Page 3 » Donald Corenman MD DC | Spine Surgeon Colorado

Forum Replies Created

Viewing 6 posts - 13 through 18 (of 29 total)

Previous 1 2 3 4 5 Next

Author

Posts
hart
Member

November 12, 2011 at 2:40 am

Post count: 34

in reply to: One in a Million? T9-T10 Symptomatic Disc Herniation #5095

Got the report…

IMPRESSION:

1. THE PRIOR EXAM OF 01/04/11 SHOWED A LARGE FAR RIGHT LATERAL DISC EXTRUSION WITH CEPHALAD MIGRATION OF THE EXTRUDED DISC. THIS AREA HAS SHOWN REMARKABLE IMPROVEMENT SINCE THE LAST EXAM WITH NOW ONLY A 3MM RIGHT LATERAL PROTRUSION AND NO DEFINED NERVE ROOT COMPRESSION.

2. MILD MULTILEVEL DEGENERATIVE DISC DISEASE WITH ENDPLATE SPONDYLOSIS AND SMALL SCHMORL NODE DEFECTS T7-8 THROUGH T10-11.

3. MINOR 1MM POSTERIOR ANULAR BULGING T8-9, T10-11 AND T11-12

4. STABLE APPEARANCE OF A SMALL BENIGN SIGNAL ABNORMALITY WITHIN THE ANTERIOR T9 VERTEBRAL BODY.

hart
Member

November 9, 2011 at 1:25 pm

Post count: 34

in reply to: One in a Million? T9-T10 Symptomatic Disc Herniation #5089

Hi Dr. Corenman:

I have yet to get my films to you. Sorry! But I now have another film. I ran home and looked at the study and I didn’t see the protrusion. The black blob was gone! Every level looked the same — that’s about my level of expertise ;)

I had the study today and we heard from the radiologist tonight. A completely normal T-spine MRI at 10 months! He and his colleagues (one of them the radiologist who read the old film back in January) have never seen or heard of such a “disappearance” in the T-spine. They have seen such findings in L-spine herniations on occasion. After taking a look at the old MRI, they returned to today’s study and decided just maybe there was a little something to be seen. Essentially normal. I await written report.

I am not 100% but I guess my MRI is! Of course, we know it is still a crappy disc! WOW…normal MRI…is this an especially good thing or just an interesting finding?

I will send you the films! Thank you for your enlightening discussion of etiology. You are the only person who has been willing (?able) to discuss possible explanations for this “injury”.

Cheers,
Hart

PS. So does this make me like one in a BILLION? Ha. I do realize that the “one in a million” number has been thrown into question and that symptomatic T-spine herniations are probably not as rare as once thought!

hart
Member

October 26, 2011 at 11:33 am

Post count: 34

in reply to: Cervical Facet Syndrome? #5045

Hi Dr. Corenman:

My McKenzie exercise question was added to my previous post on this thread per your twitter suggestion ;) If you have a “twitter assistant”, that probably won’t make any sense!

Things are improving with a bit of prednisone. No shocker there. But I have to get on top of the matter. Prednisone, while useful acutely, is not the answer, IMO! A clever physician once told me…if one can keep it under 10mg/kg body weight/year, the risk of adverse consequences is about nil. In this situation that is 1/2 a gram a year. With T-spine and C-spine woes (and shingles and…) this year, I’m closing in on that number!

Cheers

hart
Member

October 26, 2011 at 11:14 am

Post count: 34

in reply to: One in a Million? T9-T10 Symptomatic Disc Herniation #5044

Dear Dr. Corenman:

WOW. Thanks.

I will ring tomorrow about sending my films along. If it’s a re-herniation, maybe we can write it up — a first for the literature ;) More important to me though, is to understand this and not have a recurrence, be it the second, third or whatever. I suppose I am encouraged that there is less material to herniate now, less jelly at least. The idea of the tough stuff herniating is a bit scary though. While not strictly indicated, I’m keen to get this re-imaged.

The thoracic spine is especially stable, right? So will I have to worry as much about narrowing of the vertebral space and vertebral displacement with the loss of disc material?

