Torticollis and Surgery

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RaymondC1987
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March 7, 2013 at 4:51 am

Post count: 2

#8139

Hello, My name is Raymond and I come to you with a questions and concerns regarding my recent visit with an Orthopedic Spine Specialist. I was recently diagnosed with torticollis(right turning). I was issued an MRI of my cervical spine which I have been told shows a Right paracentral C6-7 Prolapse with an annular fissure. I was told this meant that my disc was essentially collapsing and pushing out of the back against a nerve. Surgery is a scary thing for me but this condition has extremely limited my life and my quality of it in turn. I was told that an Anterior Cervical Discectomy and Fusion would correct the problem. I have been unable to find any information relating a pinched nerve in this fashion or this surgery in general as a way of correcting torticollis. My question to you would be, is this a safe procedure and is this known cause and cure of torticollis?

To give you a brief description of symptoms, it began to set in around 8 months ago. I noticed it when I was at work, mainly when stressed out and only when I was in certain positions that my head would pull to the right. It was not constant at the time but over the past 2 months it has become a constant battle. My head constantly pulls to the right unless i have it supported up against a high back chair, wall or laying down in bed. I can also stop the spasms if I touch the side of my face or neck for the most part. It causes headaches if I have to be up for an extended period of time and a lot of pain in my neck and the longer I’m up, the stronger the pulling becomes. I have had to stop working because of how bad it has progressed and I’m desperate for some answers and relief. I’m more than willing to do the surgery but I’m desperate for some insight. I have searched high and low and have not been able to make any connections.

I sincerely thank you for your time and expertise.

Donald Corenman, MD, DC
Moderator

March 10, 2013 at 7:04 pm

Post count: 8660

#8148

Torticollis has many different causes and disc hernation is one of them. If you are assuming a neck position to prevent pain and the pain is caused by the herniation, this would be an indication for an ACDF. I will tell you that this presentation is unusual and I would want to prove that the torticollis is originating from this disc herniation.

First, a good physical examination would be helpful. Do you have shoulder and arm pain in certain positions that is reduced or eliminated from the assumed rotation of your neck (torticollis position)? If you do not have shoulder/arm pain or this pain is not relieved from the torticollis position, I have doubts as to the relationship of torticollis and the herniation.

Torticollis can be caused by muscle contractures (the SCM or sternocleidomastoid muscle is a common offender), by a neurological disorder or by a rotary subluxation of C1-2. I do not have this written up on the website as of yet so you will have to do some internet search for more information.

Finally, if the herniation is the cause of the torticollis, a selective nerve root block (see website for explanation) of the compressed nerve root should temporarily relieve the torticollis.

Please let the forum know what happens and how you are doing.

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.

RaymondC1987
Member

March 29, 2013 at 8:23 pm

Post count: 2

#8303

Hello again. I would like to update you on my progress. Since my last post I had been seeing a chiropractor for therapy, adjustments, and neck traction. In the past few weeks I have made progress mechanically but no symptomatic progress. I have extremely bad knots in my neck, right shoulder, and upper back between my shoulder blade and spine. I was recommended to have lidocaine trigger point injections and saw an orthopedic surgeon about them yesterday. Luckily for me, The doctor I saw had gone through exactly what I am dealing with. He is the first person I’ve talked to that could truly understand my pain and has given me another option and some great answers. He himself had the lidocaine injections which only worked for 3 days before the spasms returned so I did not have the injections done. I have been put on a 6 day regiment of steroids to help with inflammation which will be followed up with a direct injection of a steroid into the effected area of my herniated disc (c6-7). I have been told that this will either knock the problem out completely, or it wont work at all. If it doesn’t, it sounds like surgery is my only option. The doctor is highly confident that the herniated disc is the cause of my torticollis as it was the same cause for him. His experience with the surgery was great being in and out of the hospital the same day, no need for pain medication, and it took him about 4 weeks to get his voice back. He said it was an instant relief and cure for his torticollis symptoms and is confident it will be for me as well. I’m hoping the steroids will work, however if it does not I think I am finally comfortable having the ACDF surgery done. Monday of next week I go to see a doctor to talk and prep for the spinal injection, I’m on day 2 of my oral steroid dose and I’ll know monday when I can have the injection done. I will keep you posted on my progress. Thank you for your help and information, I greatly appreciate it. Any insight on my current status would be appreciated as well.
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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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