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exercise453
Member

June 25, 2012 at 5:01 am

Post count: 53

in reply to: about foraminotomy #6424

Hi Doc,
Loyal reader…potential visitor

I have read the indications for foraminotomy vs fusion including neck pain vs arm pain. I still do not fully understand. These questions are for c3/4 and c4/5.

You always ask about neck/arm pain percentage to determine foraminotomy vs fusion. C3/4) does not run down the arm and to the hand. Much of its journey is above the base of the neck. You have said it will radiate pain to the base of the skull and across the top of the shoulder. At this high level wouldn’t a symptomatic, unilateral, lateral herniation cause great one sided neck pain. Couldn’t a foraminotomy be indicated for neck pain in this circumstance?…….What about c4/5…same unilateral side?

Where there is a posterior disc (not hitting cord) and also lateral extension, and evidence that suggests the lateral part of the disc herniation is responsible for the unilateral nerve root symptoms, is it reasonable to attempt a foraminotomy in an initial attempt to avoid a fusion. (Images confirming of course)?

Can foraminotomy be performed on consecutive, same side levels(c3/4 and c4/5)?

Wouldn’t different elite doctors answer these questions differently?

Thanks,
___________________________________________________________________

These are two radiologist descriptions at c4/5……(c3/4 is a lateral herniation).
c4/5 posterior disc osteophyte-complex without evidence of cord compression with mild narrowing of the spinal canal. There is bilateral lateral extension resulting in moderate neuoforaminal stenosis. (me….the posterior disc almost reaches the edge of the canal, the cord surrounded by fluid but thin on the disc side. The disc does not contact the cord)

A second radiologist: At c4/5 there is mild disc space narrowing with partial dehydration of the disc. Posterior bulging of the disc is seen with anterior and posterior spurring. There is encroachment on the anterior subarachnoid space and left sided neuroforamen.

exercise453
Member

June 10, 2012 at 3:37 am

Post count: 53

in reply to: c2-3 facet #6343

Hi Doc,

At c3-4 the report says left lateral extension with moderate neuroforaminal stenoses. I do believe it is symptomatic and as you said may be the underlying pathology of painful trigger points. I am confused about the c4 nerve root. It seems to be responsible for radiating into the shoulder via its connection to c5. It also is connected to the c1c2c3 complex radiating upwards. You mentioned the c3-4 facet in your explanation about the c2-3 facet.

Can the c4 root cause pain in both directions (up and down)?
Can it mimic c2-3 facet symptoms. When I press the posterior trigger points or turn slightly there is tingling in the ear.
Can facet pain move around (back-side-front)? Can nerve pain?
Can a c3 nerve be symptomatic even as 2 mri’’s say normal (it does look good)?

At c4-5 (ground zero)…mri posterior disc (wipes out most of the canal but does not touch the cord) and left lateral stenoses. A nerve report was +1 fib and +1psw and the neurologist wrote possible root dysfunction. There is no weakness, there are radicular symptoms.

Did I understand you that injured or dysfunctional roots will not recover even if freed?

Someday I’ll tell you the c7-t1 cubital tunnel saga.

As always thanks from a loyal reader and potential visitor.

exercise453
Member

May 20, 2012 at 4:21 am

Post count: 53

in reply to: about foraminotomy #6229

Hi Doctor,

Assuming symptomatic levels can a foraminotomy be done above a fusion level given the correct indications (c3-4 over c4-5 fusion to avoid a double)?

Same question c4-5 fusion over a c7-t1 foraminatomy?

You say there is a return to most activities after a single and sometimes double fusion. Can a golfer return to golf and jerk his head to the left (involved side) hundreds of times a day, week and so on?

Thanks

exercise453
Member

May 11, 2012 at 1:26 am

Post count: 53

in reply to: about foraminotomy #6179

There is something else doc, if I may. From a “giving way” (unilateral) during an incline bench press I may have affected every disc to some degree, c4-t1. Other traumas make it a diagnostic nightmare.

There is a prominent white line running laterally across the spinal cord at c6-7. It is identical in an mri a year and a half ago and again in a recent one. You could not miss it if you were blind.

Different radiologists do not even mention it and all the cord findings are normal.

What could it be and is it worrisome?

Thans again

exercise453
Member

April 12, 2012 at 7:17 am

Post count: 53

in reply to: c2-3 facet #6006

Sorry to ask again but I don’t understand your answer. If periodic epidurals reduce inflammation, and inflammation causes dysfunction then wouldn’t the epidurals slow down deterioration, at least while the steroid in effect?

And if a nerve is temporarily uninflamed and thus smaller, cannot healing be promoted while it is under less pressure? (wishful thinking)?

Thanks so much Doc…the website and forum, including other peoples posts have answered many questions that have plagued me for a long time and clarified what to do and not do.

exercise453
Member

April 12, 2012 at 5:09 am

Post count: 53

in reply to: c2-3 facet #6003

Hi again doc,

In a cervical radiculopathy where there is more neck than arm pain (75-25), no loss of muscle strength but definitely strong multilevel sensory symptoms, will periodic epidurals, while easing symptoms, also prevent or slow down further deterioration of nerves, nerve roots etc?

If there is pressure on exiting nerve roots, enough to create sensory discomfort but muscles are full strength, does it have to eventually affect motor function or can it remain as it is?

Thanks again
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Viewing 6 posts - 37 through 42 (of 46 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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exercise453

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