Is a Torn Alar ligament bad?

Tagged: AAI, cci, clivo-axial angle

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Lincoln…
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May 18, 2015 at 1:41 am

Post count: 1

#19504

Hi Doctor Coleman. So I got in a really high energy head on collision 2 1/2 years ago. It was my pick up truck vs. a fully loaded logging truck.

I have had ongoing problems with neck pain and headaches which are mostly at the base of the skull, vision problems, pulsating and tingling all, over crunchy noises, vertigo, bla bla bla, I’m sure you have heard it all before.

My doctor has blamed everything on chronic pain and wants me to find Jesus and live like a monk and it might not seem so bad. My X-rays, brain ct, mri brain and spine all clear.

I have finally seen a competent physio therapist and he gave me the cervical ligament stress tests for my transvers and my alar ligaments. When he did the one for my Alar on the left side it felt like he was lifting my head off my body. He said that my left alar may be sublaxed or completely torn. And said I need to talk to my doctor about getting an mri of the ligament itself, and ask for a consult to a neurosurgeon about a possible spinal fusion.

I have spoken to 3 different G.P’s and none have even heard of such an injury. I also have seen a neurologist, who said the guy is wrong and I’m fine. None of them say I need an mri or need even look any further into it. I’m mad because I want to get on with my life, and if there is a way to make me feel better I want that option.

Can you tear your alar ligament? If it is torn is that bad? What should I do?

Donald Corenman, MD, DC
Moderator

May 20, 2015 at 4:43 am

Post count: 8660

#19515

First is the fact there is no reliable physical examination test to determine alar ligament injury. Chronic base of the skull pain could occur from a number of different problems from arthritis of the upper facets to a C2-3 disc herniation. Alar ligament injury would be way down the list for differential diagnosis. The injury that your physical therapist alludes to does exist but it is very rare.

General practitioners have such a burden trying to keep up with information regarding the entire body that they cannot be expected to be experts on the upper cervical spine.

I think that chronic upper neck pain that has not resolved in 2 1/2 years deserves a workup. An MRI would be warranted as well as x-rays including flexion/extension views. A consultation with a spine surgeon or neurosurgeon would be appropriate.

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.

medicalgen
Participant

April 22, 2016 at 3:56 pm

Post count: 11

#22035

Hi Lincoln. Yes there is something you can do. Get an upright functional MRI scan. I have suffered for three years with the same problems/symptoms and have the proof: a torn left alar ligament, substantially thinned transverse ligaments and also an abnormal clivo-axial angle. These injurys can cause nerological deterioration. If you have suffered so long, you are not going to get any better. There are specialists out there in the field that have the knowledge to help you. Anyone who says it is psychomatic is ignorant of the facts.

medicalgen
Participant

April 22, 2016 at 4:01 pm

Post count: 11

#22036

Lincoln, I have seen three neurologists all a complete waste of time. I had my upright MRI scan done in London at Medserina. on

Donald Corenman, MD, DC
Moderator

April 22, 2016 at 9:08 pm

Post count: 8660

#22037

I would very much disagree with your analysis. An upright MRI is a much poorer quality examination as there is patient motion and the strength of the magnet is about 0.7 tesla, much below the state of the art 3.0 magnets. The ability to visualize 1-2mm ligaments is obviously very limited.

I would agree that upper neck pain generally has a cause but this type of ligament injury is very rare and generally not the cause of upper neck pain.

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.

medicalgen
Participant

May 4, 2016 at 1:28 pm

Post count: 11

#22111

The upright MRI fonar scanners detect what our standard NHS scans don’t. Yes they are more sensitive, they have to be. I have obvious injuries and consequential neurological symptoms Dr Coreman. This scan proves it. I was told I was imagining my symptoms because of previous unremarkable scan results.I’m sorry but I think you need to do a bit of research, you are not giving your readers the up to date information they need to assist them in getting a diagnosis.
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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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