Prolapsed discs at C3/C4 and C4/C5.

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Jaccy
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August 14, 2011 at 1:48 pm

Post count: 2

#4770

Hello doctor, I was diagnosed at the emergency department in June this year with disc prolapse at C3/C4 and C4/C5 (MRI and CT scans). It is now mid-August.

Since, I’ve visited emergency department doctors twice, and orthopedics clinic once and didn’t receive any useful advises other than to try not to take a fall or impact. From researching in my own time, it appears this type of injury needs to be managed and not left alone. I’m hoping you can give me some advices.

To give you a quick background information.

CAUSE: Injury during impact sport (impact to the back)
DATE OF INJURY: June, 2011
MRI scan: C3/C4 and C4/C5 disc prolapse. No follow up MRI since.
CT scan: No fracture on C-spine or dislocation
NECK: Gap for spinal cord at C3/4/5 is also narrow by structure

DISCHARGE SUMMARY: Whiplash injury, neck pain, bilateral hand(s) numbness and paresthesia. Weakness in arms and hands.

I was told to re-visit a doctor or emergency unit at a hospital if any negative changes occur. Also that it was okay to do light exercises to keep my back strong (though C3/4/5 are in the neck?). The paresthesia in my hands was completely gone after 2 weeks. Less than a week later after I did a back exercise (dumbbell fly – 5kg – bent knees and whole back tilt forward) I returned home to find myself with paresthesia again!

PARESTHESIA: At about a scale of about 5 and alternating.
AREAS: Parts of hands, arms, fingers, feet, arms, thighs.
OTHER: Triceps muscle spasm, predominantly on left triceps.

I visited emergency unit and the doctor tested my hands and legs coordination, balance, scratch / pricking test with a stick and blunt needle, reflex tests. Then sent me home saying the same thing, not to take on impact sports again. But like last time, no advises to for proactive treatment, physiotherapy, or any treatment advises at all!

About a week ago, while laying in bed I experienced very intense pins and needles (and weakness in limbs) to the point of it being painful without touching. On all my four limbs and found it difficult to ignore and go to sleep. Tilting my neck too much to the left will also send a fairly strong deep muscle pain down from neck to mid fore arm on my right hand (my doctor dismissed it as muscle and not nerve related and ignored this..).

Please help! It seems all the doctors here are telling me is to go home and don’t move much for the rest of my life!

I’m now only doing sets of short and slow pushups and walking to keep my body in healthy state. The pins and needles now come and go, but I don’t know if that’s because I’m not really doing anything physical or because it is healing. My grip strength is good when testings happen but when I get pins and needles outside, my hands are weak again. My family wants me to catch a flight to see them, is this dangerous?

Donald Corenman, MD, DC
Moderator

August 15, 2011 at 3:26 am

Post count: 8660

#4772

There are many different diagnoses that could cause your symptoms. Visits to an emergency department are not typically helpful for accurate spinal diagnosis. The emergency room physician has to cope with so many potential fatal diagnoses that an accurate spine diagnosis is not expected.

The MRI reading of “C3/C4 and C4/C5 disc prolapse” also does not describe what your condition is from. Are these herniations that compress the spinal cord? Do these hernations compress one nerve root or more? Are they disc tears/bulges that don’t efface any neurological structure? Are these segments in kyphosis (a reversal of the normal cervical lordotic curve)?. Do the flexion/extension x-rays note instability? As you can see, the MRI report is incomplete.

Whenever I see the diagnosis of “whiplash injury”, it tells me that the diagnosis is incomplete. Whiplash is a generic term for a flexion/extension injury to the neck but does not delineate what structures were damaged. What did the whiplash do? Did this force tear a capsule of the facet, tear a disc, cause a herniation, tear a supraspinous ligament or an insertion of a muscle.

Your symptoms could be from spinal cord involvement. You need to evaluated by a spine expert. A full history, examination and review of all studies needs to be performed.

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.

Jaccy
Member

August 18, 2011 at 4:47 pm

Post count: 2

#4784

Hi Dr. Corenman, I’ve just received another paper from the hospital. It is said on there that there’s spinal cord compression by the two discs. I can see them actually making 2 curves on the spinal cord on the MRI.

My symptoms went away for a day where I felt completely normal, it returned yesterday but very lightly. I was at a physio today and we discussed traction. However, the physiotherapist did one on me without giving me any warning when I was laying down on my back with my head on the pillow. After the appointment it felt okay, but now that I’m at home, and if I am not imagining things.. I think it caused more harm than good as there’s now more tinglings on my arms than this morning and neck is feeling stiffer.

I have the MRI scan from June if you would like to have a look at some pictures.

Much appreciated.

Donald Corenman, MD, DC
Moderator

August 18, 2011 at 11:47 pm

Post count: 8660

#4785

Based upon your discussion of the presence of spinal cord compression, you need to get a consult from a spine surgeon. Make sure your physical therapist understands the ramifications of spinal cord compression so he or she does not perform any extension therapy to your neck.

I would be happy to review your films. You can send them on a DVD/CD to my office. Please call (970) 476-1100 and ask for one of my nurses, Diana or Sarah.

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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