MRI Cervical Neck Findings

Tagged: Stretch cervical nerve and brachial plexus injury

Viewing 6 posts - 1 through 6 (of 17 total)

1 2 3 Next

Author

Posts
Mpneagle
Participant

July 21, 2017 at 3:34 pm

Post count: 11

#25607

Hello Dr. Corenman

Sorry, I inadvertently posted this is the professional forum by mistake so I have reposted here.

I sustained some cervical spine trauma on 5/14 while in the ICU I had an MRI done on the cervical region. I was in a hard collar for 7 weeks while under the care of a neurosurgeon. I have been released from the collar but I am having some lingering issues with muscle weakness mainly in the left shoulder (deltoid, infraspinatus, etc) infraspinatus shows signs of atrophy which creates some range of motion issues mainly arm elevation/extension. I am currently in physical therapy to work on these issues. While I have noticed some improvement in range of motion and a very small strength increase I would love some input from you on my MRI results if possible. I assume I am suffering from a c5/6 nerve root impingement. I do not experience much pain just muscle weakness and loss of range. I also did complete an EMG study and its results basically just stated nerve “damage”. of the deltoid, bicep, tricep, infraspinatus. I can share these if interested. Just looking to become more educated on my issue and seek the best course of action. It seems the doctor is using the wait and see approach are you in agreement with this?

Thank you for your time and again I apologize for posting in the wrong forum initially.

COMPARISON: Cervical spine CT 05,14,2017
FINDINGS:
Straightening of the cervical lordosis. Displaced fracture of the C6 spinous
process identified. Bone marrow edema within the left posterior elements of C7
corresponding to the nondisplaced fractures on prior CT. No acute vertebral
subluxation identified. Partially imaged acute T4 and T5 compression fractures
with bone marrow edema.
The cervical cord demonstrates normal signal intensity. No evidence of cord
contusion or acute cord edema.
C2-3: The disk is preserved height. No significant disk protrusion, spinal
canal or foraminal stenosis.
C3-4: Mild disk height loss. Uncovertebral osteophytes with moderate left
foraminal narrowing. Broad disk osteophyte complex with borderline, mild
spinal canal narrowing. The AP thecal sac diameter measures 9 mm.
C4-5: Moderate disk height loss. 4 mm broad disk osteophyte complex narrows
the ventral thecal sac and indents the anterior cord surface. There is mild to
moderate spinal canal stenosis. AP thecal sac diameter measures 7 mm.
Uncovertebral osteophytes cause moderate right and mild left foraminal
narrowing.
C5-6: 3 mm central disk protrusion indents the ventral thecal sac mild to
moderate spinal canal stenosis. No significant foraminal narrowing.
C6-7: Left central 4 mm disk protrusion compresses the left ventral cord
surface without evidence of acute cord edema. There is mild spinal canal
stenosis. Mild to moderate left foraminal narrowing.
C7-T1: The disk is preserved height. No significant disk protrusion, spinal
canal or foraminal stenosis.
Extensive interspinous and paraspinous soft tissue edema is seen.
IMPRESSION:
Displaced fracture of the C6 spinous process.
Bone marrow edema within the left posterior elements of C7 corresponds to the
nondisplaced fractures on prior CT. No acute vertebral subluxation identified.
Partially imaged acute T4 and T5 compression fractures with bone marrow edema.
Extensive interspinous and paraspinous soft tissue edema is related to
high-grade cervical interspinous and paraspinous ligamentous injury.
No acute cord contusion or cord edema.
Multilevel degenerative changes with mild to moderate spinal canal stenosis
C4-5, C5-6 and C6-7 as detailed.

I look forward to your reply. If more information is required for better analysis please let me know…

Mpneagle
Participant

July 21, 2017 at 3:36 pm

Post count: 11

#25608

Hello again Dr. Corenman I thought I would add one of the many MRI static images that I was provided for help if needed.

appleannie
Participant

July 21, 2017 at 4:02 pm

Post count: 129

#25612

Hello Mpneagle,
Sorry to bother you,but could you please tell me how you put the lmage of your M.R.I. on the forum, because I would like to put my images on the forum so Dr.Corenman can comment on them.Mpneagle any help would be greatly appreciated.

Thank You!!

Mpneagle
Participant

July 21, 2017 at 4:10 pm

Post count: 11

#25613

appleannie wrote:

Hello Mpneagle,
Sorry to bother you,but could you please tell me how you put the lmage of your M.R.I. on the forum, because I would like to put my images on the forum so Dr.Corenman can comment on them.Mpneagle any help would be greatly appreciated.

Thank You!!

Appleannie, no problem I uploaded the image to a hosting service and they provide a sharing link that you can paste in the forum. Be sure to scrub personal info from the image before posting using something like paint.

Try http://www.imgur.com click the green new post at the top.

Hope that helps..

appleannie
Participant

July 21, 2017 at 5:18 pm

Post count: 129

#25614

Hello Mpneagle, Thank You !! I really appreciate the information,but my images are already on my Email address would that make a difference ? I only have a tablet I use don’t have a computer.

Thank You,
Appleannie

Donald Corenman, MD, DC
Moderator

July 22, 2017 at 12:46 pm

Post count: 8660

#25617

OK-I have a number of questions. What was the accident that caused so much cervical spine trauma? This sentence sounds like a high energy impact “Extensive interspinous and paraspinous soft tissue edema is related to
high-grade cervical interspinous and paraspinous ligamentous injury”.

You note weakness of the shoulder with loss of range of motion and atrophy on the left. One of your reports noted nerve damage (“EMG study and its results basically just stated nerve “damage”. of the deltoid, bicep, tricep, infraspinatus”). One of the causes of nerve injury can be damage to the brachial plexus ( a stretch injury). A good neurologist should be able to pick that up with EMG readings and a good physical examination. Problems with shoulder weakness could be from shoulder joint damage and I would hope you have had a shoulder evaluation and a shoulder MRI to look for joint damage.

The nerves that service the weak muscles are C5 and C6. These exit from the left side of C4-5 and C5-6. Your report notes no significant nerve compression in these areas (“C3-4: Mild disk height loss. Uncovertebral osteophytes with moderate leftforaminal narrowing. Broad disk osteophyte complex with borderline, mild
spinal canal narrowing. The AP thecal sac diameter measures 9 mm. C4-5: Moderate disk height loss. 4 mm broad disk osteophyte complex narrowsthe ventral thecal sac and indents the anterior cord surface. There is mild to moderate spinal canal stenosis. AP thecal sac diameter measures 7 mm. Uncovertebral osteophytes cause moderate right and MILD left foraminal narrowing”).

There is not enough information to make an accurate diagnosis. I recommend seeing if your docs could consider a shoulder MRI and thorough evaluation of your shoulder and brachial plexus.

By the way, the MRI shows a central view of the canal, not the foramen but the radiologist did not note left significant foraminal stenosis. You have some mild central stenosis which should not cause the symptoms you display.

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.
Author

Posts

Viewing 6 posts - 1 through 6 (of 17 total)

1 2 3 Next

You must be logged in to reply to this topic.

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel