during the lateral stress views (flexion/Extension) are indicative of Ligamemtous Instability,sub-failure or insufficiency from the evaluation of Translational motion.

Dr.Corenman could you please explain all this Chiropractor talk to me and let me know what he is saying about my cervical spine especially at C4-5 is my cervical spine in bad shape according to the Chiropractor ??
Please Help me understand what he is saying !! Thank You !!

appleannie
Participant

July 15, 2017 at 9:38 am

Post count: 129

#25544

Hello Dr.Corenman, I have a question about the pinsites area from the Halo brace I had to wear for three months. Dr.Corenman every time it rains or it’s damp or cold outside the area around the pinsites gets very painful could I have arthritis at the pinsites area ? Any help would be greatly appreciated. Thank You !!

Donald Corenman, MD, DC
Moderator

July 15, 2017 at 5:04 pm

Post count: 8660

#25555

First, the lack of stability generally results from facet wear (degenerative spondylolisthesis) and rarely results from ALL or PLL ligament tearing. Even with disc rupture, there has to be facet failure (fracture or degenerative wear) to allow forward slip of one cervical vertebra on the next. I am confused as to why your spine specialist thinks that C5-6 severe degeneration (IDR) will cause stability of your C4-5 level as this makes no sense and I believe that you might be confused by his explanation.

instability is measured by millimeters of sliding motion and your report by the chiropractor does give values in millimeters of about 4mm motion so this level could be considered unstable. Stability is considered relative so in certain contexts, this might be a stable condition even with the slip.

Pins from a halo do not enter a joint (the skull) so these pin sites cannot develop arthritis. Nonetheless, you can get pain from adhesions just under the skin that can exacerbate with weather. Since these adhesions are just under the skin, you can use your fingers to mobilize the connective tissue underneath to “stretch” the adhesions.

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.

appleannie
Participant

July 16, 2017 at 5:15 pm

Post count: 129

#25563

Hi Dr.Corenman,
I’M not confused on what my Spine Doctor told me,this is exactly what he told me word for word in the Doctor Report: The patient has gone on to an Auto fusion at C5-C6 and at this point I do not consider the patient to be “Unstable”.

Dr.Corenman this is what he told me in his office and what he said in the Doctor Report.He also told me that I don’t have any limitations and I can resume my normal activities.I’m still a little wary about my C4-5 level and I kept asking him over and over again if he is sure that I’m not unstable anymore and he resured me that I’m not.I also asked him if he meant that I was not unstable at C5-C6 level because of the Auto fusion and he said no you’re not unstable at any level of your cervical spine, because of the Auto fusion and it’s strong enough to stabilize your cervical spine.

Thank You !!

Donald Corenman, MD, DC
Moderator

July 16, 2017 at 6:09 pm

Post count: 8660

#25564

I think your spine surgeon was confused as an auto-fusion (if really present at C5-6) confirms no immunity of the C4-5 level and in fact, makes C4-5 just a little bit more susceptible to injury. Maybe another opinion should be considered.

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.

appleannie
Participant

July 18, 2017 at 8:23 am

Post count: 129

#25583

Hello Dr.Corenman,
Thank You !! Dr.Corenman are you offering, lol
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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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