MRI Cervical

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Jose
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June 1, 2014 at 7:36 am

Post count: 9

#10918

I recently had an MRI for my cervical spine. I had numbess and tingling in the fingers of my left hand, and scapular pain that seemed to originate from the neck. After focusing on my posture and doing some excerices, the tingling and numbness have gone away, but some grinding, stiffness, and a feeling that something is stuck in my neck persists and it always pops when I turn it. Here are my results:

c1-c2 mild arthrosis with normal alignment
c2-c3 no stenosis
c3-c4 disc space narrowing with decreased T2 nuclear signal but no central stenosis and the neural foramen are patent
c4-c5 decrease T2 nuclear signal with a mild bulge but no central stenosis. Slight left uncovertebral joint osteophyte change. Mild ligamentum flavum heperthrophy mildly indents the dorsal thecal sac.
c5-c6 degenerative central protrusion with mild flattening of the ventral thecal sac. Mild ligamentum flavum hypertrophy, greater on left with flattening of the dorsolateral thecal sac. Neural foramen are patent.
c6-c7 decreased T2 nuclear signal with a small right parcentral protusion. Mild right c7 foraminal stenosis.

Cervical spine demonstrates dextrocurvature whose apex is at c6-c7.

There is no cord compression or abnormal internal cord signal.

Question – How bad is this, I am 56 years old. The dextrocurvature, can that be re-aligned somehow….not too keen on going to a chiropractor or neck issues. I am deathly afraid of having to get surgery on my neck.

Thanks

Donald Corenman, MD, DC
Moderator

June 1, 2014 at 11:24 pm

Post count: 8660

#10926

Your “numbness and tingling in the fingers of the left hand” could be from cervical radiculopathy (see website for explanation) but your MRI report only notes right nerve compression (“c6-c7 decreased T2 nuclear signal with a small right par central protrusion. Mild right c7 foraminal stenosis”). There are many other disorders that can cause numbness and tingling. Look under “Nerve entrapment/compression” to understand these other conditions.

Scapular pain commonly originates from the neck. This can develop from degenerative discs, facets and compressed nerves. This pain can also originate from the shoulder.

Your MRI report is not too bad. You should be able to manage these symptoms with therapy and medications. Injections can also be very effective. Chiropractic can also be effective for symptoms. The curve of your neck (“dextrocurvature whose apex is at c6-c7”) is by itself nothing to worry about. A chiropractor will not be able to “straighten” this curve out but should be able to help you manage with your symptoms.

Surgery is only indicated if you have spinal cord compression, nerve compression leading to motor weakness or intolerable pain. You have none of these according to your report.

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.

Jose
Member

June 2, 2014 at 6:15 am

Post count: 9

#10929

Thank you so much. I thought it wasent too bad, but wanted to know what you thought. I hope that it dosent turn into surgery at some point (would love to know what you think about this possibility for someone my age).

As I said, I no longer have the numbness and tingling, that seemed to have resolve with being conscious of the way I walk, sit, stand, sleep, work. What is puzzling me though is the only remaing pain that I have right now feels like a ligament or muscle or something that is caught tight. If I turn my neck up to the left, down to the left, and just about anywhere left, it pinches the area that seems to be to the left of C7. Can that be the ligamentum hypertrophy? Yet, as you said, everything points to the right side and I have not symptoms on my right side. I am a bit apprehensive about chiropractic manipulation on the neck given the bulges and protrusions.

As an aside, I starting taking 1,000mg of curcurium a day about 3 months ago to replace the NAISDs. I do yoga, and I do cervical traction at home on a device that I hang over my door. I use about 20 pounds for 10 minutes. I also read, and started to do post isometric release excercises around my neck and do McKenzie neck excercises. Lastly, I go to accupunture about 1x per month.

Donald Corenman, MD, DC
Moderator

June 2, 2014 at 10:06 pm

Post count: 8660

#10931

The findings on your MRI might not point to the structure that is causing your pain. By your description, the facet can be your pain generator. I understand how you feel regarding chiropractic but your symptoms might be well managed by manipulation. You need to find a good, experienced chiropractor who is gentile. Physical therapy is another alternative to manipulation.

The treatments you are currently involved with look to be beneficial although I am not clear how effective curcurium (tumeric)is.

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.

Jose
Member

June 3, 2014 at 10:27 pm

Post count: 9

#10938

I think you are right. The more I think about it, the more I believe its not due to the MRI findings. It’s on my left side. It started about 4 years ago with pain in the scapular region up to my lower cervical area, it would hurt even when I sneezed. Over the past few years I’ve tried very hard to change everything – ergonomics, sitting, etc. I worked for over 30 years on a computer and I think it caused a muscle imbalance which led to pain in the joints and ligaments. I have recently started doing core excersices, yoga, and take frequent breaks at work to stand up and walk around for 5 minutes. Perhaps I can reverse some of the damage or at least stop it. I plan to go back and do Pilates which I did many years ago and felt great. Thank you so much for your prompt responses.

Donald Corenman, MD, DC
Moderator

June 3, 2014 at 11:45 pm

Post count: 8660

#10942

Please give us feedback regarding how you are doing in three months. I think the most valuable part of the forum is feedback on outcomes.

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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