Opinion on surgery

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mlr610
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January 22, 2014 at 8:58 am

Post count: 2

#10203

Dr. Corenman,

In August I had severe pain in my back in area of my scapula and pain in my neck where I couldn’t raise my head this pain lasted approximately 3 1/2 – 4 weeks. I went to my doctor and he scheduled a MRI.
MRI showed:
Diffuse bulging at 6-7 interspace with some left paracentral protusion. This produces canal stenosis with some central to left-sided cord compression without edema and what appears to be moderate bilateral foraminal encroachment.
Lesser disk bulge with central protrusion at the 5-6 level, slightly indenting the ventral cord and producing some relative stenosis. Moderate bilateral foraminal encroachment is felt present.
There is some central to predominantly right-sided disk osteophyte complex felt present at the 4-5 interspace. This produces some right paracentral effacement of the ventral cord and some right-greater-than left foraminal encroachment, which is felt to be at least moderate.
IMPRESSION:
Three adjacent levels of spondylosis producing canal stenosis and some cord compression as noted above.
The right-sided involvement is greatest at the 4-5 level, more bilateral involvement noted at the other levels as described above.

My doctor made me an appointment at an Orthopedic Spine doctor.

The week before pain started I was bench pressing 95 lb dumbbells, two weeks later I couldn’t do 30 lbs. Since that time I have lost 2″ off my right upper arm and half of my upper pectoral muscle.

In late November I took a slight blow to the face while looking up and lost use of my arm for approximately 5-10 minutes.

Pain is mainly in my neck now with dull aches in tricep and pec, this I can live with but the loss of strength has me concerned. Looking to my left only produces slight discomfort but looking to right and especially trying to look up I get pain and pins and needles in right arm down to thumb and forefinger. Approximately 4 weeks in to this I noticed changes in trying to write but that has cleared somewhat.

First two visits with the spine doctor was prescribe Mobic. In November I kept complaining on the loss of strength and tricep atrophy and the reply from the PA was “that’s strange”.
They made me an appointment for a nerve conduction and EMG.

Follow up appointment in January the doctor said c6-c7 is significant and the EMG showed “irritation to the c7 nerve root. He is now wanting to do either a 3 level fusion or a 2 level and a disc replacement.
Do you think I should get a second opinion? They went to “that’s strange to wanting to do surgery in one visit.

Donald Corenman, MD, DC
Moderator

January 23, 2014 at 9:01 pm

Post count: 8660

#10208

Your MRI notes central stenosis (see website) at C6-7 with lesser but still present stenosis at C5-6. These levels also have foraminal stenosis (the exit region of the nerve root). You also have foraminal stenosis at C4-5 on the right.

Matching with your symptoms, you have triceps weakness (going from 95 lb dumbells to 30 lb dumbells) which is a C7 nerve function. Loss of muscle diameter can be either C6 or C7 (biceps or triceps). The pectoral muscle can be C5-C8 so that does not help to identify the nerves involved.

What is very disturbing is the “blow to the face” with temporary paralysis for 5-10 minutes of your upper extermities. This could be a sign of a cord contusion (central cord syndrome-see website) or could be further injury to the nerve or nerves by extension (bending the head backwards). Did this injury involve one arm or both?

I cannot say what surgery is needed at this point but I can say that you do need surgery based upon the findings that you report.

A precise physical examination will be very helpful to determine what surgery you need. This may be only a C7 nerve involvement and only one level surgery is needed or you might need multilevel surgery. A second opinion might 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.

mlr610
Member

January 23, 2014 at 9:26 pm

Post count: 2

#10211

Thank you for you reply and for the time you put into this forum and website. It has been a great help in understanding problems with the spine.

The blow to the face only affected the right arm, hit was to the left cheek area while I was looking up. Weight of maybe 15-20 lbs fell about 3″-4″. The muscle atrophy in the arm is to the long head of the tricep with some minor strength loss possibly beginning in the upper forearm.

Original MRI didn’t show any cord contusion.

Donald Corenman, MD, DC
Moderator

January 24, 2014 at 4:49 am

Post count: 8660

#10216

OK- there was no temporary paresis bilaterally so we can put the potential cord problem to bed. You had a blow to the head causing an extension moment (bending the head backwards). This compressed the C7 nerve root in the foramen (the exit hole) and caused an increased injury to this root.

Atrophy of the triceps muscle fits nicely with a C7 root diagnosis.

If the C5-6 level does not look too bad, you could probably be helped with a one level C6-7 ACDF (anterior cervical decompression and fusion).

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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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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