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Donald Corenman, MD, DC
Moderator

April 25, 2020 at 5:45 pm

Post count: 8660

#32475 In reply to: Bertolotti’s Syndrome |

First you have to have the correct diagnosis. The symptoms should be lower back pain on the articulation side. Loading of the spine should aggravate the symptoms. The MRI STIR images should “light up” at the articulation site to indicate that there is bone reactivity which can cause the pain you have. Then finally, an injection of numbing medication into the site should temporarily relieve the symptoms.

If those criteria are satisfied, then you have two choices, fuse the segment or remove the aberrant articulation (which is what is suggested). Removing the articulation has somewhat less success than fusion but is still acceptable. Fusion doesn’t generally reduce range of motion much as this should be a very stiff segment. The way to determine if it is stiff is to perform flexion/extension X-rays. Normally, this segment will have 20-25 degrees range of motion.

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.

NSpine
Participant

April 15, 2020 at 8:21 am

Post count: 13

#32452 In reply to: Lumbar Fusion |

Many thanks for the reply.

Leg pain is the dominant issue, with standing being the worst and sitting or lying down the best.

Back pain is present in flexion and extension with a heavy stiff feeling and inflexibility.

What method of fusion would you potentially think most appropriate?

Thanks again.

Calista
Participant

April 14, 2020 at 9:44 pm

Post count: 18

#32450 In reply to: Opinion of surgical options based upon MRI & symptoms |

Spoke with surgeon today, I do not have solid fusions at L3-5, and L3/4 hardware is loose and level moves on flexion/extension, plus confirmed bilateral foraminal stenosis, both levels, worse at L3/4 – with residual disc.

He recommends a posterior full decompression with revision fusion and me taking bone density drugs in addition to using BMP. The logistics of removal of hardware is the concern, versus augmenting what is in place, due to small size of pedicles.

Need to have in person consult to review particulars. So now just waiting until in person office visit & when elective surgeries can be performed in NJ.

Donald Corenman, MD, DC
Moderator

April 9, 2020 at 6:56 pm

Post count: 8660

#32416 In reply to: Bilateral Tricep Weakness |

The triceps muscle in supplied by the C7 nerve root. Weakness is typically found with compression of this nerve. Associated muscles that are enervated by the C7 root are the MCP extensors (straightens the fingers up at the knuckles) and the wrist flexors (pulls the palm surface of the hand toward the front of the forearm). This should be associated with decreased sensation of the C7 dermatome (the palm side of the long finger) and an absent triceps reflex.

There is no compression based upon your MRI reading of the C6-C7 level: “Mild disc osteophyte complex is present without spinal stenosis.No foraminal narrowing is identified.Facet joints appear intact”. Certainly not both sides, let alone the right side. You do have C5-6 foraminal narrowing on the right (“C5-C6, right central disc osteophyte complex with mild spinal stenosis and right root exit zone and foraminal narrowing”) but that would cause biceps weakness.

If the other muscles associated with C7 are not weak and there is no sensory loss or reflex loss. something else could be causing this muscles 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.

Charles M
Participant

April 5, 2020 at 5:39 pm

Post count: 1

#32401
Topic: Bilateral Tricep Weakness in forum NECK PAIN |

Dr. Corenman,

I injured my neck badly in 2018 gardening. Pain was 10/10 from neck to wrist on right side for a month and was paralyzed in my right hand for about two weeks with constant spasm throughout right side. Went to Chiro, Pt etc.. recovered after six months, but still have constant irritation and tightness in neck.

About two weeks ago after doing nothing noteworthy I started to get spasms and weakness in both triceps. The weakness is transient but still very disconcerting. I can understand the osteophyte complex at c7 causing issues on the right side, but do not see anything on the MRI that would cause both triceps to be affected. Given the current Covid -19 situation, healthcare is obviously limited as are my options.

How concerned should I be given the symptoms in relation to MRI?

Thanks,
Charles
Taos,NM

MRI:

Procedure: MRI C-SPINE WO-72141,9/21/2019 11:30 AM
INDICATION:NECK PAIN C6 C7. Neck pain. Recent neck injury.
Comparison examination:None available at time of dictation.
The cervical spine was imaged in multiple planes and pulse sequences. Contrast: not utilized.
Vertebral body alignment: Loss of normal cervical lordosis with slight broad kyphosis is present through the cervical spine. Vertebral body heights:Vertebral body heights are intact. Marrow signal intensity:No pathologic marrow replacement is identified. Paraspinous soft tissues:Normal. Cervical spinal cord:No focal cord lesions or evidence of syrinx. Craniovertebral junction:Normal alignment without evidence of stenosis. . Intervertebral disc levels: C1-C2 articulation:Normal. No significant degenerative changes are noted. No stenosis or cord compression are identified.
C2-C3:Intervertebral disc is intact.No foraminal narrowing is identified.Facet joints appear intact.
C3-C4:Intervertebral disc is intact.No foraminal narrowing is identified. Mild facet osteoarthrosis of the right C3-C4 articulation are noted.
C4-C5: Mild disc osteophyte complex is present without significant spinal stenosis. Mild right-sided foraminal narrowing is present.Facet joints appear intact.
C5-C6: Right central disc osteophyte complex with mild spinal stenosis is present. Right root exit zone and foraminal narrowing are present.Facet joints appear intact.
C6-C7: Mild disc osteophyte complex is present without spinal stenosis.No foraminal narrowing is identified.Facet joints appear intact.
C7-T1:Intervertebral disc is intact. Right-sided for foraminal narrowing from facet
osteoarthrosis is present. Prominent right facet osteoarthrosis is noted.
IMPRESSION: 1. At C5-C6, right central disc osteophyte complex with mild spinal stenosis and right root exit zone and foraminal narrowing. 2. At C7-T1, right-sided foraminal narrowing from facet osteoarthrosis. 3. At C4-C5, mild right-sided foraminal narrowing from disc osteophyte complex

rypz79
Participant

April 2, 2020 at 10:26 am

Post count: 33

#32397 In reply to: L5 nerve root recovery |

Dear Dr. Corenman

After further checking the physical condition of my foot using a video tutorial I did find wasting of the Extensor Digitorum Brevis i.e the muscle ball near the ankle of my right foot doesn’t feel as strong and is less visiable then of my left one I’ve also tried the test for weakness of the Extensor Hallucis Longus and passed it there is no differences with the toe power. SLR was always negative, there is no noticeable diminished sensation on dorsum of the foot.

From your tutorial https://neckandback.com/conditions/home-testing-for-leg-weakness/
On L5 I’ve passed the 20 feet duck walk test with ease but when I’ve tried the 20 straight tip toe check I immediately saw that there is a noticeable difference between the two legs I can do it with my right foot (not without sending a hand to stabilise myself) but it’s much easier to do with my left one. I will practice on that more depending on the pain produced but in general is this muscle power unrecoverable if we’re talking about axonal damage?

Is the pain I’m feeling after this exercise in the balls of my feet is meets your definition of “pain inhibition”? It gets worse when I push harder.

Is my “voluntary limping” (to minimize pain while walking normally) for several months prior to the surgery could also contribute to this muscle weakness?

Are those new weakness findings suggest anything about the type of injury I sustained and the time needed for recovery?

Thank you very much Dr. Corenman
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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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