question regarding possible damage to upper neck

Tagged: cervical facet capsular tear

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gregory_ar
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August 1, 2018 at 4:56 pm

Post count: 2

#28846

Dear Dr Corenman,

I’m having an issue with my neck which is causing me lots of stress(mostly psychological), and I am just trying to get someones expertise in this area to help me gain some peace of mind.

Around five years ago I started to see a chiropractor to help me with migraines I was having. I would see him for around two years more or less regularly (several times per week).
Shortly after starting getting adjustments from him I started to have a terrible habit to perform self adjustments on my own.
I would do it multiple times per day, swinging(thrusting) my head to both sides with the help of my hands, and also briskly tilting my head from side to side.

Then, one day while rotating my head from side to side in the manner I described, I felt a slight shift of my head out of place. I felt pain in the area under my scull, which would then give me strong headaches for several months after that episode.
I also started to notice that when tilting my head backwards and rotating it to one of the sides, there would be a slight hindrance to that motion (like a slight bump).
I should have told my chiropractor about this incident, but I was really worried of how strange and silly it might look, so I did not tell him, and proceeded to get adjustments from him.
But even after this incident, my habit of self adjustment would continue, and a similar incident happened to me several months after.
At that point I decided I should tell my chiropractor about it, and he referred me to a cervical MRI which showed two herniated discs at C5-C6 and C6-C7. There were no other significant findings on the MRI.

I stopped seeing my chiropractor shortly after that but I could not stop my habit for self adjusting, and it continued for another year or so when I finally managed to put an end to it. The symptoms that I am still having are: pain at the base of scull causing headaches, slight tightness in the upper part of my neck, crunching/squeaking sound coming from the base of scull when rotating my head from side to side, slight intermittent tingling on random parts of my head and very slight numbness in the back of the head.

Last year I had a cervical MRI once again, and it showed that my herniations became much larger (around 6 mm, initially there were 2 mm). It also showed osteophytes at levels of C3-C4 and C4-C5, and mild disc desiccation, and no other findings.

The concern that I am having now is that I have to perform physical therapy exercises which include stretching to my neck to alleviate my herniations. But I am worried that I might have problems with the upper part of my neck, and that doing that exercises can exacerbate them, even though my doctor(orthopedic surgeon) does not think I have any, judging by MRI and flexion/extension X rays.
I am really worried since I have done some research online, and found out that these kind of problems might not be revealed unless using special imaging techniques(like high resolution MRI of that specific area), and in general can be elusive.
I went ahead and saw a chiropractor recently for consultation which performed a DMX study on my neck, but he also claimed that the study did not show any signs of ligament damage.

I know that this all might sound really strange, but I would really appreciate if you could help me understand whether I might have caused any ligament(or other) damage to the upper part of my neck by the manipulations that I described,
and whether it’s safe for me to proceed with the physical therapy for my hernitaed discs?
Do you think I might need any additional examination/tests, or whatever I’ve had so far should be sufficient?

I am really looking forward to your reply, and would really appreciate if you could help me with my questions!

Thank you so much in advance!
Gregory

Donald Corenman, MD, DC
Moderator

August 2, 2018 at 2:39 pm

Post count: 8660

#28854

Your history and descriptions of symptoms are quite good so I have copied the important ones and will give a discussion after this summary.

“One day while rotating my head from side to side in the manner I described, I felt a slight shift of my head out of place. I felt pain in the area under my scull, which would then give me strong headaches for several months after that episode”.

“I also started to notice that when tilting my head backwards and rotating it to one of the sides, there would be a slight hindrance to that motion (like a slight bump)”.

The symptoms that I am still having are: pain at the base of scull causing headaches, slight tightness in the upper part of my neck, crunching/squeaking sound coming from the base of scull when rotating my head from side to side, slight intermittent tingling on random parts of my head and very slight numbness in the back of the head.

“I am worried that I might have problems with the upper part of my neck, and that doing that exercises can exacerbate them, even though my doctor(orthopedic surgeon) does not think I have any, judging by MRI and flexion/extension X rays”.

“I would really appreciate if you could help me understand whether I might have caused any ligament(or other) damage to the upper part of my neck by the manipulations that I described, and whether it’s safe for me to proceed with the physical therapy for my hernitaed discs?”

You probably caused a capsular tear of the upper facets with your habit of “popping” your neck. The capsules are burlap bag type tissues that are designed to stretch to a point and then “hold” once you reach the “stop” point. You probably continued to stretch the capsule with your self-adjustments until it tore and developed scar. Scar does not stretch which is why you have a “block” when you try and turn your neck. In addition, these tears can cause headaches.

Are you putting your neck as risk with these new stretches? Not really, but you can aggravate the symptoms by trying to overstretch. If symptoms become intolerable, you could consider a set of facet blocks to calm down and also reveal what levels are involved.

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.

gregory_ar
Participant

August 3, 2018 at 1:14 pm

Post count: 2

#28863

Thank you very much for your answers, Dr Corenman!

Could you tell what are the associated risks in relation to this type of tear, and is there anything I can do to mitigate it(besides injections)?
Also, is it OK to have cervical traction in case of a capsular tear?

Gregory.

Donald Corenman, MD, DC
Moderator

August 4, 2018 at 10:44 am

Post count: 8660

#28872

Really no real issues other than pain. Traction might help but it is a mixed bag with some patients not tolerating traction.

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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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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