Syrinx/Cord Compression

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jonlyn
Member

June 1, 2014 at 10:00 am

Post count: 3

#10923

Recent MRI results:
Compared with MR dated 8/6/2013, interval increase in the size
of the left posterior disc extrusion, and the corresponding
spinal stenosis, at C4-C5. New patchy hyperintensity in the cord
at the level of C4 and C5 is suggestive of edema related to cord
compression. Recommend urgent neurosurgery consult.

I also have hx: syrinx T3-T6 / 2 mm wide
2002: c5,6,7 fusion
2010: L5,S1

Symptoms: numbness primarily shoulders, chest and rt side, abdomen and extremeties; Rt side (entire) tingling, numb; burning rt foot and outer rt bottom of leg;

Increased frequency/urgency of bladder; no bowel issues

all symptoms present since March, 2014

? = how urgent is surgery, what are the chances of permanent damage

Donald Corenman, MD, DC
Moderator

June 1, 2014 at 9:02 pm

Post count: 8660

#10924

You have a large disc herniation at C4-5 above your fusion from C5-7. This is causing significant spinal stenosis and spinal cord compression with cord injury (“suggestive of edema related to cord compression”).

The cord is further compressed with neck motion. You need to be placed in a cervical collar now with your head in slight flexion (this is the position of least cord compression). You need a surgical consultation as soon as possible to prevent further cord injury.

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.

jonlyn
Member

June 1, 2014 at 10:08 pm

Post count: 3

#10925

My case file was sent to Durham, NC VA hospital about 5 hours away. They said I would here something sometime next week. The other concern is I have had 2 episodes of idiopathic pulmonary emboli in the last two years. Thorough testing has been done trying to figure out a cause. Brain MRI is clear. What are the chances the damage is permanent.

Donald Corenman, MD, DC
Moderator

June 1, 2014 at 11:53 pm

Post count: 8660

#10928

It is hard to say if there could be permanent damage. Your job right now is to prevent any further damage while you can find a surgeon to help you. If you do not have a physician to see immediately, at least find a soft cervical collar, the foam type at a local pharmacy. When you put it on, wear it backwards (the velcro fastening in the front-not the back). This will cause some neck flexion (forward bending) which is protective to the spinal cord.

Wear this collar full time (even to bed). Do not try to look up as this action causes neck extension (bending backwards) which can cause further compression of the cord.

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.

jonlyn
Member

June 16, 2014 at 3:33 am

Post count: 3

#11042

Ok.. I have c-4 fusion w/cord decompression scheduled for July 18. Neurosurgeon stated we have a 33% chance of either no improvement, improvement or worsening. Shot in the dark in other words.. But, today, I have a lump on the right side of my neck behind my ear and yesterday I started having ringing in my right ear. The ringing is not happening today. I have an unexplainable sensation in my right eye.. nothing irritating or painful just a sensation / no pressure/ no blurring/ no headache. The neck lump is about 2″ wide and 3″ long.. best guess.. not sore, and does not hurt. Ear has a little burning sensation inside.. no fever..
Is this normal with cervical herniation? Should I call my MD tomorrow? I feel silly with all this but, do not want to minimize anything either..

I got my records from my C5-C7 fusion of 2002.. I did not realize but, there was spinal cord compression at that time as well. Just FYI

Donald Corenman, MD, DC
Moderator

June 17, 2014 at 11:55 pm

Post count: 8660

#11047

This surgery is to prevent future injury to the cord. Even though I tell my patients that this surgery is designed to prevent cord injury, I do see many patients with improvement of their myelopathy after surgery.

Facial sensations are generally not associated with cord compression as the facial nerves are cranial nerves. Cranial nerves do not exit the skull so spinal cord compression should not affect them.

It does fit that you have cervical stenosis now as you had the same stenosis at the lower levels in the past. You probably have congenital cervical stenosis (you were born with it).

Becoming nervous prior to surgery is typical. Nervousness can make us hyper-vigilant. This means that we pick up on some symptoms that we might have that we would have ignored before the neck disorder. This does not mean that these separate symptoms are not of some concern but more likely than not, they are not an issue.

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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