[Donald Corenman, MD, DC]

#11872

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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.

[waderoberts]

#11873

https://plus.google.com/112141159684280755837/posts/S38zf1WVinU

Dr. Corenman,
This active link will take you to the better quality, though still JPEG images mentioned in my previous post with additional views, from which you may be able to provide a more certain diagnosis. I would like as well to provide you with the DICOM images on CDROM at some time in the very near future as well as my most recent MRI. (05/31/2013)

Please do comment if these images allow you to make a certain diagnosis of both the existing non-union and/or instability at the C7-T1 level.

Additionally, when I place my fingertip on/between the spinous processes at the C7-T1 level, I feel limited rotational movement along with some catching when looking from extreme left to right or vise versa.

The link above will take the viewer to 10 plain X-ray views of my cervical and upper thoracic spine (absent any personal information) that demonstrate the impact of pain and instability on the spine from am instrumented (Codman plate) non-union of 14 years duration at the C7-T1 level.

Though I do have some neurological deficits that are apparently permanent in the form of reduced left sided arm reflexes and left sided arm and shoulder pain, the majority of my neurological symptoms are intermittent, dependent upon position, posture, muscle spasms and inflammation from overuse due to recent activities, that resolve in time.

Most of the pain I endure regardless of activity is in the back of the neck and my upper back between the shoulder blades, which is chronic, activity limiting and interferes with getting both sufficient sleep and exercise.

[waderoberts]

#11882

Tomorrow will be the 20th Anniversary of my DOI. The blurred image above is from my first MRI in December of 1996, some two years later, when I obtained an accurate diagnosis of the aftermath of the collision with a resisting inmate I literally ran into some two years previously.

I was in a soft collar for six weeks or so originally after I had been given a cursory evaluation at the local E.R. and was provided with light duty assignments for a few months and missed no time from work whatsoever during that initial recovery period, in spite of the extreme pain I was in initially.

I returned to working full duty the following April, though dependent upon prescription narcotics for pain relief and alprazolam or later ativan, due to my inability to rest, relax and/or sleep comfortably for the following two years, prior to the more complete diagnosis that the 1996 MRI provided.

I was shortly thereafter referred to a neurosurgeon, who dictated that continued inmate contact was far too dangerous in my condition and subsequently the personnel department told me it was to be surgery or I would have to go on disability as long term light duty or retraining wasn’t an option for me.

I later opted for surgery, which didn’t yield the promised result and the previous post shows you the current aftermath of the revision I had done some three years after that initial operation.

I was fired in 1998 when I wasn’t medically able to return after the initial surgery and had been on SOM LTD (State of MI Long Term Disability) ever since, until the end of Nov. 2013, when the LTD carrier after having rented an unscrupulous orthopedic surgeon to attest that I was properly fused and thus able to return to work full duty as a Corrections Officer, even after he had viewed most of the X-rays linked in my previous post. 4 of the 10 images were done 12/11/2014.

I would very much appreciate your honest opinion regarding the medical information provided in my last post and/or a private online consultation, as I am but 56 years old and would like to regain some of the life and lifestyle this injury and subsequent inadequate medical treatment has taken from me.

My father worked to age 74 and his father worked well beyond that. I would like to begin a new career for myself and leave the past and 20 years of chronic pain behind to the greatest extent possible and would greatly appreciate your help in doing so.

You assured me previously that you remain confident that an anterior approach revision surgery was or would be relatively safe in your capable hands after consultation with an ENT. I would greatly appreciate your surgical recommendation for reconstructing what is obviously wrong with this current “construct” and the resulting non-union as well as your recommendation regarding work restrictions in the interim.

Short of that, all I require to support my next appeal of the LTD carrier’s decision to end my benefits is an ethical, honest and straightforward statement of the obvious, based on the X-ray images from the previous post; that I am indeed not fused, nor some 14 years post surgery am I likely to become fused and couldn’t return to work full duty as a Corrections Officer even if I was.

That would be sufficient to support my level 3 appeal and upon resumption of the income I have been unjustly denied for over a full year and back payment, I can then seek a revision surgery with the Steadman Clinic as previously hoped; with the surgery performed by your capable hands if you so choose, or elsewhere, hopefully with your referral, recommendations and interest in following the results and my anticipated recovery.

It has been a long and arduous two decades, your words can end my dilemma and your hands could help to heal my spine.

Short of that, I hope you and others will have learned something of me, my condition as well as the past and current state of medical treatment of trauma induced spinal disorders in these United States of America.

[Donald Corenman, MD, DC]

#11888

There are two separate problems that need to be addressed. One is your pseudoarthrosis of C7-T1 and the other are your symptoms. These two problems may or may not be related.