Cheers

hart
Member

October 20, 2011 at 4:51 am

Post count: 34

in reply to: Cervical Facet Syndrome? #5026

Hi Dr. Corenman:

I hit the prednisone again. 20mg yesterday morning. This morning, true pain is all but gone. My neck is sore but that I can deal with. Rotation and more so lateral flexion are still limited. I had another 20mg of prednisone today. Maybe a couple more days of 10mg. Obviously, prednisone is not good for the back in the long run!

So pain can be quite easily controlled in this instance. I want to understand why I have this problem and how to avoid future occurrences. IOW, I would like to figure out if there is something in my movements, my habits that I can change. Is this problem usually just insidious as in comes and goes with no rhyme or reason? I never really thought twice about facet joints until now. Seems they are pesky little things.

The pain management doctor recommended in this instance is an anesthesiologist by training. I have a suspicion that there may be (a small number perhaps) surgeons out there who do not want to prescribe medications or otherwise treat pain when there is no operation at stake. They would rather just get you off their hands pronto. I have great respect for the pain management field. However, I don’t think this is an especially difficult case in regard to pain per se. I am aware of a diagnostic study, sometimes done by pain management physicians (including this one), that involves injection of a local anesthetic agent and steroid into joint space. The pathology or source of pain at least is presumed to be in the facet joint if the patient reports improvement after the injection? Is this procedure simply diagnostic or does it typically help with the pain/soreness/ROM for any meaningful period of time? From the information I am able to obtain, this exercise sounds a bit sketchy. It seems structures are pretty tight in there — what are the chances of hitting the target while avoiding other structures? I feel certain the pain is at the C2-C3 facet joints bilaterally. It is “joint pain” for sure.

A non-contrast standard C-spine MRI series has been done. Do you see any benefit in further imaging the facet joints by oblique plain film or CT scan. Of course, one must consider the radiation of the head CT in weighing the benefits. What is one likely to find if anything? What can be REASONABLY be done about it anyway? It sounds like some are resorting to seemingly drastic measures. I am NOT interested in fusing C2-C3

There is one more little tidbit on MRI that should probably mentioned at the outset: flattening of the normal cervical lordosis. Clinically, I have also been told that I lack the normal thoracic kyphosis.I don’t believe this has been reported on any radiologic studies though. If one is to believe the spine is curved for a good reason, this can’t exactly be a good thing. Would straightening of the cervical lordosis possibly be a factor in cervical facet problems. Could this affect facet joint alignment (there is probably a better word!)?

Is there anything I can do in terms of exercises or therapy to get curves or at least to maintain the existing curvature. Are McKenzie retraction and extension exercises likely to be useful (or at least harmless) in the setting of presumed (by me) cervical facet pain at C2-C3? The retraction feels good to me but the extension not so good! There are no symptoms of spinal nerve root compression and no findings on MRI suggestive of nerve root compression…or anything else at this level ;)

Thank you so much for you assurances and meaningful responses,

PS. How do I find a chiropractor? This is new territory for me!

hart
Member

October 19, 2011 at 1:36 am

Post count: 34

in reply to: Cervical Facet Syndrome? #5013

Dear Dr. Corenman:

I had my second appointment for this problem. An MRI was ordered during the first appointment and the purpose of the second appointment was “to review the MRI”. There were no findings on MRI consistent with the complaint. (There is an incidental disc protrusion at C5-C6.) From what I can find, it does NOT sound like the cervical facet joints are generally well imaged on an MRI, the oblique X-ray or CT possibly being better exams. I have a feeling that the lack of findings on MRI does not reasonably rule out facet joint pathology. Office X-rays were done but no oblique view.

A referral to “Pain Management” was made. This must be a dumping ground for patients who ask too many questions!

I appreciate your reassurance! This is VERY helpful! I think this may be resolving! It was a difficult episode of almost 6 weeks duration. I would like to understand what this is and why it happened in hopes of avoiding recurrence.

Cheers
Author

Posts

Viewing 6 posts - 13 through 18 (of 29 total)

Previous 1 2 3 4 5 Next

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel

hart

Forum Replies Created