Abnormal signal in C-spine

Tagged: Cord signal changes

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micheledom
Participant

May 13, 2016 at 5:08 am

Post count: 9

#22176

Good morning Dr. Corenman,
I have a question about an MRI report that shows some abnormalities. Let me give you a brief history. The MRI is post cervical fusion of C4-C5. The MRI pre-surgery, did not show abnormal signal. This MRI was done 04/08/15 and compared to the MRI done 12/23/14.

HISTORY: 43-year-old woman with motor and sensory changes as well as dysequilibrium and visual changes with significant short-term memory loss.

TECHNIQUE: Multiplanar/multisequential MRI of the cervical spine was performed with and without contrast utilizing 10 cc MultiHance.

FINDINGS: The cervical vertebral column is straightened. There is anterior plate and screw fusion of C4 to C5. The foramen magnum and craniocervical junction appear normal and fully patent.

C1-C2: There is mild synovial hypertrophy
C2-C3: There is a mild right C3 foraminal narrowing.
C3-C4: There is a mild-to-moderate bilateral C4 foraminal narrowing. Canal is fully patent.
C4-C5: There is postoperative change and there is a
moderate-to-severe left C5 foraminal narrowing due to uncinate hypertrophy.
C5-C6, C6-C7, C7-T1: Canal and foramina remain relatively patent at these levels.

Evaluation of cord parenchyma reveals abnormal signal intensity posteriorly in the midline at lower C2 through the superior endplate of C3. There is mild cord signal heterogeneity posteriorly also at C5-6 in the posterior midline. There is no abnormal mass effect.

Following contrast administration no abnormal enhancement is seen.

Will you please tell me what all that means? Especially the abnormal signal. My neck surgeon did not order this MRI, but I brought it to him anyway to look at and he said “I’m not worried about the herniated disc (does that mean I have another one? That was the reason for surgery.) or the arthritis throughout your neck, but I am very worried about the abnormal signal and you need to see a neurologist ASAP” He feels a neurologist because he feels it is MS or some sort of demyelinating disease because I have all symptoms of MS as well as an abnormal MRI of brain in 2014 showing multiple white foci, and in the impression it listed possible causes and demyelination was one of them, and abnormal EEG, BUT a followup brain MRI showed a few scattered foci and the impression said normal for age? Anyway, when I showed the cervical MRI to my neck surgeon, he feels very strongly about it being lesions due to MS. I live in Florida and I have recently been deemed permanently disabled and for that reason, I can’t get diagnosed or treated down here because Rick Scott is not a nice guy, which makes him a horrible governor for people like me, which is exactly why I am planning to move to Colorado in the next few months.

I am worried about bone cancer because I also read that somewhere. In the year since the most recent MRI, I have developed new pain recently on top of my normal chronic pain. The new pain is in the left side of my neck and goes all the way from base of skull down through my left shoulder to the joint and it feels like bone pain, as well as right upper thigh pain on the inside (groin area) and on the outside, as well as right knee pain. I have headaches everyday. I have been diagnosed with viral meningitis X 4, and history of migraines, but I’m having different types of headaches as well. My vision went from 20/15 to I can’t see shit without reading glasses. Everything is blurry! OR sometimes it seems like I’m looking through fog or smoke.

Can you tell me what the recent MRI findings mean please?

Donald Corenman, MD, DC
Moderator

May 14, 2016 at 6:29 pm

Post count: 8660

#22190

The signal change in your spinal cord is something to pay attention to. This can mean injury from anything from mechanical compression to a demyelinating disease like MS. There is no mention of “a herniated disc” so I am unclear as to your surgeon’s reference to it.

First, the new onset left sided neck and arm pain different from the chronic pain certainly could be from the residual foraminal compression at C4-5 (“C4-C5: There is postoperative change and there is a moderate to severe left C5 foraminal narrowing due to uncinate hypertrophy”).

Normally, MS is a somewhat painless disease with symptoms of paresthesias (pins and needles) and sensory change along with balance issues. Yes, the signal change in the cord could be due to MS but other disorders can also cause this. It is unlikely that the ACDF surgery caused these cord changes as they are prominent at not only C5-6 but also at C2-3 where no surgery took place. Visual disturbances can be seen with MS.

I cannot explain you lower extremity pain (“right upper thigh pain on the inside (groin area) and on the outside, as well as right knee 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.

micheledom
Participant

May 15, 2016 at 7:57 am

Post count: 9

#22193

Good Morning Dr. Corenman,

Thank you so much for taking the time to answer my questions about MRI results. You mention that there are a number of things that could cause abnormal signal. Can you give me some examples by chance? So I can research them to see if I’m having other symptoms that go with whatever process is going on to cause it.

Is it an abnormal signal in bone marrow? I just don’t understand why I’m having all the symptoms I’m having. I do feel pins and needles in my hands and feet. I am constantly tripping and falling. Sometimes, I go to take a step, and my leg just isn’t there and I eat dirt/tile/carpet and maybe that’s what’s wrong with my right knee because it’s usually my right leg and I always land on my knee. My memory problem is so bad that it could actually be mistaken for Early Onset Alzheimer’s. I get lost driving around where I have lived for 25 years. I forget not only what I was saying in the middle of a sentence, but forget what the subject was. I have shooting burning pain out of nowhere that feels like someone stabbing me with an ice pick, that’s how localized it feels, in my right temple as well as my left thigh. It lasts a couple minutes.

I know your time is valuable and I appreciate anything you may be able to think of for me to have something to go on to look up. When I first saw the MRI results, I put the findings in google to see what would come up and the first thing I saw was abnormal signal in two or more places, and heterogeneity in shape could be bone marrow cancer…..of course, the internet always has me being terminal LOL, so, that is why I am seeking help from you because I can’t in Florida so I’m basically in limbo until I move to Colorado, shooting for July….

Thank you so much!

Warm Regards,
Michele

Donald Corenman, MD, DC
Moderator

May 15, 2016 at 10:27 am

Post count: 8660

#22196

Signal change in the cord could be from mechanical injury (cord compression, arnold chiari syndrome), vascular changes (a “stroke” of the spinal cord), tumor (astrocytoma) or from autoimmune changes (multiple sclerosis).

This is not bone marrow signal changes and there was no report of bone marrow changes on your report.

Pins and needles in hands and feet could originate from cord injury. Balance is affected too. Multiple falls can injure joints (knee 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.

micheledom
Participant

May 18, 2016 at 8:09 am

Post count: 9

#22203

Dr. Corenman,

You have done more for me by answering my questions than any of the “generic” neurologists that I’ve
talked to face-to-face down here……THANK YOU SO MUCH!

Best Wishes!

Michele

Donald Corenman, MD, DC
Moderator

May 21, 2016 at 11:46 am

Post count: 8660

#22216

Please keep us informed of your progress.

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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