You noted that you had the initial surgery which I assume was a C5-T1 ACDF fusion. You then underwent another surgery (a revision surgery) “some three years after that initial operation”. What was that revision surgery performed for?

The pseudoarthrosis may or may not be causing your current symptoms. Some pseudoarthoses are stable and not symptomatic. You might have other problems that were not addressed at the first two surgeries or you might have chronic radiculopathy (see website for description).

This diagnosis cannot be made over the internet. You need a skilled spine surgeon to take a careful look at you. You will also need further diagnostic imaging and probably diagnostic blocks to determine what your pain generators are.

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.

[waderoberts]

#11892

Thank You. I appreciate your positive confirmation of the existing non-union at C7-T1. I didn’t elaborate on the first surgery that was performed in November of 1997.

It was planned to be a single level (C6-C7) diskectomy and (unplated) fusion with auto-graft from my iliac crest that was performed to remove the herniation that was then compromising my spinal column as pictured on the single MRI image previously posted.

The result was a reverse kyphosis and a single level psuedoarthrosis of the C6-C7 vertebra.

A subsequent surgery done 3 years later was planned to be an ACDF with plating of the C5,C6,C7 vertebra, once again using auto-graft from the alternate iliac crest.

The result can be seen on the X-rays provided and linked. I remain interested in having you examine my most recent MRI and X-rays on CDROMs and am trying to make arrangements to be seen as recommended, either by yourself in Vail, or by whomever you might recommend regionally in the Great Lakes/Midwest, but outside the Upper Peninsula.

The fundamental issue and remaining question is for my SOM LTD carrier, regarding my physical inability to work safely as a Corrections Officer, or in a related field that would almost certainly involve at times physically subduing and restraining resisting offenders.

From your previous posts, we have a general idea of the activity restrictions that a competent spine surgeon and physician should place upon a person with a solid 3 level ACDF. The non-union and movement behind the plate of the lowest level of my unsuccessful C5-T1 ACDF would certainly prohibit in my opinion, not only my former employment and related fields, but many others as well and remains a definite liability in my passing any pre-employment physical examination for any employment whatsoever.

My symptoms are severe enough that at present, I am strained to simply care for myself, my simple home and keep up the yard work. I do a considerable amount of research and some writing on computer, but even with ergonomically correct seating and placement of screen, mouse and keyboard, my neck pain limits the time I can spend at a desk. Driving is similarly limited and dependent upon weather, traffic and season as for actual endurance time behind the wheel. Winters here in Michigan’s Upper Peninsula are particularly cold, damp and treacherous with lake effect rain and snow.

I am a full year into this war of attrition with a governmental entity with comparatively unlimited resources and the healthcare providers available to me locally are all associated in one way or another with both the neurosurgeon and/or the facility that performed my last surgery.

My own subjective observations of my cervical spine condition over the past two decades are in agreement with your opinion stated in the previous post, that the C7-T1 non-union, though certainly a pain generator during excessive movement and when stressed to the limitations of the constraints of both the plate and the surrounding ligaments and muscles that support it, is not the only problem that I have with my cervical, or for that matter, upper thoracic spine.

That much is fairly obvious from the CT and MRI images that have been performed subsequent to the second surgery. I admire your reluctance to make a surgical recommendation or diagnosis of any sort without further information and the required diagnostic imaging/testing.

That said, your advice regarding activity restrictions should be within reason. My own rule is restrict my activities to prevent my pain levels from exceeding a 6 or 7 on a scale of 1-10 and rest long enough, even if it involves a few days to recover to return to a baseline pain level of 2 or 3.

As I’ve grown older and don’t seem to recover as quickly, doing so has become increasingly limiting; though strict diet with proper nutritional support, light non-impact aerobic exercise and the judicious use of anti-inflammatory and muscle relaxing medications are of great benefit to maintaining a fairly active lifestyle within reasonable limits.

However, subjective restrictions and recommendations aren’t recognized by insurance carriers, bureaucrats and politicians and that is where my battle for further treatment and medical support is at this point; which is why I am seeking your esteemed opinion regarding activity restrictions with a failed 3 level ACDF with non-union of the C7-T1 vertebra and likely other associated problems of the cervical and upper thoracic spine.

My sincere thanks for your valuable input and insight into hopefully resolving this decades old problem with the best and most reliable advice available to me at this time, yours.

Sincerely,
waderoberts

[Donald Corenman, MD, DC]

#11893

A three level fusion of the cervical spine should in my opinion preclude a patient being involved with potential altercations. This would include police, fire and corrections. Even if you had a solid fusion, this would be my opinion.

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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