Upper Cervical Issues

Tagged: Atlanto axial, craniocervical, upper cervical

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Pete1221
Participant

February 28, 2016 at 12:33 pm

Post count: 6

#21445

Dr. I have been experiencing a whole host of issues shortly following a fall where I impacted my head June of 2014. Although the fall and impact was definitely violent I did not experience much of any pain and therefore did not get checked out professionally after the accident, probably a big mistake. About two weeks after the accident I started coming down with horrible symptoms of dizziness, vertigo, tinnitus and many others. But since there was no pain involved I did not suspect my neck or spine. Fast forward to now I have been through the medical and diagnostic ringer. I have had every test and seen every Dr possible it seems. Just recently I had a dynamic CT scan of the upper cervical region with both left and right 60 degree rotation performed. The impression on the radiology report states “findings suspect of a moderate atlanto-axial subluxation”. ” moderate degenerative changes at the anterior atlanto-axial joint” the doctors I have presented this to do not know what to do with this information but yet I am constantly plagued with the symptoms of my head feeling too heavy for my neck to support, dizziness especially with neck movement,severe heart palpitations, severe tinitus, crunching popping and slipping out feeling in my upper neck. The deep inner muscles in my upper neck also shake and tremor when I nod my head or turn my head from left to right when lying down. I don’t know what to do and have presented my information to various spine doctors and surgeons and don’t seem to be getting any real answers. I must mention that shortly after the accident and for early months following I moved my neck relatively normally and have since develop major loss of range of motion of my neck along with all the crunching and popping which was not there in the beginning.. I feel as if I should be wearing a neck brace 24/7 but I’ve been strongly advised to not do that by the doctors I have seen. Any advice or insight would be beyond greatly appreciated. I have many other tests and reports of my cervical spine I can provide

Donald Corenman, MD, DC
Moderator

February 28, 2016 at 3:17 pm

Post count: 8660

#21446

I assume that you had an MRI that included axial images (top-down slices) of the occiput-C1 and C1-2 joints. Make sure the radiologist has read those areas (or has experience reading the upper cervical spine as many radiologists do not have the expertise in this area). Do you have a subluxation that reduces to “normal” (alignment wise) when your head is in neutral position or is the C1-2 level subluxed when you return to neutral?

Normally, degenerative changes noted at C1-2 (“moderate degenerative changes at the anterior atlanto-axial joint”) could mean a number of things. Is this the dens-C1 junction he is talking about (which means nothing) or is this the anterior portion of the C1-2 bilateral articulations?

Don’t beat yourself up about no initial care. You would not have had a diagnosis initially even with a physical examination. You could have injured the alar ligaments or injured the joint surface of C1-2. Either one can develop the issues you note. Crunching and popping are typically related to an irregular wearing of the joint surfaces of occiput C1 or C1-2.

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.

Pete1221
Participant

February 28, 2016 at 6:32 pm

Post count: 6

#21448

Dr. Yes I have had two upper cervical specific MRI studies with axial imaging. One of them was read by a doctor David who I’m told understands the area very well, the other was read by another radiologist who is versed in the area.

The study that was read by reads.
-Multilevel spondyloaropathy involving the mid and lower cervical disc levels.
– potentiation of several of the key elements of the ligamentous and membranpus static stabilization mechanism of the cervical occipital junction consistent with sequels of hyperextension/flexion hypermobility stress of the cranial vertebral junction
– loss of the normal anatomic relationship of c1 and c2 consistent with Atlanto-axial rotary instability and insufficiency
– asymmetric widening all of the left lateral ADI.
– encroachment of the cerebellar tonsils without high grade chiari.

The second study which was taken over a year later reads
– left alar partial tear
– left transverse ligament intra substance tear
– asymmetric widening of the left lateral ADI. 4mm on left 2mm on right
– more anterior position of the right side of the body of c2 relative to the left with horizontal c1 anterior arch associated with slight degree c1c2 rotation.

I don’t have any more information that goes into detail about the degenerative changes at the anterior atlanto-axial joint. Its frustrating that they do not specify as you stated.

As far as not beating myself up it’s extremely hard not to. This situation has turned my life upside down and inside out. I have not worked for over 10 months as a result. It’s pretty frustrating to know now that if I was evaluated and braced appropriately for a short period time I likely would have healed up just fine.

So the real question is where do I go from here as I am NOT getting any real answers from anyone. Is this something that will just continue to get worse and worse over time. Will I eventually become a surgical candidate. To my understanding upper cervical surgeries are life-altering and devastating to say the least, especially when it comes to craniocervical fusion.

Or is this something that can actually correct itself and get better through time. It’s hard for me to think that way as I am quickly approaching two years of dealing with this and I have feelings and symptoms now that I did not in the beginning, like for instance I now have extreme sharp pain and popping with deep breaths on both sides of my spine right at the cervical thoracic area, this pain never leaves me and I have presented it to several spine doctors and all they can say is get on pain medication.

I also had a digital motion X ray study done which shows a lot of slippage and motion of c1 on C2 with lateral bending(4mm in both directions) and also a lot of movement with flexion and extension of c4 c5 and c6 the worst of which is 5.8mm(c5 on c6).

I am beyond frustrated with all this as I have a wife and a kid to provide for. And expertise or insight and advice would be beyond appreciated.

Thanks

Pete1221
Participant

February 28, 2016 at 6:47 pm

Post count: 6

#21449

Dr. I forgot to mention that I have become incredibly concerned or scared I would say of moving my neck a certain way or taking a simple slip and fall or a minor fender bender and becoming exponentially worse. The doctors I have seen say I should not be concerned about that but my body tells me otherwise. Do I have levels of damage and instability to a point where I really should be concerned about making them worse inadvertently?

Donald Corenman, MD, DC
Moderator

February 29, 2016 at 9:19 am

Post count: 8660

#21453

First-generally once the alar and transverse ligaments are torn, they do not heal even if placed in a brace for a period of time. Identifying the injury initially would not have changed your course of history.

You have a partial instability of C1-2. The right side subluxes due to transverse and alar ligament incompetency. This will only be made stable with a C1-2 fusion. Yes-50% of rotational motion occurs at this joint but I will assume that you have significant loss of rotation due to pain and the feeling of instability when you rotate your head. Your feeling of “doom” with head motion is concerning as I always think that the patient has the best knowledge of his or her symptoms.

I no longer do occiput-C2 surgeries but if you would like, you can call the office and I will give you a referral name of a surgeon I trust.

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.

Pete1221
Participant

February 29, 2016 at 10:40 am

Post count: 6

#21454

Dr. Thanks for getting back to me. I called your office line and left a message about getting that referring doctor you are talking about. Why is it that you do not do upper cervical fusion anymore? So based on the information I presented you feel I am a candidate for a fusion surgery? Do you think there’s a chance I need up through my occiput fused or just c1 c2?
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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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