pain in neck when tilted in right/left direction/MRI Findings enclosed

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asheet
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February 1, 2013 at 4:51 pm

Post count: 2

#7883

I am 35 years old male.
My MRI findings of cervical spine are mentioned below.I have problem in my neck for last 2 yrs.I am perfectly fine if I keep my neck straight but if i have to look in left or right direction then after 5 minutes max,I get stiffness in my neck followed by pain in neck and pain in my right arm and elbow. I have taken medicines/injections/Exercise/physiotherapy/Homeopathy/Acupressure but I beleive that no one is able to diagonise the problem and give me suitable treatment.I have been told by the radiologist that as the space between c5-6 disk is reduced and it is compromising a right nerve because of which i experience pain.Please help me and advise suitable treatment.

MRI CERVICAL SPINE FINDINGS
• PARTIAL CERVICAL LORDOSIS NOTED
• CERVICAL VERTEBRAE ARE NORMAL IN SIGNALS AND MORPHOLOGY.
• MILD LOSS OF BRIGHT SIGNALS IS SEEN IN CERVICL IV DISKS.
• VARIOUS MID SPINAL CANAL AP DIMENTSIONS ARE AS FOLLOWS:
C2-3 =13.6 MM
C3-4=10.6 MM
C4-5=10.9MM
C5-6= 8.4MM
C6-7=12.0MM
C7-1=13.9MM

• MILD DESICCATION OF CERVICAL IV DISKS.
• SPINAL CANAL NARROWING FROM C3-4 TO C5-6 LEVELS
• RIGHT PARACENTRAL/FORAMINAL PROTRUSION OF C5-6 DISK INDENTING THE THECAL SAC AND MILDLY COMPROMISING RIGHT EXITING NERVE ROOT(RIGHT NEURAL FORAMEN AP DIAMETER=3 MM & LEFT NEURAL FORAMEN AP DIAMETER=4.8 MM)

Donald Corenman, MD, DC
Moderator

February 2, 2013 at 4:59 am

Post count: 8660

#7887

Your symptoms could originate from degenerative disc disease and/or facet syndrome for the neck pain and foraminal stenosis for the arm pain. The spinal canal diameter is narrowed but cord compression normally does not cause neck or arm pain but paresthesias (pins and needles) or electrical shocks in the arms and legs.

Since you have run out of therapies to consider and have continued symptoms, it is possible that an epidural or SNRB (see website) might be helpful both for diagnosis (see pain diary) and for treatment.

It is also possible that a precise physical examination can help to diagnose your disorder. You should find an experienced and good spinal surgeon to have a consult.

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.

asheet
Member

February 3, 2013 at 8:58 pm

Post count: 2

#7893

Sir,Thanks for your reply .I would like to share one more MRI Finding which I got done for my right shoulder and its quite possible that the pain i experience is because of right shoulder.

MRI Findings
1.Focal increased signal intensity is seen in the supra-spinatous tendon just proximal to its insertion at the greater tuberosity.Focal disruption of fibres noted along bursal surface of the tendon.This lesion shows intermediate signals on T1W1 and hyperintense signals on STIR images.It involves the superior surface of the tendon.these findings suggest partial tear.

2.Mild fluid is seen in the subcoracoid bursa.

3.Small amount of fluid is seen on around the beceps tendon in the bicipital groove.This suggests biceps tenosynovitis.

4.Mild joint effusion in the right shoulder joint.

As i am writing this on my laptop I would share my sitting position,laptop is on the bed and I am sitting and writing it ,both arms are in downward direction,if i would keep laptop on the bed and continue doing this then i would experience pain in my right elbow after 10 minutes so i have to raise height of the laptop .
I hope it tells you about the problem.

please study the MRI findings and my observation to see if it can be related to my neck and right arm problem.

Donald Corenman, MD, DC
Moderator

February 3, 2013 at 9:54 pm

Post count: 8660

#7894

This is why a precise history and physical examination will be one of your best diagnostic tools. The history can always hone down the potential diagnosis and the physical examination can then be specific. If there is any question regarding the diagnosis after that, it is a simple matter then to use diagnostic blocks to determine what is causing pain.

A bursal injection into the shoulder can be performed right in the office and help to indicate if the shoulder is the pain generator. The injection can also be therapeutic (give longer term relief).

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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