Neck And back Issues

Tagged: degenerative spondylolisthesis at L4-5

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erin1214
Participant

February 23, 2020 at 9:15 pm

Post count: 2

#32120

Dr Corenman,

I am a 42 yr old heathy active female. I’ve had neck and shoulder pain for about 4 years. Had an MRI done. See Findings below.
EXAMINATION: MRI Spine Cervical w/o Contrast, 01/03/2020:0949 COMPARISON: XR Spine Cervical 4 or 5 Views, 7/18/2019 9:24:00 AM EXAMINATION: MR cervical spine without contrast. INDICATION/HISTORY: Myofascial muscle pain
TECHNIQUE: Multisequence, mutliplanar MR imaging of the cervical spine was performed. Imaging performed on a 1.5T magnet.
FINDINGS:
Alignment: Normal, including craniocervical and cervicothoracic junctions.
Bone marrow: Normal. Vertebral bodies: Normal. Cervical cord: Grossly normal.
C2-C3: Left parasagittal/uncovertebral disc protrusion results in mild narrowing of the left neural foramen.
C3-C4: Mild disc space narrowing with posterior disc osteophyte complex and mild facet arthropathy with no significant spinal canal or foraminal narrowing.
C4-C5: Moderate disc space narrowing with slight posterior disc osteophyte complex. Severe right facet arthropathy with evidence of acute inflammation. There is mild to moderate right foraminal narrowing. There is mild to moderate left facet arthropathy with mild left foraminal narrowing.
C5-C6: Moderate to severe disc space narrowing with posterior disc osteophyte complex and prominent left greater than right uncinate hypertrophy resulting in moderate to severe left and mild-to-moderate right foraminal narrowing.
C6-C7: Normal.
C7-T1: Normal.
Visualized paraspinous structures: Normal.
IMPRESSION:
Advanced degenerative changes at the C4-5 and C5-6 levels with acute inflammation of chronic severe osteoarthritis on the right
at C4-5 and large uncovertebral joint osteophyte complex on the left at C5-6 which results in moderate to severe left foraminal narrowing.

I was doing PT for this but wasn’t getting much relieve. In the middle of all this, I started having lower back, hip and buttock pain. It has progressed to pain in my legs and a lot of foot numbness. Below is the MRI for the lower Back.
* Technical quality: Adequate.
* Numbering: Non-transitional anatomy.
* Alignment: There is a 3 mm (grade 1) anterolisthesis of L4 on L5, likely secondary to degenerative facet arthropathy. Alignment is otherwise maintained.
* Bones: No acute fracture or other acute osseous abnormality.
Bone marrow signal within normal limits for age. * Conus/Cauda equina: Normal for age.
* Soft Tissues: No significant abnormality.
Incidental findings: Imaging follow-up is not recommended.
* Visible thoracic and sacral region: Normal for age. * Lumbar disc spaces:
L1-L2: Small right central disc protrusion. Mild bilateral facet arthropathy. No neural foraminal or spinal canal stenosis.
L2-L3: No significant disc or facet degeneration.
L3-L4: Symmetric posterior disc bulge. Mild bilateral facet and ligament flavum hypertrophy. No neural foraminal or spinal canal stenosis.
L4-L5: Grade 1 anterolisthesis of L4 on L5. Symmetric posterior disc bulge and bilateral facet/ligament flavum hypertrophy contribute to severe spinal canal stenosis. There is compression of the bilateral transiting L5 nerve roots within the
subarticular zones. Mild bilateral neural foraminal stenosis.
L5-S1: Central disc protrusion. There is annular fissuring along the posterior disc margin. Bilateral facet arthropathy. No
neural foraminal or spinal canal stenosis.
IMPRESSION:
Grade 1 degenerative anterolisthesis of L4 on L5. Superimposed disc and facet degenerative changes resulting in severe spinal canal stenosis at this level.

My Dr told me cortisone shots aren’t an option for the lower back. She is suggesting a surgical consult. As for the neck, she is suggesting Cervical epidural steroid injection versus right third occipital nerve block.She thinks this will help with the headaches Im having. Suggestions on both issues? Should I fix one before the other?

Donald Corenman, MD, DC
Moderator

February 25, 2020 at 6:30 am

Post count: 8660

#32134

You note “I’ve had neck and shoulder pain for about 4 years” You have good reason for the pain.
C4-C5: Moderate disc space narrowing…. Severe right facet arthropathy with evidence of acute inflammation…C5-C6: Moderate to severe disc space narrowing with posterior disc osteophyte complex …resulting in moderate to severe left and mild-to-moderate right foraminal narrowing”.

Severe right facet arthropathy at C4-5 will cause local significant pain on the right, especially with right lateral bending and extension of the neck. C5-6 has significant foraminal stenosis which will compress the C6 nerve root. See https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/

You then note “In the middle of all this, I started having lower back, hip and buttock pain. It has progressed to pain in my legs and a lot of foot numbness”. The source for this is obvious.
“L4-L5: Grade 1 anterolisthesis of L4 on L5…contribute to severe spinal canal stenosis”.

This is a typical degenerative spondylolisthesis at L4-5 with severe spinal stenosis. You could try an epidural steroid injection and probably gain some relief but you probably are headed for surgery. See https://neckandback.com/conditions/degenerative-spondylolisthesis-or-spondlylolysthesis/ and https://neckandback.com/conditions/lumbar-spinal-stenosis-central-stenosis/

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.

erin1214
Participant

February 25, 2020 at 1:06 pm

Post count: 2

#32139

Thank you for your response and all the informative links. Do you feel the neck pain would be helped with epidural steroid injections or would a nerve block be the better option? Currently the only relief I’m getting is from Diclofenac Sodium and an occasional muscle relaxer. This takes the edge off, but that’s about it.

Donald Corenman, MD, DC
Moderator

February 25, 2020 at 1:59 pm

Post count: 8660

#32140

If you have right sided neck pain, I would go with facet blocks and rhizotomies at right C5-6 facet. For left sided neck pain, I would consider a selective nerve root block at C5-6 left.

See https://neckandback.com/treatments/facet-blocks-and-rhizotomies-neck/ and
https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-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.
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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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