Treatment options

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Littleshell09
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October 18, 2014 at 4:03 pm

Post count: 7

#11555

I’ve visited your forum before for my lumbar spine & your recommendations were spot on & I went forward with a L4-5 laminectomy & fusion this May with amazing results. While my neck was a problem simultaneously, the lumbar spine definitely needed to be first. Now what’s happening in my neck is very pain. The pain is pretty consistent but spikes to a whole new level from about 3 pm thru the night, interfering with sleep, etc What I learned from my CT scans had me feeling concerned. The pain I’m having is moderate to severe at night. I take aspirin, use ice, heat, tens, topical analgesics with some relief for a short period of time. CT revealed significant degeneration at the atlantoaxial joint, dens with non-union old fracture. When I place my head chin to chest a rather large chordlike ligament pops up from the back of my head at foramen magnum all the way down – occasionally I get shooting an electric kinda sensation down my back. 3 mil anterolisthesis from C3 on 4. Some suggestion that the foramina are slightly. My biggest problem is pain mgmt. When I had my spine surgery i was given oxycodone 5 mg for that pain as it was prescribed I could take 1 to 3 tabs for pain. I was so happy to have relief in my neck as well. I weaned off the narcotics. Alas neck pain resumed. It’s interfering with activity, sleep. For over a month I’ve been waiting to hear from paint managent team. I feel I’m being perceived as a malingerer or worse, a drug seeker. The pain has me lying in fetal position rocking & occasionally calling out. The best I can get thus far is flexeril. I don’t understand why I can’t just get what is effective? I’m open to injections, I use my own stuff as mentioned aspirin, ice, heat, tens with some help. But all I’m wanting is a restful sleep & days without pain. Thank you so much! Oh yes, osteopenia & articulation issues with C1C2, my neck makes snaps under the skull, there’s much crepitus with every movement & deep inside I feel a clunking sensation! Sorry to run on but this is too much! Thank you.

Donald Corenman, MD, DC
Moderator

October 20, 2014 at 12:38 am

Post count: 8660

#11560

I think I just answered this on another forum question but I will reproduce the answer on this inquiry.

C1-2 arthrosis (arthritis or wear of the joint surfaces) is a painful condition that causes base of skull pain and pain that radiates up into the ear region. The pain increases with motion and can wake you up at night.

The diagnosis (and potential management of this disorder) is facet blocks of these joints. A diagnostic block (pain relief for the first three hours) confirms the diagnosis. Hopefully, long term relief can occur with the steroid included in this facet block.

If only temporary relief is noted, a fusion of the C1-2 joint generally will give relief. There might be some loss of range of motion (rotation of the head on the neck) as a consequence of this fusion but the trade-off is pain reduction.

This injection needs to be performed by a skilled and experienced injectionist, not someone who has limited experience with this area as it is technically demanding.

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.

Littleshell09
Member

October 20, 2014 at 12:55 pm

Post count: 7

#11563

Yes Dr Corenman you did answer that one twice. Sorry about that, I’d thought the first hadn’t posted. So thank you for your responses. I’m just wondering if you think an anesthesiologist might have more experience with this than a physiatrist? Obviously, this area being so close to vital vessels, nerves, etc I’d want someone very experienced. If I’m understanding the process correctly, injections can be repeated every few months? Is there any impact on an already existing osteopenia? When I started looking for a PM I focused on experience with this type of problem. I’m understanding that it’s a rare occurrence. Anyway, thank you again & I’m guessing it’s ok to ask the MD directly just how many they’ve done for this problem.

Donald Corenman, MD, DC
Moderator

October 20, 2014 at 7:48 pm

Post count: 8660

#11566

This can be handled by an injectionist with good experience. This individual might be an anesthesiologist or a PM&R specialist. In my state, there is only one individual I would refer to for this procedure so there are not long lists of these specialists.

Injections can be repeated about every three to four months.

In general, there is little impact on osteopenia at that rate of exposure.

You will not find a primary doctor with experience in this disorder.

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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