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Donald Corenman, MD, DC
Moderator

January 14, 2013 at 12:26 am

Post count: 8660

#7721 In reply to: C3-C4 Anterolisthesis and C4-C5 Retrolisthesis? What Does This Mean? |

You have two separate problems. Your lower back pain is generated from your lumbar spine and your neck pain (and possibly headaches) are generated from your neck.

You have degenerative changes of your discs and facets in your neck. The anterolisthesis (forward slip) of C3 on C4 occurs from facet wear and retrolisthesis at C4-5 is generated from degenerative disc disease. You probably do not have significant ligamentous instability unless there is significant shifting of one vertebra on the other with flexion/extension views.

Most of the time, neck pain is generated by degeneration of the discs and facets. If you have failed chiropractic treatment and a good course of physical therapy, you should seek out a well experienced interventional PM&R doctor or interventional anesthesiologist for potential injection therapy as the next step.

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.

abowles
Member

January 13, 2013 at 7:10 am

Post count: 1

#7719
Topic: C3-C4 Anterolisthesis and C4-C5 Retrolisthesis? What Does This Mean? in forum GENERAL |

I had recently receive my medical records from my chiropractor. It has a lot of stuff in there about my neck and maybe my back and I was wondering if someone could tell me what it all means.. Below is some of the topics in my medical records.

Motion in the neutral lateral projection to full extension shows mild anterolisthesis at C3-C4.

Motion in the neutral lateral projection to full extension shows mild retrolisthesis at C4-C5.

1. Ligamentous instability with Anterolisthesis at C3-C4.
2. Reversal of the cervical lordosis.

I have alot of pain in my back and neck. My head feels heavy alot and causes strong headaches. My head also tilts back. It is extremely hard for me to sit or stand for long periods of time. I also have alot of pain going from my lower back around to my hip and down my right leg.

I would really like to get some suggestions on what to do about making a doctors appointment and what kind of doctor I really need to see.
Thank You!

Donald Corenman, MD, DC
Moderator

January 13, 2013 at 5:06 am

Post count: 8660

#7714 In reply to: Please tell me if you think I need surgery on just one disc or two |

By the sounds of your symptoms, you have cervical stenosis and compression of the spinal cord at C5-6. Myelomalacia is a thinning of the diameter of the cord due to injury. There is no question that this level (C5-6) needs surgery.

The C6-7 level is somewhat degenerative but is not compressing the cord. There is foraminal narrowing but your report does not note how severe. Normally, radiologists will place a modifier in the report (mild, moderate, severe) which can occasionally be helpful in determining if this level needs to be included in the surgery.

The physical examination can also reveal if the C7 related muscles are not functioning (triceps, wrist flexors, finger extensors-see website under cervical nerve injury). If the exam does not reveal C7 nerve disfunction, then it is probably safe to leave this level out of the surgery.

Good luck with surgery.

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.

eaduby
Member

January 6, 2013 at 3:09 am

Post count: 2

#7694 In reply to: Cervical Foraminal Stenosis |

Thank you so much for your quick response. I have been able to persuade them to do a nerve block in that area. I will be getting it done on Tuesday. I have already failed conservative therapy (PT, medications, tens unit, trigger point injections) and I do have symptoms of root compression. It is to the point now where the condition is disabling. I can’t brush my hair, cut my food, etc…

Should I ask for a referral to a neurosurgeon if the nerve block is positive?

Donald Corenman, MD, DC
Moderator

January 4, 2013 at 4:24 am

Post count: 8660

#7682 In reply to: Exercise post C5 foraminal stenosis surgery |

Extension or bringing the head backwards (looking up) causes the neuroforamen to narrow. The neuroforamen is the exit hole for the nerve root. Activities that induce this maneuver are swimming, road and mountain bike riding, the serve and overhead in tennis among other activities.

You can take steps to reduce this extension. Putting a shorter and higher angled stem on your bike will reduce the amount of extension. Using a snorkel to swim will reduce extension.

Strengthening the SCM muscles can help. Look for the video on this site (neck sit-ups) to understand how to strengthen these muscles. Careful with reverse neck sit-ups as you do not want to extend your neck too much.

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

December 27, 2012 at 7:05 am

Post count: 8660

#7647 In reply to: Questions About The Mechanics of Pars Fracture |

Question one-“Can a motor vehicle accident cause pars fractures?” Answer-yes but only very rarely and under dire circumstances-ejection from vehicle (no seat belts) or severe impact with body encroachment. The disc will not show signs of degeneration for at least three months and more likely six months or more. The typical mechanism is an extension moment (severe bend backwards).

Question two-“How immediate would be the onset of symptoms?” Answer-immediate. This would be an acute fracture with the subsequent inability to stand upright without significant pain and muscle spasm. No matter what medications you were on, you would notice the pain and dysfunction.

Question three-“How likely is it that the degenerative process could occur and be asymptomatic (painless)? Answer-This is the most common scenario. Most individuals develop this stress fracture when young and don’t develop symptoms until a relatively minor injury causes a tear of the fibrous pannus. You symptoms that have developed after a motor vehicle accident are typical. This does not mean that this preexisting condition precludes you from causation.

Forth question-“How long does it take from pars fracture to degenerative disc disease?” Answer-many years. I am currently researching this and anecdotally, it appears to take at least 10-15 years with some exceptions.

Last question-“If bilateral pars fractures are noted without a slip and with a normal disc, is it recommended to repair the pars fractures?” The answer is still under investigation. If the gap between fragments is large, I don’t think a repair can be effective. Also, the older the patient, the less natural healing response is possible, even with BMP. I can also argue the opposite side. I have repaired multiple adults under this condition successfully. Only time will tell if repair will be effective to prevent degenerative disc changes and what the fracture separation distance is for a successful repair. I have turned down patients for repair with a 5mm fracture separation (they need a fusion) and successfully repaired 3mm separations.

Will repair prevent the degenerative process? Logic and reasoning says it will but only the test of time will answer this question.

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 - 1,825 through 1,830 (of 2,200 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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