Neck pain, headaches, MRI report

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Ginger
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July 11, 2012 at 4:55 am

Post count: 2

#6508

Dear Dr. Corenman,

I have on and off neck pain and headaches since we hit a deer with our car in 2008, able have it quite under control with chiropractic care till December 2011. Then the pain suddenly got much worse. Now I feel dizzy most of the time, have daily neck and back pain and headaches, the pain radiates down the right arm, I have tingling in right hand and foot, cannot stay upright for a long time without resting my head, have a very limited range of movement.

I discontinued seeing the chiropractor because every treatment just seemed to make everything worse. I started doing physiotherapy exercises but don’t get relief. Because of rheumatoid arthritis, I am already taking anti inflammatories, and the RA is pretty much under control with Remicade and Methotrexate.

My family doctor wants to refer me to a specialist and ordered an MRI. Today I got the report:
There is moderate disc space narrowing at the C5-6 level with associated retrolisthesis measuring 3 mm. Alignment is otherwise unremarkable. No cord signal abnormalities are visualized.

I got a CD from the MRI and copied some pictures out of it to show them to my family doctor. She thinks that it looks worse than stated in the report and still tries to refer me to a specialist (which is not easy in Manitoba, Canada). I would be glad if you could have a look at the pictures and tell me your opinion. The symptoms are so bad now that they are effecting my every day life. You find some of the pictures here:

Thank you in advance,

Jutta

Donald Corenman, MD, DC
Moderator

July 11, 2012 at 12:08 pm

Post count: 8660

#6512

Your C5-6 level is quite degenerative with bilateral foraminal stenosis. This can cause lower neck pain and pain in the shoulder that would radiate down to the thumb and index finger. This level will generally not cause headaches.

Headaches can be caused by the facets at C2-3 and C3-4. This facet disorder generally does not show up on an MRI. The only way to determine if these facets are causing headaches is to use diagnostic facet blocks (see website).

To determine if the C6 root is causing the neck and shoulder pain, a selective nerve root block would be required (see website).

I deleted the address for the images to have you remain anonymous.

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.

Ginger
Member

July 12, 2012 at 2:42 am

Post count: 2

#6517

Thanks for responding so fast and the detailed explanation. I just don’t quite understand that the MRI report stated: “There is no significant foraminal narrowing.”

My husband said recently that he noticed that I quite often drop things from my right hand. I had thought it might come from the pain and do more with my left now, but my handwriting has changed as well. I used to draw but I have difficulty doing this now. Sometimes, the pain in the hand is dull but the skin seems to be burning, sometimes the pain is sharp. The left arm and hand has some tingling too, but nothing compared to the right one.

The headaches and some of the dizziness seem to get a bit better when I put my hands round the back of my neck and do a very mild stretch upwards. But this relief doesn’t last. Sometimes I have less pain but a tingling on the skin of the back of my head.

The pain and dizziness are keeping me from sitting through a movie with my family, driving in a car for more than an hour results in hours of worst pain. What can I do to get some relief while I am waiting for my appointment with the specialist? Are the problems urgent enough to ask for an earlier appointment? According to my pain and discomfort it is urgent to me, but what from a neutral point of view?

Donald Corenman, MD, DC
Moderator

July 14, 2012 at 8:25 am

Post count: 8660

#6530

If the radiologist reported “There is no significant foraminal narrowing”, I would disagree with him. You appear to have narrowing at C5-6 based upon the image I reviewed. With C5-6 foraminal stenosis, you cna have pain radiate down your arm into your thumb. Nerve compression can also cause you to drop items.

Without a full history and physical examination, I cannot tell you if you have an urgent problem or not.

Dr. Corenmna

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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