Parsonage Turner vs. Cervical Stenosis, how to differentiate?

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Irishred111
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February 11, 2015 at 4:00 am

Post count: 4

#12189

Good afternoon Dr. Corenman,

I am hoping you can shed some light on this subject for me. I have already had DDD at L4-L5 and L5-S1 with a positive discogram sourcing L4 as cause of pain, so I have researched the spine extensively, but not the cervical region, until recently.

Given that most vehicles have several blind spots, I turned my head to the left in November to check my blind spot and felt a pop, followed by a migraine and neck and scapular shoulder pain. I waited three days, as I frequently get migraines (since age 14, became increasingly worse around 2007) and figured I may have just triggered another one. I went to the ER, the Dr did not examination and only ordered medications to “keep me comfortable”. Two days later, I returned and had a great doctor, who ordered a CT Scan. Readers digest version, I had a migraine in April, they did Ct Scan, advised me I had a pinched nerve and used that scan for comparison. Report states small central disc protrusions C4-C5, vacuum disc phenomenon C3-C4 and C4-C5, multiple levels of osteophytes. Second report outlines disc desiccation, osteophytes and minimal anterolisthesis of C6 upon C7. Was referred to neurologist. He ordered MRI, IMPRESSION:Small posterior disc ossified complex at C4-C5 and C5-C6, resulting in mild left-sided neuroforaminal stenosis at these levels. He referred me to a physiatrist and suggested that I may have Parsonage Turner syndrome, but wrote cervical spondylosis without myelopathy on the order for physical therapy.

To date, the pain has escalated in intensity and spread from the shoulder blade to the collar bone, down the left arm to the wrist and thumb, pointer and middle fingers and also affects the shoulder blade and upper arm in the right side. Most recently, within 5 days, the pain now radiates from my shoulder up my neck to my cheek/jaw bone. Nothing controls the pain, and I have been prescribed Lyrica, Nucynta, Dilaudid (which I believe may not be as effective given that it was the medication given for my migraines every 3-4 months) and diazepam. I have had an epidural injection which provided no relief at all. I barely sleep and when I do, its on a mound of pillows in a recliner bearing all weight on my right side. Mind you, I am petite, I am 5’6″ and weigh 105 lbs, so obesity is not a factor. My left shoulder contacting the back of a chair, or a pillow or the seat of a car while driving immediately generates the burning pain in my left shoulder blade and down to my arm. Holding the steering wheel at 9 and 3 for even 10 minutes makes the pain extremely worse, and I recently drove for 5 hours to pick someone up at the airport. That was a week ago and the pain will not subside, no matter what combination of medications I have tried. The dilaudid does not give me the drunk feeling, and it keeps the migraines at bay, which is why I prefer that, but all it does is take the edge off, maybe from a 9 to an 8 at best.

My question is, given everything that has progressed over the three month period, the failed conservative treatments, the location and intensity, the inability to sleep, the impact on normal daily routine, even though I stretch frequently, do a modified yoga routine, showering multiple times, although the water hitting the back of my neck is excruciating, alternating a heating pad on for 30 minutes then off then use ice for 20 minutes on, then off for 20 minutes then on for another 20 minutes every four hours, and still do housework, dishes, laundry, vacuuming. I am on leave from one job, had to quit another because I can not hold my arms up for 8-10 hours per day and the one job I do still have, I can do one handed thankfully. Could this very well be Parsonage Turner, or could the combination of everything going on within the cervical region from c3-c6 be causing this pain? I have images where I as an average person and not a trained professional am able to see disc matter from the herniations and believe that the chemical reaction may be part of the problem as well.

I will have the MRI/ CT Scan images and will upload them as soon as I can, for now my primary concern was to determine if I could have a permanent issue or if I have some sort of light at the end of the tunnel.

Donald Corenman, MD, DC
Moderator

February 11, 2015 at 8:55 pm

Post count: 8660

#12199

More likely than not, your neck and shoulder pain is caused by severe degenerative disc disease. See “IDR” (isolated disc resorption) and “degenerative kyphosis” under neck conditions to understand these disorders.

You pain down the left arm is probably cervical radiculopathy (see website) but could be chronic radiculopathy with a slight possibility of Parsonage Turner syndrome. An EMG/NCV (see website) will help to differentiate this disorder from radiculopathy.

You need a careful meticulous spine surgeon to help you understand the pain generators and find a solution to your pain.

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.

Irishred111
Member

February 11, 2015 at 9:23 pm

Post count: 4

#12202

I have the most mediocre insurance available and prior to having MRI report in hand, neuro said everything was right sided.

Because of the pain running out of control, I went to ER last night where MRI was performed. Report states disc dessication at every level from c2-t1. Also states c4/5-broad based disc protrusion indenting thecal sac with mild spinal canal narrowing, bilateral uncinate hypertrophy with mild bilateral neural foraminal narrowing. C5/6 mild bulge indenting thecal sac, left uncinate hypertrophy with mild left neuro foraminal narrowing.

Irishred111
Member

February 12, 2015 at 12:33 am

Post count: 4

#12205

And thank you very much for taking the time and responding so rapidly.

Donald Corenman, MD, DC
Moderator

February 12, 2015 at 9:03 pm

Post count: 8660

#12210

Please keep us informed of your outcome.

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.

Irishred111
Member

February 25, 2015 at 10:46 am

Post count: 4

#12305

No neuro consult yet, physiatrist seems more interested in giving band aids ie medication instead of addressing the cause. Very frustrating. Like I said, mediocre insurance, options are limited,
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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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