Please help me! MRI results show problems in the cervical, thoracic and lumbar

Tagged: fibromyalgia, Hemangiomas

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mamato4
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April 4, 2016 at 2:18 pm

Post count: 3

#21879

Hello, due to severe pain, numbness, weakness, balance issues etc I was sent for an mri, bone scan and ct. I am waiting to see an ortho surgeon but my symptoms are worsening.
Can someone please tell me what diagnoses I have from my mri report and what can be done about it? I have a family Doc as I have recently moved to a new province but he says he cant help me . I also have Fibromyalgia and can’t handle all the pain.
I understand what the MRI says. What I don’t understand is what I can do about it. Surgery?
The majority of my most intense pain is in the thoracic area which radiates across my ribs and into my abdomen. It does not lessen with rest. I also have neck pain, daily headaches, lower back pain with sciatica down left leg into foot.
Is the endplate depression a fracture and could it be responsible for all the pain in my thoracic are?
I also have globus and dysphagia. Osteophyte causing this?
I am 39, 5 ft 9 and 133 lbs. My GP says my cholesterol is 6.9 and LDL is 5.4. I have blood in my urine and a normal wbc. They also found multiple hepatic small tumors. US to follow soon.
I have bilateral foot drop but hyperreflexia bilaterally. I am very uncoordinated. I have mild urinary retention (no pain or burning) and intense urinary urgency.
I am a single mom to 4 kids. One with severe disabilities who is having another shunt revision this month. Im a mess.
Should I see oncology for radiation for the larger symptomatic hemangiomas? Or alcohol injections? or attempt to have them removed?
The mri report says…..Vertebral body heights are maintained. There is endplate depression superiorly at T8.
There are multiple foci of abnormal marrow signal. The largest lesion is a L2. This is T1 hyperintensive and in keeping with a benign hemangioma. There is a lesion at C6 with some intrinsic T1 high signal. This could be a hemangioma. There is a lesion at T4 with low T1 signal measuring 10 mm. There is a lesion at T8 measuring 10mm also with low T1 signal. There is a small lesion at L1 with low signal. There is a small lesion at T5.
Spinal cord caliber and signal apperar satisfactory. conus terminates at L1-2.
There is degenerative change:
At C3-4 there is mild bilateral foramen narrowing from uncovertebral osteophyte facet change.
At C5-6 there is a mild impression on the thecal sac from posterior disc osteophyte complex. There is mild bilateral foramen narrowing from uncovertebral osteophyte.
At C6-7 there is a moderate bilateral foramen narrowing from uncovertebral osteophyte.This encroaches on both C7 nerves.
In the Lumbar spine there is a mild right foramen narrowing at L4-5 and L5 S1 from disc bulging and facet change.

any advice you can offer would be so very appreciated as I cant see the orthosurgeon until May and I don’t know what to do.
Thank you so very much for taking time to read this

mamato4
Participant

April 4, 2016 at 2:24 pm

Post count: 3

#21881

oh! I forgot to say that primary and metastastic cancer was ruled out. And the tumors are typical and atypical hemangiomas they think :-/

Donald Corenman, MD, DC
Moderator

April 4, 2016 at 4:22 pm

Post count: 8660

#21882

Generally, hemangiomas do not cause symptoms unless they are very large (take up more than 1/2 the vertebral body). If you have been ruled out for neoplasm or infection, we can put those issues to rest.

The statement by the radiologist “Vertebral body heights are maintained. There is endplate depression superiorly at T8” sounds more like an old compression fracture. If you had no fall and the fracture is new, suspicion of osteoporosis has to be considered.

You note a “shunt”. Is this a shunt from the central nervous system to the peritoneal cavity? If so, why it is present? What condition necessitated a shunt? This might explain some of your symptoms.

You do have foraminal stenosis at C6-7 bilaterally. See the section https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/ to understand what a C7 nerve root compression looks like.

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.

mamato4
Participant

April 4, 2016 at 5:48 pm

Post count: 3

#21885

Thank you very much for your super fast reply Dr. Corenman.
It is my son that has the shunt for hydrocephalus.

Is 10 mm hemangioma big rnough to need removal? Sadly i know 2 hemangiomas are symptomatic as i can feel the pain and resulting radicularpathy.

Will i need surgery for the foraminal stenosis?

I have had no fall or physical trauma. Would the bone scan not have shown any possible osteoporosis?
Thank you once again. Your advice is worth millions to those waiting to see a Doctor! :-)

Donald Corenman, MD, DC
Moderator

April 4, 2016 at 10:00 pm

Post count: 8660

#21888

Bone scans are performed to look for abnormal fast bone turnover-generally a cancer scan and does not look for osteoporosis. That would be a bone density scan.

It is highly unlikely that any of your hemangiomas are your pain generators.

I cannot tell you if you might need surgery for your C7 radiculopathy. See the section https://neckandback.com/treatments/when-to-have-neck-surgery/ to understand indications for surgery. I would be careful as fibromyalgia amplifies pain and can make a condition seem more painful than it really is.

Without a shunt, your imbalance is unexplained by your cervical MRI.

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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