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thebird
Participant

January 19, 2018 at 3:40 am

Post count: 23

in reply to: Symptom question #27343

Hi Dr Corenman

Thank you for your time so far. I am hoping for some advice if you could please

I have since had a spinal tap, another brain mri and another balance expert check me out and still have no answers with worsening symptoms. Tests all come back clear. My symptoms are still burning sensations in both legs (not feet) and a feeling of my head out of sync with my body. The word dizzy does not fit it as it is difficult to explain. It is like propriception briefly where my head loses contact of my body where abouts, so sort of an imbalance but not enough to make me fall as it is only seconds. It occurs with eyes closed showering etc I feel unstable. I can trigger this by sitting in poor posture, (for some reason sitting on the toilet is guaranteed to bring it on, and I think that’s because I’m not supported well on the toilet) also moving head up and down like nodding etc. walking with my head down. At times, my neck will go really stiff when this all occurs also. If I walk down stairs and look down in a semi flexion position, it will occur the whole time until I level out. A big part of me feels that it is something mechanical triggering this symptom but no one can put their finger on it or even identify the issue in my legs. I do not have cord compression as there is still CSF at the back of the cord however the anterior side of cord has flattening at c5 to c7 with no CSF present, as previously discussed.

Everyone seems to be unsure if the cervical cord can do this in the current state but unable to find anything else. my history points to physical injury and this area as having the injury. I did also hear them say my leg reflexes are brisk also.

I’ve had so much ruled out now that it’s either these discs doing some sort of cord dysfunction or I’m at the wrong kind of doctors, or wrong tests been performed. Would you have any suggestions I could mention to my doctors for further testing or how would one proceed in this scenario? I guess it also comes out of your speciality been a spine expert but I’ve noticed you giving helpful advice to people. Obviously I’d like to get the issue identified and treated but not looking good for me at the moment, sadly. My neurologist seems to think it’s my sensory nervous system having an issue but can’t locate what’s causing it.

You run a great forum and it has allowed me to track where I’m up to in this debacle and your added input is so helpful. Thank you again

thebird
Participant

December 24, 2017 at 1:41 pm

Post count: 23

in reply to: Symptom question #27152

Me too. Thanks again Dr Corenman. I will advise if I get anywhere.

thebird
Participant

December 23, 2017 at 8:16 pm

Post count: 23

in reply to: Symptom question #27136

Thank you for your reply this time of year Dr Corenman. The neck flexion/extension MRI has been completed with no compression evident however the discs further protruding the cord and causing further flattening.

I am a bit stuck with this whole thing now. I get a sensation when moving my neck up and down that lasts a split second that feels like my head is disconnected from my body, along with neck stiffness. I can trigger this by the up and down motion but not left and right. They are sending me to a different ENT once again for further tests.

I have one final question if you don’t mind. Do you think It is possible that the disc protruding my cord causing flattening can produce the symptoms I’m experiencing? My Neurosurgeon said it is possible but rare, hence further tests to rule more out. Really hard position to be in as all tests check out fine, except these discs.

Thanks for all your replies, hopefully I get somewhere in the new year.

Cheers

thebird
Participant

December 5, 2017 at 4:20 am

Post count: 23

in reply to: Symptom question #26983

Hi Dr Corenman

Further update if you wouldn’t mind reviewing. Symptoms are still burning in both legs and adhoc imbalance feeling. Seems to be based on neck movement up and down, experienced sitting or walking.

SSEP passed with no signs of dysfunction of cord with neurologist.

Neurosurgeon ordered a new MRI of cervical spine with contrast (New from the results I provided originally) and main findings below:

Report: the alignment is preserved. There is generalised disc desiccation. There is mild loss of disc height with endplate reactive changes, mainly at c5/6 and c6/7. The visualised posterior fossa structures are unremarkable. The cervico-medullary junction is normal.

At c3/4, there is a minimal osteochondral bar. There is minimal right foraminal narrowing.

At c4/5, there is a mild osteochondral bad. There is mild indentation to the thecal sac.

At c5/6, there is a moderate osteochondral bar towards the left. There is mild flattening of the cord on the left, although CSF is still present posteriorly and there is no appreciable cord oedema. There is moderate left foraminal narrowing. There is minimal right foraminal narrowing.

At c6/7, there is a moderate osteochondral bar. There is minimal flattening of the cord although CAF is still present posteriorly and there is no appreciable cord oedema. There is mild to moderate left foraminal narrowing. There is minimal right foraminal narrowing.

Impression:
– multilevel spondylosis with flattening of the cord at c5/6 and c6/7 , although CSF is present posteriorly and no appreciable cord oedema.

– moderate left foraminal narrowing at c5/6 with possible compression of the left c6 nerve.

– mild to moderate foraminal narrowing at c6/7.

The Neurosurgeon has now ordered a dynamic MRI with neck flexion and extension. He advises I’m experiencing cord compression symptoms however current MRIs are showing no compression in the neutral lay down position.

My physical examinations check out fine from what I understand. No strength or reflex issues which I understand to be common symptoms of cord compression. I just wonder is it possible to have the symptoms I’m experiencing from cord flattening or dynamic compresssion (if it Is even occuring) without the physical signs been present? Evidence of any compression has not been found currently.

Appreciate any input you may have

Thanks

thebird
Participant

November 6, 2017 at 5:39 pm

Post count: 23

in reply to: Symptom question #26778

Thanks for your reply Dr Corenman,

I believe the SSEP is to test the burning sensation in my legs only. I understand they will measure from my head to my legs to see if their is any interruption. The nuerologist explained to me that the burning sensation in my legs is possible from dynamic cord compression, based on the fact so many other things have now been ruled out. He mentions to have identical symptoms in each leg is generally from the brain or spinal cord. Brain has been checked which has lead him back to the cord.

Hes replies to me are similar to yours, he said normally other things would appear but again these symptoms are still possible from dynamic compression and unable to locate any other issue with me. He did not make much comment on the dizziness/unbalanced feeling I get. Have you seen this symptom before with central bulges at c6/c7 level?

Could you provide any further advice? after the SSEP, i do think i’ll schedule this surgery based on so many tests and this appears to be the only issue I’ve ever had.

thebird
Participant

November 6, 2017 at 3:22 am

Post count: 23

in reply to: Symptom question #26769

Hi Dr Corenman,

I have since developed a dizzy/unbalanced feeling that comes with movement of my head/neck. It is short and brief (as in seconds) and purely based on neck movement. I receive this while sitting or standing. The unbalanced feeling feels like it is in my head only, I don’t feel as though I’m going to fall over but don’t feel steady – quite hard to explain.

Have seen ENT specialist who ruled out inner ear infection and vertigo issues.

The nuerologist has seen me again and revisited the cervical MRI and advised at c6 level there is not enough room due to disc bulge and possibly receiving dynamic cord compression. He is conducting a further SSEP test shortly and has advised he is recommending decompression at this level of the cord. Most likely when I see surgeon again will be looking at ACDF.

The nuerologist did not comment on reflexes of legs. Therefore, I’m not sure if the delayed comment by the surgeon was a miss judgement. The nuerologist also has mri on brain which was all clear.

Thanks for your time and just wondering your feedback on new symptoms and current process ?

Kind regards
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Viewing 6 posts - 13 through 18 (of 22 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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thebird

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