Surgical Options For Cervical Instablity

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rmooney
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June 12, 2012 at 11:44 pm

Post count: 2

#6362

I have had chronic migraine for 8+ years (every day) due to neck problems. After a few years of failing to have positive results from medication and physical therapy, I tried chiropractic for a few years that would give me temporary relief. Osteopathic manipulation was even better, but my cervical vertebrae (most importantly C1 and C2) would twist back out of place and cause my symptoms again. Prolotherapy (injections of HGH and Testosterone in most cervical and some thoracic ligaments) has helped some but I have reached a plateau with that treatment.

My symptoms are constant pain in my neck on the upper right and left sides. Sharp and dull pains on both sides and the back of my head (it moves around a lot). Blurry vision, vertigo, nausea, visual disturbances (shadowy movements on everything), confusion, teeth grinding, irritability (sometimes aggressive), somewhat disassociated (feeling like I’m underwater). I feel like when its really bad (when it is inflamed or irritated the most due to physical or mental stress) it greatly affects my ability to comprehend what I see (I can see it but can’t “understand” it) and my ability to formulate speech.

I obviously have acquired hypermobility from years of working out and playing sports with my bones already in a place they shouldn’t be, and years of chiropractic treatment after that. Due to the neurological issues, it sounds like its borderline cervical instability.

Note also that this instability has caused further bone problems with my whole spine: my cervical spine zigzags all the way down (causes pain everywhere) and my pelvis is out of place causing back pain.

What, if any, surgical options are available for me? What are the risks and recovery times?

Donald Corenman, MD, DC
Moderator

June 13, 2012 at 1:48 am

Post count: 8660

#6364

Migraines are not typically neck generated but I believe you mean constant type headaches that originate from the neck that “feel like migraines”.

The constant pain at the base of your skull could be from facet inflammation, actual degenerative joint disease (wear of the cartilagenous surfaces) or from nerve compression. The other symptoms you express can be from vertebral artery problems but that would be an extremely rare finding.

You don’t typically get hypermobility of the upper cervical spine from sports activities (unless significant trauma is involved) but more commonly from genetics.

Before you consider any surgical options, you need a diagnosis. Many times, this condition is treatable without 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.

rmooney
Member

June 13, 2012 at 3:59 am

Post count: 2

#6365

I have been diagnosed with acquired hypermobility disorder by my osteopathic physician. I was diagnosed with migraines by a neurologist, and I think this is accurate due to the temporary healing effects of vasoconstrictors on my condition.

I guess what I’m trying to say is I know upper cervical vertebrae don’t stay where they need to and muscle strengthening and ligament strengthening treatments have failed to hold them there. How can I get them to stay? I know the lax ligaments to be the cause of my pain as diagnosed by several physicians and my own experience and research. The greater the pain and inflammation, the worse the neurological issues. So when its bad, the bone causes inflammation that puts pressure on either the nerves or blood vessels that supply certain areas of the brain, most likely the cerebellum in the case of my vertigo and the nearby visual processing area near the occiput.

You mentioned avoiding surgery. Do you know of any non-surgical treatments that work well for this situation?

Donald Corenman, MD, DC
Moderator

June 14, 2012 at 11:43 am

Post count: 8660

#6380

You note lax ligaments. These should be able to be demonstrated with x-rays at endpoints of motion. The motion of one side should be much greater with subluxation noted of the joint as compared with the other side. Occasionally with a CT scan at the endpoints of motion, this instability can be demonstrated.

Most times, it is not ligamentous hypermobility but it is facet or nerve inflammation that causes symptoms. Diagnostic blocks of these structures (see SNRB or facet blocks on the website) should yield temporary relief and treatment is based upon the disorder discovered.

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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