STRAIGHTENING OF CERVICAL SPINE

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TracyL
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December 15, 2014 at 2:56 am

Post count: 2

#11856

Dr. Corenman , I had an automobile accident 8 months ago. Other car hit me in the tire I was going 50 mph and car t boned me totaling my suv. Left scene ok 2 day later arm numbness and neck pain x-ray said

Findings : cervical spine is visualized to the c7-t1 disk pace on the lateral view.
there is straightening of the normal cervical lordosis. there is no spondylolisthesis, vertebral body heights are preserved. There are prominent anterior endplate osteophytes at c2/3. there is a mild 6/6 disc space narrowing, endplate osteopphyte formation an duncovertebral arthrosis . there is no significant foraminal stenosis. There is mild lower cervical facet arthrosis. Lateral masses of CT and base of the odontoi process have an unremarkable relationship on the open-mouth view. There is no erosion or aggressive osseous destrucion. There is no prevertebral soft tissue swelling, lung aprices are clear .

Impression : NO fracture visuaized. If there is presistent clinical concern ofr acute traumatic cervical spine injury , CT is recommended

what is your opinion of this x-ray : complaints were arm pain, numbness, shoulder blade pain and headaches , unable to turn my head . given hydrocodone for pain ( didn’t help )

8 days later my doctor said OA and sent me to physical therapy with mechanical traction. Passed out after 2 sessions of traction, dr said not related. 10 weeks later neurological symptoms got worse .with no where to turn went on my own to an ortho . MRI was preformed and said 2 ruptured disc c5c6 c6c7 called within hrs and told to see a neurosurgeon. MRI only shows part of c1, same radiologist did both x-ray and MRI diagnosis. x-ray only showed above but to me on x-ray looked like c1/c2 was pulled away from my skull. said visualize c7-t1 can only see part of C7 4 months later Had decompression surgery for spinal cord compression at c5c6 c6/c7 with c6 corpectomy. Now having trouble turning my head side to side. How can I get a second opinion of my x-ray feeling that they missed a fracture. and I was totally misdiagnosed. Want to send me back to physical therapy scared I have another fracture or ligament damage at c1c2 .

Donald Corenman, MD, DC
Moderator

December 15, 2014 at 6:12 am

Post count: 8660

#11858

As typical in an auto accident, patients have preexisting asymptomatic (no symptoms) degenerative changes. The accident trauma causes injury to these structures as they are already weakened and will be the focal point of the traumatic forces.

It sounds like prior to surgery, you did not have a workup to determine what your pain generators were (facet, disc or nerve). This would have required facet blocks, nerve root blocks or discograms all with a pain diary (see all these topics on the website).

The neurosurgeon did what he was trained to do, decompress the cord with a corpectomy. Unfortunately, without knowing what was painful, this did not address your pain generators or you have a pseudoarthrosis (lack of fusion) of C5-7 along with other pain generators.

You need to find a careful, well-skilled spine surgeon to go over your history, physical examination and images to determine what was missed.

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.

TracyL
Member

December 15, 2014 at 9:29 am

Post count: 2

#11866

thank you , could this go back to the original x-ray and radiologist that didn’t have a sufficant view of the spinal injury. Plus with the MRI not showing the complete c-spine. Now that I have neurological deficits should I see a neurologist? and would they beable to find what happen or what was missed. Do you recommend PT to get back range of motion or wait to see what the real problem is ? The MRI looks like there’s a tear drop fracture at c3 and lots of white and lots of ligament damage could that have been due to mechanical traction of 10 week/ 3x week ? Prior to MRI I did have 2 trigger point injections that did absolutely nothing maybe even to the point of causeing more pain. consulted with 3 neurosurgeons before deciding surgery. they all had a different approach ? I called my primary care doctor 4 times and each time talked with his nurse , never getting a call back from him prior to having surgery in Aug. Just recently I asked him for a referal to a neurologist and was denied.
so what do you suggest I do next. Can you recommend a neurosurgeon in CT

Donald Corenman, MD, DC
Moderator

December 15, 2014 at 8:53 pm

Post count: 8660

#11868

The original X-rays will reveal only any mechanical problems (instability, facet disease). The MRI will reveal inflammatory disorders and compression of neurological structures. At this point, a neurologist might be helpful but there are not many neurologists that I have found that can help diagnose this type of injury.

A PT might be helpful but without a diagnosis, the PT might not know what can be done.
Trigger point injections can be helpful for general soreness but this is not a specific treatment.

Regarding the quote “consulted with 3 neurosurgeons before deciding surgery. they all had a different approach”, the old joke is if you ask 5 neurosurgeons in one room a question, you will get ten different answers.

There is a difference between neurosurgeons and spine surgeons. Neurosurgeons come from a neurosurgery background and spine surgeons come from an orthopedic background (they have a spine fellowship in addition to their orthopedic training). For mechanical disorders like you have, spine surgeons generally have an advantage in diagnosis and treatment.

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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