Vertigo caused by spurs/facet degeneration/uncovertebral hypertrophy

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littleninja
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July 28, 2012 at 1:30 pm

Post count: 2

#6607

Hello and thanks for the wonderful forum/site/youtube! everything is very informative, concise and easy to comprehend. MUCH APPRECIATED!

Have a question regarding a recent onset of moderate to severe vertigo. Could foraminal narrowing from stenosis/spurs/bilateral uncovertebral hypertrophy be involved/causing vertigo?

I am a 40yr old caucasian female – wt 130 ht 5’6. hypothyroid for 15 years, well managed with synthroid – no other conditions to report. I am active and exercise at least 5x a week – sometimes less in the winter with increased cervical symptoms and muscle spasms.

I had discectomy and fusion of C5/6/7 in 2008 with cadaver bone graft and a plate/6 screws. No trauma to the area to report. I have experienced severe muscle spasms for approximately a year prior to surgery and continuing since. A feb 2012 MRI showed herniations in the discs above/below the fusion area, increased narrowing of spaces/canals, degenerative discs, significant spurring etc. Have gone through 2 bouts of physical therapy (both during winter time) 1st round cervical traction 3x a week for 6 weeks provided minimal relief but caused major headache and vertigo. BPPV treatment was administered with no relief. Vertigo subsided after end of traction tx. 2nd bout of therapy used ultrasound which provided great relief of spasms in upper traps/rhomboids. experienced mild vertigo with BPPV tx again failing to resolve.

During 2nd round of PT (november 2011) I was prescribed 2mg tizanidine at bedtime. experienced significant relief of muscle spasm and continue on this dose at present. Feeling great to be relieved of severe spasms, I attempted to re-incorporate running/jogging into my weekly exercise routine. After 1 week including 4-5 runs of 3 miles or less, I experienced a vertigo bout lying in bed and turning my body to the left side. Significant nystagmus for 30 seconds to 1 minute occurred. I was able to repeat the scenario only when laying down and turning to the left. changing head position while turning did not matter, the turning of the body seemed to be the cause. After my 2nd week of running the vertigo increased in frequency and began occurring upon walking/standing and included bouts of blurred vision.

Running has been discontinued for 4 days but the vertigo persists with increasing severity and an almost non-stop frequency. Nausea is now added to the mix. Experience nystagmus and significant vertigo with positional changes of the body moreso than postional changes of head/neck. Standing up, bending over, turning in bed (either direction), and even walking (feels like I’m walking on a trampoline constantly) bring on symptoms of dizziness, false movement and nystagmus.

Attempted self BPPV tx to no avail. From research I am wondering if a spur/narrowing might be affecting nerves related to vision/balance? I’ve incorporated NSAIDS with the hope that perhaps my running precipitated a pinched/impinged nerve and that reduction in inflammation may relieve pressure thereby reducing and/or eliminating the vertigo symptoms.

Thoughts? On the right track? other things I should consider?

Thanks again for your wonderful website!

Donald Corenman, MD, DC
Moderator

July 31, 2012 at 7:05 am

Post count: 8660

#6627

Vertigo is rarely caused by the cervical spine and when it is, the vertigo is caused by a problem with blood supply from the vertebral artery. This condition (called Wallenberg’s syndrome) is so rare that after looking for it for 30 years, I have never seen a case of it (except with injury to the vertebral artery).

Vertigo is typically caused by the vestibular mechanism. Some cases are caused by a “stone” in these canals. The vestibular mechanism is a group of three interconnecting rings of fluid lined by hair cells that deflect with motion of the fluid. A small stone in these channels will cause defection with certain head positions and can cause vertigo. There are some exercises that can “trap” the stone in a nonfunctional area.

Of course, there are other causes but I am not a specialist in this field. An experienced ear/nose/throat doctor (ENT) should be able to help you.

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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