surgery for broken neck and cord injury

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jsleemd
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May 25, 2014 at 8:34 am

Post count: 2

#10888

Hi Dr. Corenman, as a fellow physician I commend you on this incredible website and your tireless commitment to all those in need of your expertise. I had a mountain bike accident 12 weeks ago with a C4 burst fx of the bilateral lamina and a nondisplaced fx of the left lamina of C7. At the time of impact I was a complete quad and only by some miracle and luck my neck was reduced by a passing hiker and immediately regained lower extremity motion and sensation. MRI reveal a congenital spinal stenosis which compounded my cord injury with severe bilateral dysathesias and right arm paralysis. The neurosurgeon recommended a C3-T1 post fusion and bilateral laminectomy which was done and aside from residual neuropathic pain in both hands(taking neurontin with some relief), I have regained almost all function in all my limbs. I still suffer from bilateral posterior shoulder pains but this is also improving. I have started noticing a grinding noise from the Cervcothoracic junction without pain. Is there cause for concern over this noise? What is my long term prognosis in terms of potential morbidity from the surgical fusion? Lastly can I start cyciing again, Road vs Mtb.

Donald Corenman, MD, DC
Moderator

May 27, 2014 at 10:59 pm

Post count: 8660

#10900

First-I must admonish passers-by generally not to try and reduce a spine injury but to call 911 immediately. You were very lucky that this individual was able to “reduce” your neck fracture without further injury. I had a patient with a mountain bike injury go over the handlebars and suffer a thoracic fracture dislocation without immediately knowing it. His back he reports was “very sore”

A passer-by physician helped him get up and with that effort, the spine dislocated causing a cord injury that was not present before. Thankfully, with surgical intervention, he recovered almost all function.

It might be that you suffered a central cord injury. These injuries are known to cause immediate paralysis that recovers for the most part in minutes to hours. See the website for further details.

Now with a fusion of C3-T1, there are some points that need to be considered. The grinding noise you hear could be from a pseudoarthrosis (lack of fusion) of one segment which is not uncommon. An X-ray with flexion/extension views would be very helpful to determine this. Your surgeon could do these easily.

Your neck is no longer as supple as it was before and a fall now has more consequences. You sound very active in cycling, both mountain and road. You will need a shorter, higher stem to accommodate your lack of hyperextension. You will need to be careful when descending. Reduce your descent speed on the road bike and on the mountain bike, walk some rock strewn technical descent sections so you don’t endo. Develop a less aggressive approach and you should be OK.

Then, go purchase some lotto tickets as you have recovered from what could have been a devastating injury and your luck might continue!

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.

jsleemd
Member

May 28, 2014 at 12:08 am

Post count: 2

#10902

Thank you for your prompt reply. Indeed the preop MRI did show extensive signal changes in the central spinal cord from C3-C7. My followup MRI 9weeks post up showed near complete resolution. The grinding noise abruptly stopped the day after I started this thread. Maybe you have healing powers that transmit through the internet? RIght now it’s the posterior shoulder pain and tightness/spasm of the upper back and shoulders that are the most significant problems. I had read in one of your replies that this could be due to stretching of the cervical nerve root following a post decompression. If so, will this resolve over time?

Donald Corenman, MD, DC
Moderator

May 30, 2014 at 10:41 pm

Post count: 8660

#10913

I have tried to heal over the airwaves but have been a dismal failure.

Yes-the cord drifts back after a posterior decompression. The nerve roots are attached to the cord and of course, stretch when the cord drifts back. Any defecit from this generally will fade away over time. It might take as long as six months.

Sometimes I have found that a local trigger point injection can be helpful to reduce this discomfort.

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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