more PT, chiropractic, or what?

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DKDC
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April 6, 2011 at 11:45 pm

Post count: 2

#4470

Hello Dr. Corenman,

How nice of you to be answering questions :)

Since October 2010, I have had numbness in my left hand/fingers, mainly index and middle fingers, but it can change to the other fingers and tingling in the palm throughout the day, and slight weakness in the left arm. Also, muscle cramping in my left armpit area throughout the day, but mostly in the morning. I had an MRI of my c-spine and it showed moderate DDD between C5/6 with mild bilateral foraminal stenosis and moderate DDD between C6/7 with mild left foraminal stenosis. My neurologist sent me to physical therapy in which the PT did massage and manual traction, gave me a set of exercises to follow (which I continue to do at home), and he tried mechanical traction twice, in which after the second time, I developed an eyelid twitch after the session (which took about a week to go away). So, he decided to not continue the traction. I’ve had people recommending other therapies to me: acupuncture, chiropractic, and other physical therapy clinics. I’m really at a loss as to what to try next. If anything? Can a chiropractor or acupuncturist help with DDD? Would another PT do anything different? I have been working on my posture, which the PT said is probably the major culprit in contributing to the DDD. Do I have to live with numb fingers for the rest of my life? (I’m a 46 yo female). I’ve also noticed in the last month or so the bottom of my left foot being tingly and a ‘weird’ feeling in my lower leg-not really a numbness, but a heaviness-upon waking in the morning.

From what I understand about DDD from my neurologist and the PT, is that it won’t get any better, I just have to try to avoid exercises/postures that will make it worse.

To me, traction makes the most sense, but maybe I can’t tolerate it?

Any advice/suggestions would be greatly appreciated.
Thank you!!

Donald Corenman, MD, DC
Moderator

April 7, 2011 at 4:10 am

Post count: 8660

#4471

You mention that your symptoms are arm related and do not mention neck pain. This is very good because degenerative disc disease causes both neck pain and arm symptoms. The fact you have no neck pain means this degenerative disc disease should give you no neck trouble other than some stiffness.

In regards to your arm symptoms, it would be unusual to have weakness associated with mild foraminal stenosis. Arm paresthesias (pins and needles) and “numbness” can occur but if foraminal stenosis is present, the symptoms should become more intense with bending the head backwards or to the side of the symptoms. If that is not the case, then have your physician look for something called “thoracic outlet syndrome” or a peripheral nerve entrapment.

Chiropractic for degenerative disc disease works well in general. For nerve irritability, it can work well as long as the nerve is not aggravated. Acupuncture can be effective for temporary relief but generally doesn’t yield long term relief of symptoms. Traction can be effective for significant nerve compression but for your neck will probably not be as effective. The eye twitching most likely was not directly related to the traction. If the numbness in your arm is related to compression of the nerve root or even irritability, an epidural can be effective also.

Without any cord compression, your leg symptoms are not related to your neck.

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.

DKDC
Member

April 7, 2011 at 6:25 am

Post count: 2

#4472

Thank you Dr. Corenman.

Thoracic outlet syndrome was something that I came across when I was in my acute pain phase and I was researching what might be wrong with me. I had terrible left shoulder and arm pain and muscle spasms that started 4 days after receiving a flu shot (and I had the eyelid twitching-that’s why I mentioned it earlier). I went for almost 3 months with this pain until I saw a neurologist that ordered the MRI. When he saw the DDD, he attributed my symptoms to that and I feel like I’ve been dismissed to have this numbness with no relief. I do not really have any neck pain, other than a little soreness and stiffness on some days. Could it be coincidental that I have the DDD and something else is really causing my numbness and tingling? I think it is positional with my neck though.

Thank you so much for your time.

Donald Corenman, MD, DC
Moderator

April 7, 2011 at 11:42 am

Post count: 8660

#4473

Having severe pain 4 days from a flu shot may or may not be interrelated. There is a syndrome called Parsonage Turner Syndrome that is associated with weakness and rarely pain. Feel free to look it up but I am not clear if you had that. Your differential also includes shoulder pathology (like rotator cuff tear) and entrapment neuropathy. I think another set of eyes on you might be helpful and possibly an EMG/NCV test. This all might be from the neck but your MRI report does not fit. Occasionally, radiologists under read films and there might be more on your films then you are aware.

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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