Vertebral Artery Stenosis secondary to cervical bone spurs (DDD)

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dustingfab
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April 14, 2012 at 10:54 am

Post count: 27

#6017

Dear Dr. Corenman,

In your professional experience, how many patients do you see with vertebral arterial stenosis due to cervical bone spurs or degenerative disc disease?

I recently had two incidents of lip drooping. The first time it was just the left side. I had no other symptoms, except for a headache. But I always have a headache due to the herniated discs in my C-spine. In the ER, in the medical exam room, my pressure was high. I don’t have a hx of HTN. Bloodwork and MRI was normal. The doc believes I had a TIA. And referred me to a neurologists. I saw the neurologist a few days later. The PE was normal, pressure was normal. That same evening, I had a foggy headache and the lip drooping happened again but the right side of my lips only. No other symptoms. 2nd time in the ER, the doc believed I had an angioedema.

The doc wanted to keep me to do the MRA in the AM. But wanted to go home. My neurologist agreed. I did the MRA today. I have the films, but no report. Of course, I don’t have the experience or trained eye to read whats normal or whats abnormal.

Given the fact I have absolutely no co-morbidities, I believe this might have to with the fact I have DDD in my C-spine.

Your thoughts. Thank you so much in advance.

Donald Corenman, MD, DC
Moderator

April 15, 2012 at 1:34 am

Post count: 8660

#6018

The vertebral arteries supply the medulla, pons, cerebellum, thalamus and occipital cortex. The symptoms of vertebral artery insufficiency would affect these structures. These symptoms therefore include vertigo (imbalance), headaches, nausea and vomiting, problems with speech, visual disturbances and partial vision loss, sensory disturbances and even possible incontinence.

The lip motor supply (obicularis oris) is from the facial nerve (cranial nerve seven) which is not part of this syndrome. As you note, headache can be from vertebral artery insufficiency but the vast majority of headaches are not related to this syndrome.

I have looked for vertebral artery stenosis in patients for years. Patients that develop nausea and vertigo with neck twisting can have a dynamic problem as the twisting motion can cause temporary blood loss. I have had imaging studies performed for suspected vertebral artery insufficiency multiple times and have never found a patient with this condition.

This syndrome does exist as there are cases found in the literature but no matter how diligent I have been to look for this, I have personally never found it outside of patients with a traumatic 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.

dustingfab
Member

April 18, 2012 at 9:03 am

Post count: 27

#6031

Dear Dr. Corenman,

Thank you very much for your feedback. I got the MRA results back. I have right congenital vertebral artery hypoplasia (VAH). All vessels are patent and not sclerotic.

Is there any possible connection to the VAH and cervical bone spurs. The exact impression of the recent C-spine MRI stated stable alignment, multilevel degenerative spondylosis. There is increase in size of left midline disc extrusion at C5-C6 resulting in left ventral cord impingement.

The same day I visited the neurologist….On Tuesday (late) evening, I experienced the same symptoms again. Lip drooping. I had an excruciating headache early in the evening. But I always have a headache, so I didn’t think nothing of it. Then 9:30 came and went, 10:30 came and the right side of my upper and lower right lips were droopy. When I got to the ER, I was feeling pins and needles in my right cheek.

The ER doc wanted to keep me overnight for observation and in order to perform the MRA first thing Wednesday morning. But I didn’t want to stay over. My neurologist agreed to let me go home. The ER felt that it might be an angioedema. But I wonder if it possible to have an angioedema so localized with no other associated symptoms of an allergic reaction.

If there is absolute no correlation between the VAH and spondylosis then great. But despite my cervical and lumbar stenosis and disc herniations, I need to get healthy. Thankfully, my arteries are not atherosclerotic. But if that one vertebral artery gets any build up in the future I’m TOAST! I think, but of course I need to get medical advisement and guidance…cardio I suppose. Because this whole situation is way beyond my scope of knowledge. Or lack thereof.

Thank you, thank you for everything…. reading and most definitely your feedback. I sincerely appreciate this.

Donald Corenman, MD, DC
Moderator

April 18, 2012 at 1:14 pm

Post count: 8660

#6032

Right congenital vertebral artery hypoplasia is somewhat typical. There is normally a dominant vertebral artery and normally it is the left. There is really no significant relationship between congenital hypoplasia and spur formation.

Headache and lip drooping sounds more like a stroke set of symptoms. As one of your physicians stated- this could be TIAs or ?????? This is not my speciality. Angioedema could be a differential I imagine. You need a neurologist.

It is unusual for atherosclerotic plaque to build up in the vertebral arteries.

Hope you find some answers.

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.

dustingfab
Member

April 19, 2012 at 10:39 am

Post count: 27

#6034

Thank you Dr. Corenman. I have to complete the blood work before I follow up. The results were already forwarded to my neurologist. So I assume this isn’t serious as I haven’t received a phone call to return to her office sooner than later.

The spine specialist stated he didn’t see any significantly large bone spurs that would potentially impinge the vertebral artery. But I should make sure to follow up with a neurologist.

Due to the recent C-spine, he is insisting on an ACDF. Which freaks me out. But I can only agree to this if it will decrease my risk of further TIAs/strokes.

Thank you again for reading and providing your feedback.

Donald Corenman, MD, DC
Moderator

April 19, 2012 at 12:18 pm

Post count: 8660

#6035

In my opinion, an ACDF will not prevent your chance of a stroke which is very low to begin with. You apparently are already having TIAs and an ACDF will not change that occurrence. I cannot comment on the need for an ACDF as without a thorough history, physical examination and review of all images.

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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