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BRONCOFAN1
Participant

November 13, 2017 at 6:28 pm

Post count: 42

in reply to: Neck and Shoulder Pain #26818

Hi Dr. Corenman,

3.5 days out from my right side RFA and I am starting to feel some pain relief… seems to confirm again that the facets are the issue here. I understand it can take 7-14 days for the full effect to be reached.

A quick question in the meantime… I am noting significantly more joint stiffness when I bend my neck laterally,particularly first thing in the morning, along with increase cracking or even mild “catching” type sensations with motion. I’m 4 months out from the c5-7 mobi-c replacement. Since it now appears obvious the facets were injured going in, would it be typically for bone spurring / arthritis to develop fairly rapidly? Guess I am a bit concerned that simply trying to manage it is only going to buy a little time before it becomes necessary to explant and fuse anyway. With no natural disc to degenerate further and slow down the segment, is it correct to imagine that the facets will tend to degenerate much more rapidly than they would in a typical scenario?

Thanks,
Kevin

BRONCOFAN1
Participant

November 11, 2017 at 10:59 am

Post count: 42

in reply to: Chronic neck pain #26805

Just wanted to post a note to concur with Dr Corenman… I am 39 and had an ADR for a terribly painful degenerative disc this year after 6 months of conservative treatment. Cleared up a lot of the symptoms but left me with a persistent ache right over my c5-6 facet on the right side and some of the same kind of aches you describe on both sides. If it weren’t for Dr Corenman I’d still be wondering what it could be because neither my surgeon nor pain management recognized it was probably facet pain. Be persistent if you think that’s what it is – I had to force the issue to get a medial branch block and just had an RFA yesterday.

Kevin

BRONCOFAN1
Participant

November 5, 2017 at 6:38 pm

Post count: 42

in reply to: Neck and Shoulder Pain #26768

Interesting… I did wonder if insurance was the reason I had a medial branch block rather than facet injections. I didn’t get a great explanation, and I was a bit disappointed as I know some people, albeit a small minority, get good long term relief from the facet injections. But it occurred to me that insurance might require the medial branch block before an RFA, and if so they’d be trying to skip a step to get straight to the long term solution.

The “good” news is that the right side is orders of magnitude more painful for me, but this scenario would be most irritating (literally) for someone who had more symmetrical facet pain. Also fortunate that it appears I can proceed with the second RFA two weeks later.. I’ve scheduled for three weeks out so if the first one fails I can cancel or push back the second one.

Thanks,
Kevin

BRONCOFAN1
Participant

November 5, 2017 at 1:37 pm

Post count: 42

in reply to: Neck and Shoulder Pain #26762

Hi Dr. Corenman,

I’m scheduled for an RFA on Friday, however, the pain management doctor I use indicated they can do a minimum of 4 medial branch nerves at a time. Since they want to get C5-7 (3 nerves to RFA) that means he will do the right side first, then come back a few weeks later to do the left side. Is that a typical constraint? I am going ahead with the first two RFAs with this doctor since it will take a while to switch, but this seemed somewhat unusual to me. Since there is a at least some likelihood I’ll need to repeat these over the years, I might try to find someone else longer term that could get them all done in one procedure.

Thanks!
Kevin

BRONCOFAN1
Participant

October 29, 2017 at 1:03 pm

Post count: 42

in reply to: Neck and Shoulder Pain #26719

Thanks Dr. Corenman,

Curious if you have had positive long term results from managing failed ADRs with RFAs? It seems that with the overloaded facets, the degenerative process would likely continue over time – but I wonder if having facets that are not arthritic or enlarged may give some hope that they will eventually adjust to the new motion pattern?

In any event, I believe I’ll be able to get the RFA scheduled in the next few weeks, so hope to be able to report results back in a month or so.

Also, for anyone else out there considering ADR versus fusion, this is a good thread to read. I had 80% neck pain and 20% arm pain… you’ll note somewhere back in the thread that Dr. Corenman advised ACDF if conservative options failed. I thought I had all the right indications for ADR (good segmental mobility, limited collapse of disc space, good relief from SNRB, etc.). The surgery did relieve the back of the neck pain / spasms and arm pain, but either made worse or caused what seems to be almost certainly facet pain, and in the end I’m not any better off than I was pre surgery… may have even made things worse.

Long story short, it seems that it is very difficult to determine all the pain generators once a disc breaks down and causes significant neck pain. Even thought the disc / disc space inflammation was responsible for most of my pre op pain, the facets have been painful ever since, and I clearly wish I had gone with ACDF… now I will need to either manage with RFAs or have a revision procedure done at some point.

Thanks again for all your help Dr. Corenman!
Kevin

BRONCOFAN1
Participant

October 27, 2017 at 11:21 am

Post count: 42

in reply to: Neck and Shoulder Pain #26708

Hi Dr. Corenman,

I had bilateral medial branch blocks done this morning. They did medial branch nerves 4,5, and 6, which they indicated would correlate with my surgical levels of C5-7 (mobi-C). I had immediate pain relief on both sides, however on the left side I developed some injection site soreness after about thirty minutes that made it more difficult to track the effect on that side. My symptoms are normally fairly similar on both sides, although typically quite a bit worse on the right side.

I had almost no pain response to typical painful activity for about 2 hours, then had a gradual return to my normal symptoms over the following hour. Is this timing typical for a medial branch block? Many websites note 4-6 hours, but your site indicates 2-3, more in line with my experience.

I will see my pain management doctor on Thursday of next week – would you consider the above strong enough evidence to proceed with an ablation? The posterior neck pain has gotten to the point where if the ablation does not work I am going to strongly consider a conversion to ACDF…

Thanks,
Kevin
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Viewing 6 posts - 25 through 30 (of 41 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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BRONCOFAN1

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