Left Hand Tremor

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dustingfab
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January 11, 2012 at 11:50 pm

Post count: 27

#5339

Dear Dr. Corenman,

I’ve discovered a left hand tremor since the end of December. I notice it when performing very fine and detailed tasks like punching the alarm code or sometimes writing.

I’m very nervous about this symptom because I am left handed.

I have a history of cervical herniations with central canal stenosis as a result of a car accident in May 2011.

Initial I did have a tremor and was very clumsy. But this last for about a week. Until recently.

I’ve been going to physical therapy since early June 2011 and has help the pins and needles tremendously. My doctor has recommended a discectomy but I’ve been very weary about considering it.

I’m concerned with recovery time and pain and outcomes if I considered surgery.

If I had the discectomy, would that eliminate the tremor 100%, will surgery eliminate the muscle twitching which has been ongoing since August? I’m at a point where I feel the damage is done. But now my biggest concern is the tremor, will this symptoms progress and become more pronounced over time?

Here are the results: C3-C4, C5-C6 and C6-C7 disc herniations; mild to moderate C5-C7 stenosis and mild C6-C7 stenosis.

Donald Corenman, MD, DC
Moderator

January 12, 2012 at 12:39 am

Post count: 8660

#5341

I cannot comment on the need for surgery as there are many more factors involved to make that surgical decision. Your physical examination is paramount for some of this decision-making. If you have long tract signs (see section on myelopathy on website) indicating spinal cord irritability or motor weakness that has not improved, you could be a candidate for surgery.

The tremors in your left hand could be from weakness of a specific motor group or from a familial tremor. A familial tremor is a genetic predisposition and not related to the neck or your injury. If the tremor is from muscle weakness, surgery does give the nerve the best chance to recover but there is no guarantee that the nerve will fully recover. Again, if the tremor is from nerve compression, the sooner the surgery, the better the chance of recovery.

Depending upon the surgeon, recovery time is not too bad for an ACDF (see section on website). For a sedentary job, you could be back to work in one week and driving in one to two weeks. You won’t be climbing Mt. Everest until 8-12 weeks however.

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.

dustingfab
Member

January 12, 2012 at 1:08 am

Post count: 27

#5342

Thank you, thank you for your quick feedback. At the present time, I’m stuck between a rock and a hard place as I am scheduled for shoulder arthroscopic surgery due to a tear in my labrum and supraspinatus. I’ve already informed my employer of the need for a leave. But the idea of a leave for another surgery is pretty scary.

Is it possible for both the arthroscopic surgeon and spine surgeon to perform surgery at the same time?

You mention an ACDF, which according to whats described on your site seems more involved than a microdiscectomy surgery.

Is the recovery time for an ACDF vs. microdiscectomy similar?

Donald Corenman, MD, DC
Moderator

January 12, 2012 at 2:31 am

Post count: 8660

#5344

There are three procedures to decompress the cervical nerve root, an ACDF, an ADR and a posterior foraminotomy (see website). The ACDF is the “gold standard”. This procedure has been used for more than 60 years and is generally safe, effective and reproducible. The “failure rate” in the right hands is less than 4%.

The ADR (artificial disc replacement) is a relatively new procedure that allows surgical decompression but continued motion of the segment. This has some benefits and some risks. The benefit of course is continued motion of the surgical segment. This theoretically will reduce the stress on the segments above and below and may somewhat reduce the degenerative breakdown that can occur. This is still theoretical and not yet proven by long term studies.

The risks are that this artificial device will wear out and need to be replaced or changed to an ACDF. This device allows motion which can produce bone spur formation and possible nerve compression down the road but I have not seen this phenomenon at this point. Revision of this device to an ACDF is relatively simple with generally good results.

The posterior foraminotomy is a good procedure in the right patient. If there is disc herniation that is not under the cord itself and there is no neck pain that accompanies the nerve compression, this procedure can work well. Post-operatively, there is neck pain that can be associated with this procedure. The posterior foraminotomy is not always successful however (remember Peyton Manning’s failure after two separate procedures).

Recovery time is fastest for ADR, second for posterior foraminotomy and third for ACDF but all are quite fast in general.

I would generally not consider performing both cervical surgery and shoulder surgery at the same time. Risks of infection and prolonged surgery time would not be beneficial.

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.

dustingfab
Member

January 12, 2012 at 3:20 am

Post count: 27

#5346

Thanks Dr. Corenman. Your explanation is very helpful.

Donald Corenman, MD, DC
Moderator

January 12, 2012 at 4:19 am

Post count: 8660

#5347

My pleasure.

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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