flexion & extension x-ray of 2017

Tagged: cervical degenerative kyphosis causing degenerative spondylolisthesis C4-5

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Donald Corenman, MD, DC
Moderator

October 27, 2017 at 11:19 am

Post count: 8660

#26707

Thanks

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

November 14, 2017 at 6:59 pm

Post count: 129

#26826

Hi Dr. Corenman,
I went to see a new Orthopedic Spine Specialist for a second opinion last week and I just received his Report yesterday in the mail.
Dr.Corenman he reviewed the same X-RAY Images that I posted on here and you reviewed for me, and would like your opinion on his findings, because your a great Spine Doctor and you give everyone who writes you great advice.
Dr. Corenman this is what the Doctor said in his report listed below.

I have reviewed your X-RAY Images which demonstrates that you have evidence on your neutral film of Spondylosis and fusion in a slightly Kyphotic position at C5-6 level.On your Flexion views, I see you have Moderate instability at C4-5. I also see that you have a fairly significant Neuroforaminal Stenosis at C4-5.Your Plain X-RAYS also demonstrate that you have an abnormality in the shape of the Vertebral body of C5,Where I suspect you had your damage done at the time of your accident.You have completely collapse the C5-6 disc space.You have developed an anterior Osteophyte and do not have any movement on Flexion extension at C5-6,as well as the fact that it is at a slightly Kyphotic position.
When you Flex you dramatically Kyphose and open up the C4-5 region,as well as the Angular motion you also have a slight Subluxation of C4 and C5.
In Extension you don’t quite get back to a normal alignment and you continue to have a Kyphotic deformity at C4-5, again as a result of the injury and abnormal shape of the Vertebral body of C5.The Head weighs approximately 12 to 15 pounds which contributes this problem.
Your plain x-rays also demonstrates ,as I have mentioned before, a Fusion in a Kyphotic position at C5-6 and your Flexion\Extension x-rays demonstrate very little movement at C5-6, but you do Sublux at C4-5 when you Flex and by that I mean the Vertebral of C4 moves forward when you Flex and backwards when you extend at C4-5.Your plain x-rays also demonstrates that you have Chronic Ligamentous Instability at C4-5 as I mentioned before and severe disc space narrowing, and endplate sclerosis at C5-6.

Dr.Corenman could you please review my X-RAYS again and let me know if you agree with with his findings and could you please explain what he means when he said I Sublux at C4 level ? What is endplate sclerosis ?

What is Chronic Ligamentous Instability at C4-5 ?

Could you please explain what he’s saying above ?

Thank You so much for your help

Donald Corenman, MD, DC
Moderator

November 15, 2017 at 7:23 am

Post count: 8660

#26827

He is correct in most statements but I am not assured that you have a fusion at C5-6. This level might be stable with adhesions but a fusion is not obvious (unless an MRI or CT is definitive). The level at C4-5 I believe he is spot on. You already know what instability is from my prior discussion.

What is Chronic Ligamentous Instability at C4-5? This is the inability of the facets and ligaments to hold the vertebra above stable to the vertebra below. This is both a bony facet and a ligament issue.

Subluxation is a partial dislocation. The vertebra above should not slide forward or backwards on the vertebra below. Your C4 moves about 3mm on C5 making this a mild instability.

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

November 15, 2017 at 10:59 am

Post count: 129

#26835

Hi Dr. Corenman,
First Thank You for answering my questions for me,I really appreciate it!!

I have a few more questions ?

What does he mean when he said the Head weighs approximately 12 to 15 pounds which contributes to this problem ?

Dr. Corenman maybe the Doctor meant that I have an Auto fusion at C5-6 level, like the first Doctor I seen also said I have ?

Dr.Corenman in your opinion from viewing my X-RAYS is my C5-6 level stable or do I have Mild Instability also at this level to ? Or do you think the Adhesions that you said that I have will stabilize the C5-6 level ?

The Chiropractor I saw in the past told me that I had Mild Instability at C5-6 level and Moderate Instability at C4-5 and he would not do any adjustments on me? Do you agree

I guess I will have to be careful what I do for the rest of my life because of this Instability I have, because the Spine Doctor who took care of me in 1988 when I injured my neck told me that I Will have Mild to Moderate Instability at C4-5 and C5-6 level for the rest of my life, I guess he was Right.

Thank You again for explaining everything to me I really appreciate it!! You’re a great Doctor with a compassion for helping people by giving great advice.

Donald Corenman, MD, DC
Moderator

November 17, 2017 at 5:58 am

Post count: 8660

#26844

If your head weighed 6 ounces, there would be much less pressure on your neck and less chance of further slip or instability. Since you have a bowling ball on top of your neck, there is significant weight pressing down on your neck.

Maybe you do have an auto fusion at C5-6 but that condition is unusual so I would not assume that is a fact at this point.

C5-6 is probably stable but this does not mean it is not a pain generator. Many degenerative discs have significant loss of height and still have painful micromotion.

You could have Chiropractic mobilization and soft-tissue work without manipulation (adjustments) to gain some relief> I would agree with no adjustments at 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.

appleannie
Participant

November 17, 2017 at 7:01 pm

Post count: 129

#26855

Hi Dr.Corenman,
Thank You for taking the time out of your busy schedule to answer my questions for me. I wish I lived closer to your office so I could make an appointment to see you.

Dr. Corenman what you said in the last post above, when you said that “maybe you do have an Auto fusion at C5-6 but that condition is Unusual so I would not assume that is a fact at this point”.

What else could it be ?? What did you see when you viewed my X-RAYS at C5-6 level ? Your opinion please

Dr. Corenman when you said that the C5-6 level is probably stable it makes me feel a little wary.Could you please view my X-RAYS again and assure me that it’s not unstable like C4 level.

Thank You again !! Have a great weekend
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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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