Prior patient new neck pain

Viewing 3 posts - 1 through 3 (of 3 total)

Author

Posts
juliaj
Member

November 15, 2013 at 3:46 am

Post count: 2

#9797

I saw you a few years ago, and at that time you confirmed that I had Degenerative Disk Disease. During the last three or four years my neck is often not very comfortable, and I sometimes have some physical therapy, but not the great pain that I have been having during the last two weeks, to the right of my upper spine, radiating out to my right shoulder, shoulder blade, somewhat under my arm; weakness and poor coordination in my right hand. My MRI shows the following: Clinical Data: Severe neck pain radiating to right shoulder. History of myasthenia gravis. Findings: Significant reversal of the normal lordotic curve centered at C5. Grade 1 anterior spondylolisthesis seen at C3-C4 and C4-C5. Vertebral body heights are well-maintained. Multilevel degenerative discs are demonstrated with height loss and low T2 signal most prominent at C3-C4, C4-C5, C5-C6 and C6-C7. Bone marrow signal is heterogeneous, likely normal for age. Visualized brain and spinal cord demonstrate normal intrinsic signal and morphology. Paravertebral and surrounding soft tissues are grossly unremarkable. C2-C3: Uncovertebral and facet arthropathy with posterior bulging annulus are demonstrated without significant stenosis. C3-C4: Uncovertebral and facet arthropathy with posterior bulging annulus resulting in moderate-severe left foraminal stenosis with minimal right foraminal and spinal canal narrowing. Suggestion of a central annular tear. C4-C5: Uncovertebral and facet arthropathy with posterior bulging annulus are demonstrated resulting in minimal bilateral foraminal narrowing. C5-C6: Uncovertebral and facet arthropathy with posterior bulging annulus are demonstrated resulting in moderate left foraminal stenosis. C6-C7: Uncovertebral and facet arthropathy are demonstrated resulting in minimal to moderate left foraminal and minimal right foraminal narrowing. Impression: 1) Multilevel degenerative discs and arthropathy resulting in multilevel narrowing, most prominent at C3-C4 on the left. 2) No acute osseous or ligamentous abnormalities. 3) Significant reversal of the normal lordotic curve centered at C5. I was diagnosed with the Myasthenia Gravis about 3 years ago, but mostly the muscle weakness is in my eyes and I take medicine five times a day to keep my eyes open fully. I had an upper respiratory infection starting two weeks ago, was given an antibiotic that I learned later I should not have been given as it was likely that it led to further muscle weakening. The pain in the right side as described above grew very bad, very quickly. I currently am not able to work much, and I take a lot of Tylenol, Motrin and Flexeril. At least when I do that I am able to be up and around some. Since I am a former patient of yours (from Aspen) I am asking if you could possibly give me some guidance. We moved to Wichita, Ks. two years ago, and I have been traveling back and forth to Vail in the last couple of years to see Dr. Viola who has fused both of my thumb/wrist joints. Since you were my previous doctor, I would of course rather see you again, or at least hear you impression of the above. If you think I only need perhaps physical therapy, perhaps chiropractic or a pain shot, then I could see a doctor here in Wichita, but naturally I trust you the most. Thank you Dr. Corenman.

Donald Corenman, MD, DC
Moderator

November 15, 2013 at 9:54 pm

Post count: 8660

#9800

You have mainly right neck pain that radiates into the right shoulder. X-rays with flexion/extension would be very helpful in your case. With the severe degenerative changes of the discs, you could have the origin of your pain as disc pain radiating into the right shoulder. Right shoulder disorders can also radiate pain into the neck so that possibility cannot be ruled out.

There is some possibility that this could be nerve root compression pain but your MRI finding (as read by the radiologist) do not note right foraminal compression. Everything is on the left side (according to the radiologist).

“C3-C4: Uncovertebral and facet arthropathy with posterior bulging annulus resulting in moderate-severe LEFT foraminal stenosis with MINIMAL RIGHT foraminal and spinal canal narrowing. Suggestion of a central annular tear

C4-C5: Uncovertebral and facet arthropathy with posterior bulging annulus are demonstrated resulting in MINIMAL bilateral foraminal narrowing

C5-C6: Uncovertebral and facet arthropathy with posterior bulging annulus are demonstrated resulting in MODERATE LEFT foraminal stenosis

C6-C7: Uncovertebral and facet arthropathy are demonstrated resulting in MINIMAL TO MODERATE LEFT foraminal and MINIMAL RIGHT foraminal narrowing”.

I am uncomfortable to accept a reading of MRI images through someone else’s eyes but assuming that this reading is correct, nerve compression should not be part of the potential pain generators.

Hopefully, your local physician has referred you to a good spine physical therapist. Medications can be helpful also. See the medications section on the website to understand what possibilities there are for this type of treatment.

You are welcome to send your films to me if you choose.

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.

juliaj
Member

November 16, 2013 at 3:48 am

Post count: 2

#9805

Thank you so much for your time, Dr. Corenman. I will start some physical therapy next week while I wait to get in to see a spine surgeon on Monday, November 25. I am sending you by Fed Ex my MRI from this week as well as my MRI from this time last year if you wouldn’t mind looking at it. Although my family doctor has scheduled me to see a spine surgeon here in Wichita, I would prefer that I come to Vail to see you, especially if you think it is looking like the MRI shows deterioration that needs anything further than physical therapy. Thank you again, you are wonderful. (tingling and numbness/weakness in right hand seem to be getting worse)
Author

Posts

Viewing 3 posts - 1 through 3 (of 3 total)

You must be logged in to reply to this topic.

Donald Corenman, MD, DC

Average rating:

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel