Donald Corenman MD DC | Spine Surgeon Colorado

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amandabu
Participant

June 25, 2021 at 2:01 pm

Post count: 6

in reply to: Trying to understand my post op problems and work-up #34162

I still have hyper-reflexia. I do not have Hoffman’s sign. I do not believe I had clonus. I had a “prominent titubation”, “Trace Tromner”, “gait is slow, tremulous distal and proximal activation of legs”

The neurologist told me I had an Essential tremor?? It showed in my hands, tongue and head.

I do have muscle spasms/cramps in my neck, shoulders, shoulder blades, diaphragm area and outer hips as well.

I hope I answered your questions correctly. I couldn’t copy and paste his visit note.

Thank you!

amandabu
Participant

June 24, 2021 at 8:52 pm

Post count: 6

in reply to: Trying to understand my post op problems and work-up #34160

Hi Dr Corenman,

I may have used the incorrect terminology, I was diagnosed with Functional neurological disorder after the first surgery and now again. Another name for this disorder that has been used in the past is conversion disorder. The neurologist cannot find a neurological reason for my symptoms on exam nor on mri. I was under the impression that a person could still have cervical myelopathy even after their spine had been surgically corrected??
I have pasted a copy of my latest mri below. The neurologist has ordered an mri of my brain to verify I don’t have MS. I was checked for that after my first surgery as well, but he wanted to confirm that it is still negative. I will have the mri in a couple of weeks.

MRI CERVICAL SPINE WITHOUT CONTRAST,

04/10/2021 at 1348 hours.

HISTORY: Spinal stenosis, cervical region.

TECHNIQUE: Multiplanar multisequence imaging was obtained of the cervical spine on a 1.5 Tesla magnet. Images were obtained without IV gadolinium.

COMPARISON: MRI cervical spine dated 9/11/2020, cervical spine radiographs dated 3/9/2020, and CT myelogram, cervical spine dated 10/28/2019.

FINDINGS: Postsurgical changes of prior anterior cervical spine fusion are redemonstrated from C4 through C6, with a ventral surgical plate, vertebral body screws, prior corpectomy at C5, and vertically oriented strut graft from C4-C5 through C5-C6.
Additional postsurgical changes of prior posterior decompression and fusion are demonstrated from C4 through C7, with pedicle/facet screws connected by vertical rods, new compared to the prior exams. The surgical hardware would be better assessed on the
prior CT/x-ray exams. Susceptibility artifact related to the metallic surgical hardware degrades images and limits evaluation of the surrounding structures.

There is persistent straightening of the normal cervical lordosis. No new abnormalities of sagittal alignment are identified. The vertebral body heights are maintained. The marrow signal is notable for mild endplate degenerative signal changes that
are most prominent at C6-C7 outside of the postsurgical levels.

The cervical cord has a normal caliber. There are no areas of abnormal cord signal. No masses or fluid collections are seen in the spinal canal or paravertebral soft tissues. The craniocervical junction is unremarkable.

Multilevel degenerative changes are identified with diffuse degenerative disc desiccation and disc space narrowing, most prominent at C6-C7 outside of the postsurgical levels, where there is moderate loss of intervertebral disc height (slightly more
pronounced ventrally).

C2-C3: Negative

C3-C4: Negative

C4-C5: This is a postsurgical level. Evaluation on the axial images of limited due to the susceptibility artifact related to adjacent surgical hardware. No definite high-grade spinal canal or neural foraminal stenosis is identified.

C5-C6: This is a postsurgical level. Evaluation on the axial images of limited due to the susceptibility artifact related to adjacent surgical hardware. No definite high-grade spinal canal or neural foraminal stenosis is identified.

C6-C7: This is a postsurgical level. Evaluation on the axial images of limited due to the susceptibility artifact related to adjacent surgical hardware. No definite high-grade spinal canal or neural foraminal stenosis is identified.

C7-T1: Evaluation on the axial images of limited due to the susceptibility artifact related to adjacent surgical hardware. No definite high-grade spinal canal or neural foraminal stenosis is identified.

