neck muscle spasms misdiagnosis?

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Donald Corenman, MD, DC
Moderator

June 30, 2013 at 8:05 am

Post count: 8660

#8966

With a normal brain MRI and a cervical MRI that does not note cord compression, your increased reflexes are an indication of an “irritable’ nervous system but does not help with a diagnosis.

The pain doctor hopefully is an interventionist and can use facet injections to help with diagnosis. If all his or her diagnostic attempts cannot indicate a local problem, there still is spinal cord and peripheral nerve stimulation. See cord stimulation section 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.

zookriz
Participant

July 4, 2013 at 2:42 am

Post count: 19

#8992

Dr. Corenman,
I was able to get a quick appointment at a pain clinic, as you suggested. I explained both areas of my pain. Pain in the middle of my neck on the left and under my skull on the right (worst of the pains), with a constant headache. No doctor or radiologist so far has been able to see a problem with the right side, under the skull pain. The pain doctor would only treat the areas from reading the reports, not actually looking at the mri’s or x-rays. I don’t know if this is how they normally operate. My last mri says:
Straightening of the normal cervical lordosis is noted. At C5-6 there is a small left lateral disc herniation noted creating slight left neural foraminal compromise at this level. At C6-7 there is a small central focal disc herniation without cord compromise. No myelomalacia is present.
The pain doctor would only address this issue and gave me an epidural which should cover both disc problems.
I almost passed out two times and they had to pull the needle and try again later. Third time was a charm and we got it done. Needless to say, my neck is a bit sore.
The injection did seem to help somewhat with the headache but not entirely and the upper right side pain is still there. How do I get this spot addressed? Do I demand a flexion extension x-ray? Is there another test that might help diagnose this upper pain? I’m getting tired of getting pushed from one doctor to the next. This has been going on over 1 year. The pain doctor thinks I’ve almost exhausted my resources, if these injections don’t work he suggests seeing a surgeon.
Thanks for your time,
You have no idea what this means to your readers!
Kathy

Donald Corenman, MD, DC
Moderator

July 4, 2013 at 4:39 am

Post count: 8660

#8994

Unfortunately, the facet syndrome diagnosis is made by history and palpation of the facets reproducing pain. If your pain physician is just going to use the image reports then he will most likely not perform facet injections in the upper cervical spine.

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.

zookriz
Participant

July 20, 2013 at 8:18 pm

Post count: 19

#9066

Dr. Corenman,
I went to an appointment with a great spine surgeon. Unfortunately I got sick during the appointment and he did not really get to talk to me or examine me. I did get a brain MRI. He said he doesn’t see anything on either MRI in which he can help me and again suggested pain management or a head ache clinic.
From my understanding of what you say, an upper cervical spine facet problem can’t always be seen on film.
I’m going to a new pain management clinic hoping they will do an upper cervical facet block. I still have not got a diagnosis.
My upper neck and head hurt just from laying on a pillow and it makes it difficult to sleep. I’m now on another short dose of steroids to see if it helps.
If this top spine surgeon from Pittsburgh can’t see anything, should the facet block be my next step? If the facet block works, what then?
Do I keep doing the blocks for relief or is this fixable?
I’ll let you know what they find.
Thanks for your time.
Kathy

Donald Corenman, MD, DC
Moderator

July 22, 2013 at 6:46 pm

Post count: 8660

#9073

I can’t specifically guide you as to the next step. I can tell you that the upper cervical facet diagnosis is a clinical diagnosis. That is, the diagnosis is made by a thorough history and physical examination and not generally by review of X-rays or MRI. A good pain clinic should be able to make this diagnosis and recommend facet blocks if they suspect the diagnosis of facet syndrome.

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.

zookriz
Participant

September 21, 2013 at 4:03 am

Post count: 19

#9425

Hello Dr. Corenman,
It’s been a while and I’m now receiving cervical epidural injections for my two herniated disks. It seems to help but the effects are very short lived. I only get 1-2 days of minimal relief. My headaches lessen and the muscle spasms lesson but I still have shoulder pain and upper cervical pain. The doc said if I don’t get good relief he’s going to try some other areas. He has me on Celebrex and hydrocodone/apap 10 mg 3x day. I’m trying to stay away from the meds so I can get a realistic effect from the injections.
I was looking at my mri and I’ve noticed that from my c3-c6 looks very narrow. No doctor has said anything about stenosis congenital or otherwise. The mri program allows measurements so I decided to try to measure my canal and cord to see the difference. According to my research most canals are about 13mm give or take according to the disk itself and anything less than 10 is stenotic. Less than about 8mm is severe stenosis. My measurements of the c3-c6 canal range from 9.6 mm to 7.4 mm. (They may not be exact but it’s close) At the site of one herniation the measurement is 7.4 mm and the cord itself is 6.3 mm. Is it me or does that seem narrow? If my measurements are even close and I have a loss of lordosis also does this set me up for an easy injury if I hit my head or get whiplash? At what looks like a more normal level my measurements are more like 11.2 mm still a bit narrow not like the other levels. Should I be concerned or is this relatively normal for my age of 41?
Thanks for your time,
Kathy
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Donald Corenman, MD, DC

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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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