what is causing my neck pain??????????

Tagged: Alar ligament injury, headaches

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mikey
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June 23, 2017 at 3:38 pm

Post count: 1

#25271

Hi dr, im 24 from NZ and im interested in your opinion on my neck problems. it started about a 18 months ago, i began getting muscle spasm, just above my c1 c2 c3 facet joints on the left, i would get massages which would get rid of my pain. this happened about every month, this got progressively worse to the point massage would not get rid of my pain. so i started with osteo for a few months which did nothing, then about 6 months ago i went to someone who realigns your spine, similiar to chiropractic treatment. I had immediate relief, after 3 treatment i was completely pain free, this was for about a month i was able to start with sport and work again for the first time in 4 months. I was getting my strength back and feeling great. He said that my c2 was sublaxed, and once he put it back in i was good to go.

Then i hit my head (directly on my forehead) on a shelf quite hard causing whiplash, this put my c2 back out, i went back to him and he but it back in, and i felt great again for a week, then out of nowhere i was turning my head to look over my left shoulder in a car this gave me a sharp pain as if i was ripping something, ( it didnt feel like i was pinching a nerve, more like a tearing sensation, im not sure though) anyway so i went back to my man and he put it back in, but now it would never stay in for longer than a week….. this was 5 months ago. ive been on a life line having to go to either him or am upper cervical specific chiro or deep tissue massage in order to keep my muscle spasm away. I cannot do any physical activity and cannot do anything active without increasing the muscle tension.

so i started searching a bit deeper, a physio told me i had alar laxity and diagnosed me with Upper cervical instability, so i went and had x rays, DMX and mri, these all showed nothing. so my muskeloskeletal specialist seemed to think that the alar laxity was wrong. His idea was maybe that id stretched some ligament structures that hold c2 in the perfect position. so we did cortisone injections in c1-2 and c2-3 facets of the left side, this did nothing. i really dont know whats causing my muscle spasm, i understand that something must injured thats holding 2c in the right place, sends a signal to my brain, which sends a signal back down telling the muscle to spasm up in order to protect. Is it wise to completely rule out upper cervical instability? Culd this be causing the spasm? (however i have no heacaches) is their anyway i could have injured these ligaments without such a substantial force like a car crash?

Any ideas on what else i should try? I think the big clue here for me is that once c2 is sitting in the right place i feel ok (i feel fragile but i feel pain free, with no spasm). Then ill do something which puts it back out or else the muscle spasm just comes back up a week later and pulls the bone out of place….

what do you think?

Donald Corenman, MD, DC
Moderator

June 24, 2017 at 6:16 am

Post count: 8660

#25277

First, the diagnosis of alar ligament laxity is almost always wrong as the amount of energy necessary to cause damage to these ligaments would certainly disrupt all the occipital ligaments. This energy would almost certainly kill you (ejection from a speeding car, fall from a substantial height, getting hit by a train). See https://neckandback.com/conditions/stabilizing-ligaments-upper-cervical-spine-occiput-c2/ to understand this anatomy.

Headache pain (occipital pain) can be typically caused by inflammation of the upper facets or tension around the greater occipital nerve (GON or greater occipital neuralgia). Manipulation of these facets can be helpful if performed with care and skill.

There is no “it’s in” or “it’s out” as noted by some practitioners but variations of range of motion of the joint. If the joint is inflamed and then manipulated, the joint becomes more mobile and therefore less compressed and less painful.

You could consider facet or nerve blocks for both diagnosis and treatment of 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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