IMPRESSION:
1. Postsurgical changes of prior anterior cervical spine fusion are redemonstrated from C4 through C6, with interval posterior decompression and fusion from C4 through C7. Susceptibility artifact related to the surgical hardware degrades images and
significantly limits evaluation of the surrounding structures.
2. Mild multilevel degenerative changes of the cervical spine, without definite evidence of significant spinal canal or neural foraminal stenosis.

Thank you for your reply. I just can’t seem to believe that my symptoms would be all in my head. It doesn’t make sense to me.

amandabu
Participant

October 2, 2020 at 7:23 pm

Post count: 6

in reply to: Cervical pseudoarthrosis #33091

Thank you so much for
Taking the time to answer my questions.

I plan to do physical therapy again, after I’m cleared by my surgeon of course. With the symptoms going on over the length of time that they have, do you think that I have a positive chance that I will get my full function back to my arms and legs with hard work? I’ve been told that surgery basically stops progression and will relieve the pain some, but there is only a small possibility that I will get some function back if I work at it. I was curious what your opinion is.

Thanks for your patience!

Amanda

amandabu
Participant

September 30, 2020 at 9:27 pm

Post count: 6

in reply to: Cervical pseudoarthrosis #33076

Hi Dr Corenman,

Thank you for your response.

The original ACDF surgery used a cage, I do know an allograft was not used.

Only the flex and Ext x-ray showed the kyphosis. I believe the surgeon at the time was worried about my weakness and whether I would be ok going thru with surgery and recovering. He wanted PT and another opinion. After the CT myelogram I underwent several months of physical therapy. The mri doesn’t mention the kyphosis. Forgive me for my ignorance, but I’m not sure if an mri usually would show that or not. The mri was limited as well due to the current hardware as well as the limited mri procedure they had to use due to the medical device. (Even though it was “mri compatible”). Not sure if I answered your question or not, but as a patient’s perspective, that is what I know.

I’m not sure how to answer your next question about cord signal changes. I have copied and pasted part of the mri and ct myelogram below.

The Cleveland clinic just wants to do the posterior C5-C7 posterior fusion. The dr states that with that the rest of my spine will correct itself?. I am concerned now that I may not be doing enough. I’m trying to get the best option for myself right now. Thank you so much!

This was from my mri:
C3-C4: Artifact is present. Small disc osteophyte formation is present. No significant canal narrowing is present. Foramina are patent.

C4-C5: No significant canal or foraminal narrowing identified.

C5-C6: No significant canal or foraminal narrowing.

C6-C7: Artifact is present. Disc osteophyte formation is noted. On the sagittal imaging of the canal narrowing is present. At least mild cord flattening is noted. Uncovertebral joint hypertrophy is present. Mild to moderate foraminal narrowing is
identified. This is greater on the left side.

C7-T1: Negative

CT Myelogram:

FINDINGS: Congenital spinal stenosis. Reversal of the usual cervical lordosis. The Graf craniovertebral Junction: Negative.

C2-C3: Grade 1 anterior listhesis. Minor facet degenerative change.

C3-C4: Grade 1 anterior listhesis. No cord or nerve root compression.

C4-C6: Postop C5 vertebrectomy. The prevertebral plate and bilateral C4 and bilateral C6 screws are in good position and intact. No hardware fracture or loosening. Anterior interbody cage extends from inferior C4 through superior C6. Lucencies are seen
within the bone graft within the cage on both the sagittal and coronal reformatted images, indicating nonunion. No cord or nerve root compression at C4-C5 and C5-C6.

C6-C7: Degenerative disc disease and spondylosis. Left posterior lateral foraminal disc extrusion. Flattening of the left anterior cord surface. Slight reversal of the cervical lordosis.

C7-T1: Negative.

T1-T2: Negative.

CONCLUSION:
1. Nonunion of the anterior interbody fusion, C4-C6.
2. Left posterior lateral and foraminal disc extrusion, C6-C7.
3. Congenital spinal stenosis.
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Viewing 4 posts - 1 through 4 (of 4 total)

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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amandabu

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