Left Hand Tremor

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dustingfab
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January 12, 2012 at 6:23 am

Post count: 27

#5349

I just saw the spine surgeon today and he still recommends surgery, more so the neck than the lower back.

He thinks the mild tremor could be a result from the baclofen and told me to stop.

I understand the risk of infection, but I would rather just do the shoulder and neck and get it out of the way.

If I agree to the microdiscectomy in the neck, what type of scarring will I have to deal with?

Donald Corenman, MD, DC
Moderator

January 12, 2012 at 7:19 am

Post count: 8660

#5351

I have never seen Baclofen cause tremors as it is normally used to treat tremors. None- the-less, there is a small outside chance that this medication can cause tremors.

The procedure for your neck is not a microdiscectomy. That procedure is used for the lower back only. If it is a proposed microscopic procedure, then it might be a posterior foraminotomy. See website for video of that procedure. Scarring is generally minimal for this procedure.

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 13, 2012 at 2:01 am

Post count: 27

#5361

Thank you so much again. So the appropriate procedure is a posterior foraminotomy for my neck issues. Its a bit concerning my doc said microdiscectomy, unless I misunderstood him. I will review the video on your site.

Also, is it common to have soooooooo many follow up visits. The spine specialists did suggest conservative measures first but also recommended surgery in the very beginning. I saw him for the first time late August / early September.

It took me about a month to even consider the epidural steroid injections for my neck and back radiculopathy.

As you stated before since post foraminotomy cannot be done concurrently with a shoulder arthroscopic surgery. He recommends f/u with him 4 wks after my shoulder surgery. I would have thought that he would have discharged me from his care since I’ve been so hesitant to surgery.

My neck pain remains at a steady 3-4. And my neck is stiff constantly. But I’m still able to perform my ADLs. As with my back pain it has remained at a steady 4-5. I’ve been able to manage both neck and back discomforts with Relafen 1000mg per day.

I’ve been offered narcs but I refused. I don’t have addictive tendencies, but worry the long term treatment would bring me to that point.

I think I would consider surgery if my neck pain increased beyond 6 and back beyond 7. I feel surgery is such a major risk with my current pain level. And lastly, at every visit I am asked how is my pain level. Its been the same. What response does my doctor expect. I can only say I’m better if I’m 100% normal.

Donald Corenman, MD, DC
Moderator

January 13, 2012 at 6:36 am

Post count: 8660

#5362

I cannot tell you what the appropriate procedure is for your neck. As I mentioned before, there are three procedures and the best one for you depends upon many factors. Many follow-up visits are not a problem. If the specialist is concerned with your symptoms, frequent follow-up is necessary.

If your neck pain is a 3-4, I assume you have been through a thorough program of therapy and if there is no weakness, a good program of injections. Medications can be helpful and do not have to include narcotics. NSAIDs, membrane stabilizers, SSRIs and a slew of others can be helpful.

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

February 29, 2012 at 5:29 am

Post count: 27

#5681

Dr. Corenman post=1051 wrote: I cannot tell you what the appropriate procedure is for your neck. As I mentioned before, there are three procedures and the best one for you depends upon many factors. Many follow-up visits is not a problem. If the specialist is concerned with your symptoms, frequent follow-up is necessary.

If your neck pain is a 3-4, I assume you have been through a thorough program of therapy and if there is no weakness, a good program of injections. Medications can be helpful and do not have to include narcotics. NSAIDs, membrane stabilizers, SSRIs and a slew of others can be helpful.

Dr. Corenman

I have another follow up in two weeks. His initial PE was more detailed, but at each f/u visit the PE is very brief. This I understand is expected. At each visit my surgeon assesses my reflexes and asks to report my current symptoms. I plan to pose the following question during my next visit: what the surgeon is observing in his reflex assessment (of me) is correlating with my current symptom update? Does my reflex status concern him, which is why he is recommending surgery? Are diminished reflexes a RED FLAG to spine surgeon? In 8 weeks my neurologist plans to perform a repeat EMG. So I’m eager about those results. The initial EMG was performed in August. Is this standard of care? Or does my recent shoulder surgery warrants a repeat EMG? Thank you in advance for your time Dr. Corenman.

Donald Corenman, MD, DC
Moderator

February 29, 2012 at 9:53 pm

Post count: 8660

#5682

Checking reflexes is a way to understand the health of the nerves. The reflex arc involves the tendon of the muscle tested, the sensory nerve, the spinal cord and the motor nerve/ muscle.

A diminished reflex can indicate a problem with any of the above structures but normally is an indicator of nerve compression (herniated disc). An increased reflex indicates irritation with the central nervous system (spinal cord compression or brain problems). Unless there is a new onset of symptoms while you are seeing the physician (a new herniation), the reflexes will not change.

Your shoulder surgery does not warrant a new EMG unless there is some thought of a nerve injury from the surgery. I have found that EMGs for cervical issues are generally not necessary as the examination should reveal what the EMG will reveal and the EMG does not pick up responses from the pain nerves.

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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