Thoughts on test results

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Steve0730
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September 1, 2024 at 11:56 am

Post count: 1

#36285

Hello,

Thank you for providing this forum. I think it’s amazing that you take the time to help people in need out of compassion.

I’m a 36 year old male with no underlying health conditions such as EDS or Down syndrome. About two years ago my symptoms started possibly due to heavy weight lifting and a lifetime of bad posture (rounded shoulders, forward head, posterior pelvic tilt). There are two moments that come to mind before my issues started which once I felt like my c-7 area moved when I was barbell squatting and once I had a jolt go up my neck behind my ear barbell shoulder pressing. My symptoms started with panic attacks and body feeling extremely stressed (two weeks after feeling the jolt go up my neck) with a racing heart rate at rest which I went to the ER but they found no issues. A month or two later I had to go to the ER because I was unable to urinate but again they found no issues. I was fine a couple days later. These were both one time events two years ago.

My symptoms are lightheadedness, pain in the eyes and neck, high anxiety and trouble focusing. I have myofascial pain syndrome all across my upper torso. My head is also slightly tilted to the left with some dextroscolisious on my thoracic spine. Symptoms improve laying down but get worse the longer I hold my head.

Here are my test results:

MRA of Brain:
No issues

MRI cervical spine:
Cervical spondylosis resulting in multilevel left-sided foraminal stenosis, including mild/moderate stenosis at the C6-7 level. No significant central canal stenosis or cord signal abnormalities.

MRI brain:
No issues

X-RAY of thoracic spine:
Mild dextroscoliosis of the thoracic spine.. No significant spondylosis, fracture, or visible bony lesion.

X-ray flex and extension cervical:
Mild to moderate degenerative disc disease most pronounced at C6-7.

MRI Spine Lumbar:
L5-S1 left posterior paracentral disc protrusion which contacts the descending left S1 nerve root without mass effect. 2. Mild degenerative disc disease at L4-5 without central canal stenosis or nerve root impingement

MRI BRAIN MRA BRAIN+MRA NECK
No acute intracranial abnormality.
2. No high-grade stenosis, occlusion, aneurysm, or dissection is identified within the major intracranial or cervical arterial vasculature.

CT ANGIOGRAPHY, CAROTID ARTERIES W AORTIC ARCH
Normal CTA of the carotids.

Upright Cervical Spine MRI:
Abnormal Clivoaxil (142.7 in neutral and 141.2 in flexion) and Grabb-Oakes (6.5 in neutral and 6.8 in flexion). Straightening of cervical lordosis.

Cervical DMX:
PRESSION for patient Steven Schoiber:
• Damage to the anterior longitudinal ligament is indicated by a retrolisthesis at C2 on C3 (2.53mm) and C3 on
C4 (3.04mm).
• Damage to the capsular ligament is indicated by gapping of the facet joint at C5-C6 bilaterally.
• Damage to the capsular ligament is indicated by intervertebral foraminal encroachment of the facet joint at
C3-C4 on the right.
• Damage to the alar and accessory ligaments is indicated by an overhang of the lateral mass of C1 to the left
(7.34mm). Also change in the para-odontoid space during bilateral lateral bending.

I’m currently working with a myofascial therapist on trigger points which are improving but still chronic as well as posture correction. The chiropractic office who did the DMX study say I have severe instability specially at c1-c2 and suggested chiropractic adjustments, PT and neck brace. I’m hesitant to do this because I tried a different chiropractor in the past who said my issue was atlantoaxial related and did adjustments which made my symptoms worse and the adjustments would never hold. They did not do anything though as far as a neck brace or PT.

Recently my therapist wanted me to do chin tucks and SCM stretches which made my symptoms dramatically worse. I have severe pain and feels like strain (heart palpitations when touched) in the back right side of my neck all the way up to my c-1. Feels like my splenius capitis is stuck in contraction and so tight that touching it causing my ear to vibrate. Eye pain increased even when laying down, extreme dizziness, heart palpitations and panic attacks. Before those exercises, my symptoms were stable outside of the lightheadedness and myofascial pain. I’m also getting more crunching noises around my c-7 area.

Looking back, I feel like I possibly injured either my right levator scapula (I also have scapula winging on this side), upper trap, SCM and splenius capitis when I felt that jolt which possibly caused my head to tilt left and body tilt right causing myofascial pain syndrome over the last two years but now I’m concerned that this led the ligament laxity so I’m not sure if muscle rehab can correct my issue. I read that more than 3mm and mine is close to 7mm requires c1-c2 fusion but I’m not sure if that is the case for lateral dysfunction. I also believe my eye pain and lightheadeness are trigger point related.

1) do you think atlantoaxial instability is the root cause of my issues or is it possible that I just need to rehab my neck muscles and that misalignment will correct itself?

2) is there anything here you see that I should seek immediate help. I’ve read that atlantoaxial instability can be life threatening and now my symptoms are very similar to how this started after doing the chin tucks and/or SCM stretch.

Thank you again for your time and sorry for so much info but I wanted to be thorough.
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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.

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