Is a Torn Alar ligament bad?

Tagged: AAI, cci, clivo-axial angle

Viewing 6 posts - 13 through 18 (of 24 total)

Previous 1 2 3 4 Next

Author

Posts
medicalgen
Participant

May 12, 2016 at 1:28 pm

Post count: 11

#22167

Professor Francis W. Smith M.D, FFRRCSI, FRCR, FRSC(Ed), FRCP(Ed), FFSEM. Dip Sp Med, DMRD.

He obtained his medical training at the University of Aberdeen. After residencies in medicine & orthopaedic surgery, he completed his radiological training at the Hospital for Sick Children in Toronto Canada. In Aberdeen, starting in1980, he pioneered the clinical application of MRI performing the world’s first clinical trial of MRI in 1980 and the world’s first diagnostic MRI service at Aberdeen Royal Infirmary in 1981. He published the first clinical applications of MRI to musculoskeletal radiology, head and neck malignancy, liver and pancreatic disease, pelvic malignancy and pregnancy. He has over 250 publications in peer reviewed Journals, 32 book chapters.

In 1982 he was the inaugural President of the SMRI and in 1990 he received the Gold medal from the ISMRM. Between 1984 – 91 he was Editor in Chief of Magnetic Resonance Imaging. In 1999 he was the recipient of the Barclay Medal and in 2009 The Sir Godfrey Hounsfield Memorial lecturer from The British Institute of Radiology. Currently uses upright MRI for the diagnosis of spinal complaints. He specialises in Upright MRI imaging of the cervical spine and cranio-cervical junction in patients following whiplash injury and also those suffering from the hypermobility syndrome, demonstrating ligamentous damage or laxity not readily visualised by conventional MRI of the cervical spine. He also provides an MRI imaging service examining all weight bearing joints in the upright position.

Between 1980-97 working as a Consultant in Nuclear Medicine he pioneered the use of SPECT for the measurement of regional cerebral blood flow performing the preclinical evaluation of the technetium labelled blood flow agent HMPAO, as well as publishing the earliest papers on its value in the assessment of patients with dementia. He performed some of the earliest work on the use of PET for the diagnosis and staging of malignant disease.

Hi Doctor Corenman, I think it would be good for you to discuss your opinions about the fonar upright MRI with Professor Francis Smith

Broken
Participant

May 12, 2016 at 9:59 pm

Post count: 1

#22169

Thank you Dr. Corenman and Karen for this discussion! I am waiting to get an MRI to determine what in the world has happened to me. I believe a ligament has been damaged and also that Chiari is involved as I am fine with a collar on but practically invalid without it, including suicidal ideation!
I am very interested in obtaining the best image for diagnosis, but I am much more interested in HOW TO FIX IT! Does anyone do surgical repair of alar ligaments or prolotherapy? How does one get relief! I am at my wits end! Thank you!!

Donald Corenman, MD, DC
Moderator

May 13, 2016 at 4:05 am

Post count: 8660

#22170

The individual who helped develop the Fonar system has experience with the engineering of MRI but still does not change the problems associated with the system.

Surgical repair of the alar ligaments cannot be performed due to the inaccessible location of these ligaments. Prolotherapy is the injection of a damaging liquid into and around structures to cause scar tissue to form. It would obviously be inadvisable to inject these substances in and around the alar ligaments immediately adjacent to the spinal cord. The only way to stabilize the occiput-C1 or O-C2 joints is with a fusion of these vertebra.

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 14, 2016 at 1:24 am

Post count: 11

#22180

Hello broken, I’m so sorry to hear of your pain and suffering. I wish I could help you. I assume it’s been caused by an accident. Surely your Doctors will need to know what actual damage there is before they can consider how to treat you. I’ve got 3mm cerebellar tonsillar ectopia which is classed as borderline chiari but I understand that the pain doesn’t go hand in hand with the amount of descent. As well as my thinned ligaments my odontoid peg is also off centre and my clivo-axial angle is abnormal (kyphotic). It’s important that you have a full picture of your injury because some of your pain and disability might be attributed to other damaged structures. As Dr Corenman said there isn’t a lot they can do to repair the ligaments at the CCJ. Chiari causes horrendous headaches, this is operable but has long recovery time. Are you having a suppine MRI scan? If so, this type of scan does not show your internal structures in the weight bearing mode and may not show the full extent of any chiari.

medicalgen
Participant

May 14, 2016 at 1:47 am

Post count: 11

#22181

Dr Corenman do you do any fusion operations of the top cervical vertebrae to help with this type of damage?

medicalgen
Participant

May 14, 2016 at 2:00 am

Post count: 11

#22182

Sorry ignore my last post Dr Corenman I see that you do cervical fusion. Xx
Author

Posts

Viewing 6 posts - 13 through 18 (of 24 total)

Previous 1 2 3 4 Next

You must be logged in to reply to this topic.

Donald Corenman, MD, DC

Average rating:

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel