Severe Right Foraminal Stenonis

Tagged: stenosis foraminal C5C6

Viewing 6 posts - 1 through 6 (of 9 total)

1 2 Next

Author

Posts
jr999
Participant

July 5, 2017 at 4:42 pm

Post count: 5

#25418

Dear Dr Corenman. I am in the NY city area and have been handed a diagnosis of severe right foraminal stenosis at level C5-C6. My right hand grip is 50% of my left hand grip even though I am right handed. I also get shooting pains, burning, pains in right chest and inability to type at a desk or use a bicycle with severe right arm pain. My spine doctor recommends meeting a surgeon since 2 weeks after a steroid injection the symptoms are unchanged. My symptoms started 2 months ago. I have a few questions:

1, Should I see a orthopedic surgeon or neurosurgeon?

2. Should I consider both ACDF and foraminectomy?

3. Should I bother with pre-operative physiotherapy? Is it even safe?

4. Can I possibly have a second contributing condition like pinched ulnar nerve or thoracic outlet syndrome that I should investigate first?

5. Is it possible to regain grip strength?

jr999
Participant

July 5, 2017 at 4:45 pm

Post count: 5

#25419

FYI: Radiologist report
MRI CERVICAL SPINE W/O CONTRAST

Age: 45 yrs

Sex: M

Exam Date: 05/27/2017

Clinical statement: 2 weeks of right arm numbness and tingling

Technique: An MRI examination of the cervical spine was performed without intravenous contrast. The examination consists of sagittal T1, sagittal and axial T2, sagittal STIR, and axial 3-D gradient echo sequences.

Comparison: None available

Findings: There is straightening of the normal cervical lordosis. There is no cervical spondylolisthesis. The cervical vertebral body heights are maintained. No destructive osseous lesion is identified. Multilevel cervical degenerative changes as detailed below.

C2-C3: There is minimal left uncovertebral hypertrophy. There is no canal or foraminal stenosis.

C3-C4: There is mild bilateral uncovertebral hypertrophy. There is mild left foraminal narrowing. There is no canal or right foraminal stenosis.

C4-C5: There is a disc osteophyte complex, mildly eccentric to the right. There is mild canal stenosis. There is minimal left foraminal narrowing. There is no right foraminal stenosis.

C5-C6: There is a disc osteophyte complex, with an eccentric right foraminal component consisting of both a disc protrusion and associated osteophytic ridging. There is severe right foraminal stenosis. There is mild canal stenosis. There is no left foraminal stenosis.

C6-C7: There is no canal or foraminal stenosis.

C7-T1: There is no canal or foraminal stenosis.

T1-T2: There is a left central disc protrusion. There is no high-grade canal or foraminal stenosis.

The cervical cord is normal in morphology and signal characteristics.

No epidural collection or mass is identified.

Impression: Multilevel cervical degenerative changes as detailed above. Findings are most pronounced at C5-C6, where a disc osteophyte complex with an eccentric right foraminal component contributes to severe right foraminal stenosis and mild canal stenosis.

Donald Corenman, MD, DC
Moderator

July 5, 2017 at 7:39 pm

Post count: 8660

#25422

Your problem seems to be a C6 nerve compression (“C5-C6: There is a disc osteophyte complex, with an eccentric right foraminal component consisting of both a disc protrusion and associated osteophytic ridging. There is severe right foraminal stenosis”. This means the C6 nerve is severely compressed. Look here to understand how a C6 nerve problem presents (https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/).

This diagnosis would probably fit with your current symptoms.

I personally think you should see an orthopaedic spine surgeon but a capable neurosurgeon should be OK. An ACDF generally is much better than a foraminotomy (remember Peyton Manning?) but there are occasions that a foraminotomy would work. Based upon your symptoms including weakness, you should see out a surgeon sooner than later.

It’s alway possible to have two different disorders at the same time but this is rare. There is generally only one problem that is causing symptoms.

Yes, it is possible to regain grip strength and the neck is more forgiving of nerve compression than the lumbar spine. Nonetheless, see a surgeon soon.

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.

jr999
Participant

July 5, 2017 at 9:16 pm

Post count: 5

#25423

Thank you very much Dr. Corenman. That is quickest, most detailed response I have got from anyone till date including my NYC physiatrist whom I like and respect. I will bear your advice in mind as I conduct my search.

Donald Corenman, MD, DC
Moderator

July 6, 2017 at 8:08 am

Post count: 8660

#25425

Please keep in touch with the Forum to let us know how you progress.

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.

jr999
Participant

July 7, 2017 at 7:15 am

Post count: 5

#25432

1. I am considering 3 NYC doctors who are all in network. All three are 40-something year old neurosurgeons who specialize in spinal surgery including ACDF, foraminectomy and even minimally invasive surgery. Unfortunately I could not find older (i.e. more experienced) doctors who take my insurance. Two of these surgeons come highly recommended by my physiatrist and the third was a Castle Connoly Top Doctor a few years ago.

2. The other question for me is: autograft or allograft.
Author

Posts

Viewing 6 posts - 1 through 6 (of 9 total)

1 2 Next

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