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Donald Corenman, MD, DC
Moderator

August 1, 2020 at 11:00 am

Post count: 8660

#32803 In reply to: C4-c6 disc buldge |

You have degenerative disc disease of the C4-5 and C5-6 levels (somewhat common) without reported spinal cord or nerve root compression. There is no report of the facets (again-somewhat commonly missed) which could demonstrate some unrecognized degeneration. You would need X-rays including flexion/extension views to discern motion, stability and disc height as well as a good examination to try and discover what your pain generators could be.

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

July 24, 2020 at 10:29 pm

Post count: 8660

#32789 In reply to: Arm weakness |

The C4 nerve (C3-4 level) connects to no important muscles so it could not be causing perceived muscle weakness in the arm. The C5-6 level however can cause weakness of the biceps and wrist extensor which is involved in grip. Your husband has “Bilateral Severe foraminal stenosis” so this still could be causing problems even with the cord injury.

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

July 24, 2020 at 10:23 pm

Post count: 8660

#32787 In reply to: ACDF didn’t fix pain |

Pain is not “mental” (typically) but a peripheral nerve signal triggered due to tissue damage. The pain is dependent upon the structure damaged. Your pain could be generated by the C6-7 disc or even from a pseudoarthrosis (lack of fusion) at C7-T1. A set of flexion/extension X-rays or even better, a CT scan would be helpful to differentiate those two. Facet degeneration, commonly unrecognized can also cause this 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.

Donald Corenman, MD, DC
Moderator

July 16, 2020 at 9:38 am

Post count: 8660

#32768 In reply to: Getting progressively worse after microdiscectomy |

Central stenosis at L5-S1 would possibly cause two different sets of symptoms. One is neurogenic claudication; pain and fatigue in the pelvis/buttocks region that would become more intense and start to radiate to the posterior thighs with standing and walking. The longer the stand or walk, the worse the symptoms become until you were forced to sit down or lean over a counter.

The other symptom could be radiculopathy (nerve root pain) and weakness of the S1 nerves with severe cases leading to calf (foot push-off) weakness.

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.

metallikat
Participant

July 14, 2020 at 10:18 pm

Post count: 9

#32759 In reply to: Getting progressively worse after microdiscectomy |

And now that I think of it, even before surgery, I tried decompression by hanging from a Teeter Dex 2 (back extension exercise equipment) and both legs would totally fall asleep while on it.

metallikat
Participant

July 12, 2020 at 10:44 pm

Post count: 9

#32743 In reply to: Getting progressively worse after microdiscectomy |

Hello Dr. Corenman,

New MRI came back. It says among other things:
“Disc desiccation and mild loss of disc height ta L5-S1.” [Note the word “mild”]
“L4-L5: No evidence of […] neuroforaminal stenosis.”
“L5-S1: Broad-based disc protrusion measure 5mm without significant central canal stenosis. Previously seen right subarticular disc extrusion has resolved. No significant foraminal stenosis.”
“Impression: Broad-based disc protrusion measure 5mm without significant central canal stenosis. Previously seen right subarticular disc extrusion has resolved. No significant foraminal stenosis.”

Previous MRI before surgery said:
“Disc desiccation with loss of disc height.” [Note the absence of the word “mild”]
“L4-L5: […] Mild bilateral foraminal stenosis”
“L5-S1: Disc desiccation with loss of disc height. Large right subarticular disc extrusion measuring 11mm AP. Complete effacement of the right lateral recess with impingement on the traversing right S1 nerve root. Mild central spinal stenosis with AP thecal sac diameter of 8mm. No significant foraminal stenosis.”
“Impression:
1. At L5-S1, large right subarticular disc extrusion with impingement on the traversing right S1 nerve root.
2. Facet arthropathy at L4-L5 with mild bilateral foraminal stenosis.”

Comments/Questions:
1. I am getting referrals to a neurosurgeon and a neurologist
2. It is my hope that the surgeon might be able to see on the MRIs if the disc height increased slightly due to traction, etc that was done for some weeks prior to surgery.
3. The new MRI does not note the mild foraminal stenosis that the old MRI did at L4-L5. Is that something that could have gone away with traction and mobility exercises?
4. The new MRI did not note the mild central stenosis with AP sac diameter of 8mm. Nor did the old MRI clearly explain what the source of that stenosis was? Any clue? Was the “hose” just narrow for no reason? And could it really have resolved since the last MRI?
5. The new MRI says protrusion does not cause “significant” stenosis. I take it this is not the same thing as “zero” stenosis. And I read that even without actual contact with the dura, protrusions can cause inflammation in the area, causing nerve symptoms. Given my new bilateral symptoms including weakness, does this protrusion look like the probable cause?
6. Any chance a surgery would allow me to keep the spinous process, and just get away with maybe having another laminotomy on the other side as well?
7. Any chance of treating this with traction?
8. If hernia retracts with traction, would the annulus heal itself over?
9. Is there time to mess around with such alternatives, or given the weakness symptoms should I just get surgery in your opinion? No one would know I have weakness by looking at my gait.
10. Since right after the first surgery, extension of both legs would cause nerve symptoms. Does that make sense anatomically given I presumably did not have this protrusion at that time, but only had the extrusion on one side? What explains it? Inflammation/irritation in the general region caused by the surgery?

Thanks,
David
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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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