Need help with MRI results

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Grandmother457
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March 24, 2014 at 5:11 am

Post count: 3

#10604

Hello.I have not been here in awhile because,I have been going back forth to different doctor’s.I had surgery On Dec.7,2012 for C4-C5.In June of 2013 the doctor done an ex-ray and another MRI told me that I am not fusion and that the reason I am having problems with my right arm is because of another disc C5-C6.So,was sent to see another doctor and he said the same thing but didn’t see a bulge disc.I have had two MRI done without contrast and a CT SCAN without it.Had an EMG test done and that came back with nerve damage C5 (chronic)so,I can’t use my left arm much,it swells a lot and burns and aches.My right arm swells to and burns,so does my neck and have been getting bee stinks on the right side of my neck.So,the doctor I am going to a pain management order a Bone Scan to see if I don’t have RSD.She told me that I have artistic on my shoulder’s hands,wrist,elbows with lots of inflammation.She order an MRI without contrast and that came back saying:C2-C3:Small disc osteophyte complex without significant canal stenosis.
C3-C4:Minimal disc osteophyte complex with central disc protrusion without significant canal stenosis.
C4-C5:Postsurgical changes of anterior cervical discectomy and fusion
C5-C6:Paracentral disc bulge with associated disc osteophyte complex causing effacement of the ventral aspect of the thecal sac and mild canal narrowing.No significant neural foraminal narrowing.

A week later that doctor order another MRI with contrast and the results says that I don’t have anything wrong.That doctor also sent me to a diffent doctor another pain one because I may still have RSD.That doctor order a Brain MRI and I gotten the results in that doctor wanted to see if I have MS or something else after the trauma I went through at work.Here are the results from that

Skull/marrow/soft tissues:Unremarkable.
Orbits:Unremarkable.
Sinuses:Unremarkable.
Vessels:Normal flow voids within the major intracranial vessels.
Brain:There are a few punctuate areas of T2-weighted hyperintensitied in subcortical white matter regions.The sulci,cicterna and ventricles are unremarkable.There is no extra-axial fluid collection or intracranial hemorrhage.There is no mass effect or midline shift.

Impression:1.No acute intracranial abnormality.
2.Few small discrete white matter lesions are identified.These lesions are abnormal but nonspecific,usually resulting from benign/remote/incidental causes(e.g.Prior trauma/inflammation/demyelinization,or chronic ischemia associated with migraines/atherosclerosis/other vasculopathies processed.

I know sometimes I get sharp pain in my chest too but it comes and goes on the heart side.Why did all the other test I had done without contrast showed something,but the one with it showed nothing?And could I have MS or RSD?

I went to the pain doctor today.And she told me that the new MRI didn’t show no scar tissues I asked why did the other tests showed that i have bulge disc or small herniated disc on the right side, but with the one with contrast nothing.She said that with a bulge disc it may have healed when I took the MRI with contrast and it showed it bugle out on the other tests at the time.She also don’t think I had a stroke.They think it’s the nerve doing it.I can understand the left side but.I didn’t have problems on the right until after three months of surgery.I get burning on the back of my right side of neck to my shoulder and it goes down my arm to the fingers and bee stinging and pain will shot down it and feels like someone is sitting on my neck.Both arms will turn red too.Could it still be more then just nerve damage?I am seeing two pain doctor’s and they both want me to do a type of nerve block.Had one done in the back of neck that made the burning spread more to the arms and fingers.The first doctor I seen was a neurosurgeon and that doctor is the one that told me that I am not fusion and the reason I have right arm pain is because of another disc.I am on workers comp and that nurse didn’t like what he said and didn’t understand about the shots he wanted to try first.So,she is the one that order a second opinion for an orthopedic doctor he told me that I am not healing but didn’t see no disc bulge order a CT SCAN and that test says that I have two disc problems but EMG test nerve damage on the left side only.Done PT and that made me worse too.Sent me to this pain doctor and now this doctor sent me to another pain doctor and he is the one that done the brain MRI test.So,I am so confused.So I have the nerve block in the front of my neck?Or should I ask for a neurosurgeon?

Donald Corenman, MD, DC
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April 19, 2014 at 12:51 am

Post count: 8660

#10768

You might have a chronically injured nerve (see chronic neuropathy on this website). If a nerve is compressed, sometimes even surgery to decompress the nerve will not cure the condition if the nerve was injured initially by the compression.

You could consider a selective nerve root block of the C5 nerve. This will coat the nerve with both steroid and numbing medication like novocaine (lidocaine) the dentist uses.

This injection will temporarily numb the nerve. If the nerve is causing the pain, the temporary numbing will give you relief from the pain for about three hours. This will confirm that this nerve is causing the pain. If you do not obtain relief, then this nerve is not the pain generator and another source of pain has to be considered.

The steroid can help to give some longer term relief in some circumstances as long as the nerve injected (C5) is the cause of the pain.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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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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