Is this a serious issue?

Tagged: depression and L'hermittes sign, Myelopathy, stenosis

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Spine-less
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August 10, 2012 at 1:39 pm

Post count: 3

#6712

Hello,

I had an MRI that I’ve literally been begging for since January of 2011. My symptoms started as facial numbness on the left side of my face. I thought I was having a stroke, but my blood pressure and heart rate was fine. This continued to happen and has been more consistent over the last 18 months. I also had visual disturbances in my right eye, where my eye would suddenly go blurry for hours or for days at a time. i had an eye exam by an optho who said that there was blood vessel restriction in the back of my eye. I have had increase in pain midline back of the neck below my skull radiating to the top of my head. This pain has been excrutiating at times. I’ve had pain to the left and right side of the back of my neck, and between the shoulder blades. I have restriction of my range of motion with my head on both the right and left, that was noticed upon exam by a Rheumatologist who ordered an x-ray. These findings indicated that I had an degenerative issues at C5-6 and C6-7. I have had pain in my legs on and off for many years that felt like a constant burning pain, but would come and go. I have fibromyalgia and it was blown off as that. The last year, I have had new pain in this area that is much more severe: Going from my lower back through my hips (aching/lightning like pain in right hip), through my buttocks and down my legs to my heels. It is painful when standing, or sitting. I have noticed the last two months that I have heaviness in my legs, as well as a deep pain from the top of my legs all the way down to my feet, making it feel as if I am carrying concrete pillars. walking for long stretches, which i use to enjoy doing now brings on excrutiating pain for anything longer than ten minutes and standing in check out lines is nearly intolerable. This is inconsistennt with the pain, but the heaviness AND weakness, is scary. This happens inconsistently as well. The last several months, I have felt off balance. I’ve nearly fallen several times. I feel like I’m going around the world to my left. I have trouble grasping small items. I at times experience vertigo as well. These symptoms are totally frightening and also come and go. I feel like this is all in my head as it all started so subtly for me. I have become greatly limited the last year and a half, but yet keep pushing anyway and get through with pain medications and trying to move slower while I wait for my insurance company to get me to a neurosurgeon.

My MRI read as the following. I also need oral surgery to remove all of my lower teeth, i wonder if having this done is dangerous with the conditions I am currently dealing with related to C spine.
Anyway, MRI results. I won’t get into them all, but am wondering if this could be contributing to these wild, wacky and increasingly obvious symptoms this last year and a half. What is interesting to note is that on the x ray taken in February C 4-5 showed no involvement, but by June, when I had the MRI done, it was now involved. How rapidly can these things progress? I am really scared but thinking no one takes it seriously.

MRI:

C4-5-There is a mild central disc osteophyte complex which normally effaces the ventral thecal sac but causes no significant canal stenosis or cord flattening. There is no significant formaninal narrowing.
C5-6-There is a central disc osteophyte complex which effaces the ventral thecal sac and flattens the cord with moderate canal stenosis. Uncovertebral hypertrophy results in mild right foraminal narrowing. The left foramen is patent.
C6-7- There is a central/right paracentral broad-based disc protrusion which effaces the ventral thecal sac and results in moderately-severe canal stanosis. Uncovertebral hypertrophy causes mild to moderate right foraminal narrowing. The left foramen is patent.

Lower lumbar

L3-4 there is minimal circumferential disc bulging and mild facet degenerative changes.
L4-5-there is mild circumferential disc bulging and mild facet degenerative changes.
L5-S1- There is a small central disc protrusion with an associated annular tear. This results in no significant canal stenosis, formanial narrowing or definitive root impingement. There is mild facet degenerative changes bilaterally.

Then why are my legs this way? Why am I feeling such pain? why am I so off balance? I also have lighthing like sensations and my arm goes numb on my left side. I have numbness and tingling in both hands. sometimes, my right hand toward the pinky up to where my wrist begins will go completely numb. My legs also fall asleep easily, as when I’m driving. I have literally gotten up in the middle of the night to use the bathroom and fallen directly to the floor because I could not feel my legs at all. I’m clumsy and stumble alot, having bruised myself up quite a lot this last year.

Is this dangerous? The condition of my C spine and could these symptoms be contributing? Currently, i am awaiting a referral to a neurosurgeon. thank you.

Donald Corenman, MD, DC
Moderator

August 10, 2012 at 2:57 pm

Post count: 8660

#6714

You have significant narrowing in the canal in your neck “C6-7- There is a central/right paracentral broad-based disc protrusion which effaces the ventral thecal sac and results in moderately-severe canal stenosis”. The MRI noting disc degeneration but the X-ray being normal is typical. X-rays do not reveal early degenerative changes.

This condition (stenosis) can cause myelopathy (dysfunction of the spinal cord) which can cause imbalance. See the section regarding myelopathy on the website to see if your symptoms match. Your complaints of “why am I so off balance? I also have lighthing like sensations and my arm goes numb on my left side. I have numbness and tingling in both hands. sometimes, my right hand toward the pinky up to where my wrist begins will go completely numb” do coincide with myelopathy. You do have to be careful as fibromyalgia has some matching symptoms.

A thorough physical examination would help to differential those two conditions.

There is nothing in your lower back MRI which would cause “heaviness in my legs, as well as a deep pain from the top of my legs all the way down to my feet, making it feel as if I am carrying concrete pillars. walking for long stretches”. Those symptoms could be from your fibromyalgia.

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.

Spine-less
Member

August 10, 2012 at 11:16 pm

Post count: 3

#6720

Thank you, Dr. Corenman,

I have an additional question. It mentions cord flattening, as well as foraminal narrowing. What is cord flattening? And what symptoms can this cause?

Thanks you so much!

Donald Corenman, MD, DC
Moderator

August 11, 2012 at 12:52 am

Post count: 8660

#6722

Cord flattening is the same as canal stenosis or narrowing of the canal. This condition deforms the normal “bean shaped” cord and flattens the rounded corners of the spinal cord. The symptoms are under myelopathy on the website.

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.

Spine-less
Member

August 11, 2012 at 1:15 am

Post count: 3

#6723

Is cord flattening the same as cord compression? I’ve seen the terms used interchangeably…

Thank you for your response. I hope to have an appt. with a neurosurgeon soon.

Donald Corenman, MD, DC
Moderator

August 11, 2012 at 1:37 am

Post count: 8660

#6724

Cord compression causes cord flattening. They are essentially the same disorder.

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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