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Donald Corenman, MD, DC
Moderator

April 6, 2022 at 2:54 pm

Post count: 8660

#34995 In reply to: C3-4 and possible c2-3 Facet pain |

Your symptoms could be generated by the C2-3 facet (“Radiotracer uptake localizing to the left C2-3 facet joint, associated with facet arthrosis”), radiculopathy by the foraminal stenosis from C3-4 (“MRI shows pretty significant disc bulge into the left foramina at c3-4”) or possibly from the degenerative disc at C3-4 (“Moderate radiotracer uptake localizing to C3-4 disc level, associated with moderate degenerative disc disease”).

If the pain is aggravated by head extension (bending the head backwards), the either facet origin or radiculopathy origin is most likely to blame. If flexion increases the pain, the disc is more likely the cause.

The best way to determine what structure is to blame is to first perform a facet block of the left C2-3 facet and keep a pain diary (see below). If relief is noted, RFA (rhizotomy) is the treatment. If minimal relief, then a selective nerve root block of C3-4 left. If relief and you have failed PT, then an ACDF of this level should yield relief.

https://neckandback.com/treatments/facet-blocks-and-rhizotomies-neck/
https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/
https://neckandback.com/treatments/diagnostic-therapeutic-neck/
https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/

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.

Donald Corenman, MD, DC
Moderator

March 23, 2022 at 5:52 am

Post count: 8660

#34967 In reply to: MRI Result |

You note: “I’m so afraid to go work. I had an episode after a heavy workload. I was profusely sweating, dizzy and weak….I have quite a few of these episodes ever since that day”.

You then note pertinent MRI findings of:
C3-4 Disc osteophyte complex contacting and minimally indenting the ventral margin of the cord to the left of midline. Mild central canal stenosis.
C4-5 Diffuse posterior disc osteophyte complex contacting and mildly indenting the cord with mild central canal stenosis. Mild left foraminal stenosis.
C5-6 Diffuse posterior disc osteophyte complex with left uncovertebral spurring. The complex contacts and mildly indents the cord with mild central canal stenosis. Severe left foraminal stenosis.
IMPRESSION: Multilevel disc osteophyte complexes with mild cord impingement. Small focus of hyperintense T2 signal within the cord at C3-4. probably representing myelomalacia.

This means your central canal which houses the spinal cord is too narrow causing cord compression and some injury. This is especially noted at C3-4. You need to be examined for signs of myelopathy and definitely need a spine surgeon’s consultation.

See :https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/

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.

chris_dee
Participant

March 21, 2022 at 1:16 pm

Post count: 2

#34964
Topic: MRI Result in forum NECK PAIN |

Hi Dr. Corenman,

I had an MRI done but still have to see a spine doctor. There is a lot of medical terms and I have been Googling them, trying to understand what they mean. I am certified nursing assistant since 2002. I had an episode after a heavy workload and so afraid to go to work. I was profusely sweating, dizzy and weak. I thought I was going to faint, I had to sit down. I have quite a few of these episodes ever since that day but not as bad. I would appreciate it if you can explain my MRI result. Thank you so much!

C2-3 No disc herniation, central canal stenosis or foraminal stenosis.

C3-4 Disc osteophyte complex contacting and minimally indenting the ventral margin of the cord to the left of midline. Mild central canal stenosis. No significant foraminal stenosis.

C4-5 Diffuse posterior disc osteophyte complex contacting and mildly indenting the cord with mild central canal stenosis. Mild left foraminal stenosis.

C5-6 Diffuse posterior disc osteophyte complex with left uncovertebral spurring. The complex contacts and mildly indents the cord with mild central canal stenosis. Severe left foraminal stenosis.

C6-7 Shallow disc osteophyte complex. No disc herniation, central canal stenosis or foraminal stenosis.

C7-T1 No disc herniation, central canal stenosis or foraminal stenosis.

IMPRESSION: Multilevel disc osteophyte complexes with mild cord impingement. Small focus of hyperintense T2 signal within the cord at C3-4. probably representing myelomalacia. Mild central canal stenosis.

Randy
Participant

March 20, 2022 at 2:20 pm

Post count: 4

#34961 In reply to: Neck-Bilateral Shoulder Blade Pain |

Thank you Dr. Corenman: I see that I can pay for a consult by sending you my MRI. I am going to do that. I’m guessing me having a flexion-extension x-rays as you noted would be helpful to send as well? Do I need a referral to have these x rays done? Last, can a nerve block be done on an area that is already fused to help determine if that is in fact a pain generator? If yes are epidurals able to be done on that fused area for relief?
Thank you again

Donald Corenman, MD, DC
Moderator

March 17, 2022 at 8:40 am

Post count: 8660

#34956 In reply to: Hands & Fingers pins n needles post ACDF |

No CRPS is good. With your symptoms still intense and present, a new MRI is warranted.

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.

Donald Corenman, MD, DC
Moderator

March 14, 2022 at 2:09 pm

Post count: 8660

#34950 In reply to: Neck-Bilateral Shoulder Blade Pain |

Pain radiation into the shoulder blades is a common pain referral location for nerves C3-T1. It is not uncommon for the C3-4 level to radiate into the scapula. I would make sure that the fusion at C4-7 is really solid. An MRI can reveal that but also can give misdirection. Flexion-extension X-rays would be a better tool for evidence of fusion.

If solid fusion is noted, and you have “moderate to severe right foraminal stenosis, and moderate left foraminal stenosis”, a selective nerve root block at C3-4 with good temporary relief would give evidence of the pain generating capacity of C3-4 where you could do something about this surgically (or the injection calms down the area and can be used for treatment).

See:
https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/ and
https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/

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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Viewing 6 results - 79 through 84 (of 2,199 total)

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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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