Right side pain c 4-5 c 5-6 c 6-7

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Hurtinforcertin
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September 10, 2014 at 1:54 am

Post count: 2

#11407

I have sharp right side neck pain for months..tried medications,traction,chiropractic.Pain worsens with activity and going over bumps in car. Turning head right or tilt head right and back increases pain. Very faint numbness in right hand last two fingers on and off. Pain burning pins needles cramp in upper neck shoulder area.Comes and goes with severity.

Recent MRI:
Spinal canal stenosis 9mm C 3-4 in extension not flexion or neutral.
Spinal canal stenosis 6mm C4-5 in extension not flexion or neutral.
Spinal canal stenosis 9mm C5-6 in extension not flexion or neutral
There is 50% narrowing of disc height C5-6, 50-75% narrowing C6-7
C3-4 1mm bulg and 2mm ligamentum flavum hypertrophy.
C4-5 1mm bulg, bilateral uncinate osteopyte formation with 50% bilateral foraminal narrowing.Flexion:spinal canal 10mm Extention:Spinal canal narrows to 6mm.
C5-6 75% left foraminal narrowing from osteopyte formation, 50% right foraminal narrowing. Flexion: Spinal canal 11mm Extention: Spinal canal 9mm
C6-7 Osteeophyte formation and bulging is seen. 75% bilateralforaminal narrowing. No central canal stenosis.

What is your opinion and what are my options? I am 62 and very active, this has hurt my golf, swimming and overall exercise, let alone the mental drain.

Thank you

Donald Corenman, MD, DC
Moderator

September 14, 2014 at 4:59 am

Post count: 8660

#11417

Neck pain that is one sided has the differential of facet disorders and nerve root disorders. It is unlikely that disc pain by itself will cause this pain.

You have central spinal stenosis-relatively significant at C4-5 and moderate at C3-4 and C5-6. This is a problem with spinal cord compression that can lead to myelopathy or central cord syndrome (see website).

You note these symptoms occur with extension only. Did you have one of those Fonar MRIs that records motion? If so, these images are generally not very good or diagnostic for the most part. There is also no comment on the size of the foramen at each level. This is necessary to determine what nerves could be compressed.

The most immediate attention should be brought to the spinal canal stenosis. The neck pain can be diagnosed by either SNRBs or by facet blocks (see website).

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.

Hurtinforcertin
Member

September 14, 2014 at 10:33 pm

Post count: 2

#11430

Thank you for taking the time to answer.
Yes I had a Stand up MRI FONAR..mistake?
I am a Veteran and have no insurance due to the new healthcare reform.
I go to the V.A. However they are slow, very bureaucratic and don’t get my pain, it has been months. I drive 4 to 4.5 hours to get care. It will take over a month to get a nerve block or facet block with the V.A.
So now I am going self pay as far as I can afford.
I will get a regular MRI, are there specific things to request of the MRI/Radiologist?
I don’t sleep well at all and my everyday routine is a grind.
I got up this a.m. symptoms are a little more intense.
I need to get this resolved, life is not good right now.
You stated “The most immediate attention should be brought to the spinal canal stenosis”.
Can you please tell me the correct steps to take so I don’t prolong this longer than necessary.
Your help is greatly appreciated, I would be willing to come to Colorado to this resolved.
I am so glad I found your website.

Donald Corenman, MD, DC
Moderator

September 15, 2014 at 1:08 am

Post count: 8660

#11432

Fonar MRIs are of lesser quality but if you already have paid out of pocket for this, don’t immediately run to get a higher quality MRI. The images might be acceptable.

I understand completely about your experience at the VA. Years ago I was on staff there and know how problematic it is.

The spinal canal stenosis (narrowing of the spinal canal) can put the cord at risk with a fall impacting the front of your head (see central cord syndrome). However, with a Fonar MRI, the potential for this injury is limited if they only found stenosis in extension (bending your head backwards).

Find a good sympathetic local spine surgeon who has good diagnostic skills. The history and physical examination should give a very good idea of your potential pain generators. The imaging should lead to one or two “suspects”. It is then a matter of using diagnostic injection (see website) to understand what the primary pain generator is.

You might need surgery if the injections do not yield long term relief and surgery is not inexpensive (and either are the injections). You could use the work-up by this outside physician to take to the spine clinic at the VA and see if they will consider doing the surgery.

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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