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backtolife
Participant

May 30, 2012 at 6:34 am

Post count: 10

#6286 In reply to: Cervical Lateral Flexion Extension X-ray |

Thank you very much for your response. I did not do them like that at all–could it make a difference in checking for instability which is what, as I understand, my neuro is checking for? I have a “retrolisthesis of C5 on C6.” I have read about an MRI made by FONAR that can allow for an MRI of the neck in flexion and extension. Is that a good study to measure for instability or is the flexion and extension x-ray better? I had a myelogram with a CT scan that shows nerve root compression at C5-6, 3 injections without a great deal of success (continued arm weakness, continued neck pain that can increase astronomically with movement.). Thank you for any response in advance.

Donald Corenman, MD, DC
Moderator

May 30, 2012 at 5:15 am

Post count: 8660

#6284 In reply to: Cervical Lateral Flexion Extension X-ray |

Normal technique for flexion/extension cervical X-rays is to literally bend forward from the head as far as possible keeping the shoulders in the neutral position. It is the exact reverse for the extension view again keeping the shoulders in the same position but extending the head backwards as far as possible (but creating no significant pain).

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.

backtolife
Participant

May 30, 2012 at 4:36 am

Post count: 10

#6283
Topic: Cervical Lateral Flexion Extension X-ray in forum GENERAL |

I just had a cervical lateral flexion extension x-ray. I kept my neck very straight and bent only my chin down for this for flexion and kept my neck very straight and looked straight up for extension. Was this the right way to check for instability? HAd it done at chiro office. Neuro ordered it.

Donald Corenman, MD, DC
Moderator

May 30, 2012 at 4:12 am

Post count: 8660

#6282 In reply to: Risks of ACDF? |

Your symptoms could be from a demyelinating disorder or from myelopathy. Most individuals with your intensity of symptoms and stenosis have cord signal changes but not all. If the brain MRI is normal, then more likely than not, these symptoms would be from the cord compression. Nonetheless, there are other neurological disorders that can cause these symptoms. A thorough neurologist can help to differentiate this.

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

May 29, 2012 at 8:51 pm

Post count: 8660

#6280 In reply to: Neck & Shoulder Pain w/ MRI Results |

Based upon your symptoms and “findings” of weakness and especially imbalance, you most likely need surgery of C6-7. It is interesting that as a general rule (with some exceptions) the cervical nerve roots are more forgiving than the lumbar nerve roots (a later surgical decompression can still allow recovery in the cervical spine). The exception is cord compression. The cord is part of the central nervous system (CNS) and does not recover well. If you have symptoms of cord compression along with some signs (hyperreflexia, Hoffmans’ sign, imbalance signs), surgery should not be ignored.

The disc tears/herniations in your cervical, thoracic and lumbar spines indicates a genetic weakness of the discal collagen fibers. There is nothing you can do for that but just learn better spinal biomechanics and take greater care when loading your spine.

You can get a block of both the lumbar and cervical spine at the same time but in regard to your cervical spine, this would be a mistake in your case. The epidural will relieve your pain but not remove the compression of the spinal cord. You are then lulled into the belief that you are “better” because the symptoms are not as disabling but that conclusion would not be accurate. The cord compression would continue, possibly leading to further damage.

Sealants for the disc really do not seal the discal tear. The biology of the annular wall of the disc is that it is avascular. Without a blood supply, there is no ability of the disc wall to repair itself. In addition, the fibers of the disc wall are under great tension. When they tear, these fibers retract so they cannot be approximated again.

Some of the injections you mention reduce the inflammation of the pain fibers in the disc wall and that is what reduces the back pain. Unfortunately, these injections are only a temporary fix.

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.

BamaMike
Member

May 29, 2012 at 11:19 am

Post count: 3

#6279 In reply to: Neck & Shoulder Pain w/ MRI Results |

Dr. Corenman-

Thank you very much for taking time away from your family on a holiday to answer my questions.

You asked:
You do also have some cord compression as noted by the radiologist. Do you have symptoms of imbalance, incoordination or symptoms in any other extremity? Yes, but I had not tied the two together. I have noticed recently that I will lose my balance relatively easy. I will be walking and lose balance and bump in door frames, desk..

I most certainly get relief by placing my left forearm on the top of my head. Due to the sensitivity of my scalp during the occipital nerve related headaches I am not able to do this often. I have pain at a 4-5 in my neck at all times. When it flares to a 7-8 (5-6 times daily) the headaches intensify also and my scalp is just too sensitive to touch.

I sell medical grade plastics used in instrumentation and sizing trials. With my career, I have had the opportunity to meet many Orthopedic surgeons and Neurosurgeons. A few days after my MRI I ran into one of the Neurosurgeons I work with and he looked at my MRI and did a quick exam. As part of the exam he had me squeeze his fingers, he pushed and pulled on my forearms in different positions and noted that I have significant weakness in my left arm. Since your first reply I tried the push up and I did not have equal strength in both arms. My left arm was rather weak. I saw this Physician before for my lumbar back condition and he sent me to pain management since I was reluctant at that time to have fusion at L4-L5 so he is pretty familiar with my condition.

After the quick exam and reviewing my MRI he said his opinion was the disc needed to come out weather I used him or not. He urged me to not wait around like I did with my low back and stated that I should be concerned with possible permanent nerve or spinal cord issues if my condition deteriorated further. He lead me to believe that the cervical spine might not be as forgiving as the lumbar spine.

I am much more concerned about my cervical spine issue than I was about my lumbar problem. Maybe because I am much older now and take these kind of things more serious. I have a 20 year old daughter, 15 year old son and a 4 year old son. Being 45 with a 4 y/o I need to get healthy and stay health so I will be around and able to participate in raising him.

A couple of quick questions if you would: My L4-L5 disc has flared up recently and I was thinking of getting a block. Based on your experience in your practice would you consider doing a block at L4-L5 AND C6-C7 at the same time? Or, do you find it better to spread them out over a several week period?

I now have a total of three disc problems. C6-C7, L4-L5 and one in my thoracic spine that was found by chance via MRI as part of the workup before I participated in Spinal Restoration Bio-Stat fibran sealant clinical trial. It has not caused any issue and I don’t remember the exact location.

What could be the cause of all these ruptures? I am 45 years old and other than this I am relatively healthy. Would this be a genetic issue? If it’s a genetic issue is this something my children could possibly experience later in life?

What are your thoughts on the use of sealants in disc? It is my understanding that sealants have been used in Europe for many years. It looks like there are several companies working on FDA approval for sealants. Are you aware of any that are currently approved for use in the USA? Are you familiar with the Biostat Biologx Fibran Sealant? It would be nice if there was a product that was a more permanent nature. I was sedated so I am not sure about the pain involved during the procedure but the post procedure pain was significant and they asked that we try to manage it with OTC meds if possible. If narcotics were required if would not disqualify you from the trial. I don’t think anyone who received the actual study drug would be able to get by on OTC meds I know i was not able too.

Thanks again and I will be contacting your office and look forward to seeing you soon.

Warmest regards,

Mike Couch
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Viewing 6 results - 1,993 through 1,998 (of 2,193 total)

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Donald Corenman, MD, DC

Average rating:

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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