Thoracic and cervical MRI Huge white blob??

Tagged: Continuing problems after 3 level pcdf & acdf

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lila
Participant

December 17, 2017 at 7:13 pm

Post count: 9

#27090

Hello Dr Corenman,
I have reached out to you in the past and you gave me really great information. I hope to be able to come meet you one day. Your advice is very helpful.
Do you accept NYS workers comp from self insured employers??

I have had a 3 level c3-7 acdf and 3 level c3-7 PCDF, as well as a SLAP repair to my right shoulder.
The pain and discomfort continues and now they are suggesting a spinal cord implant. I requested they finally get an MRI of my Thoracic area because it’s always bothersome and I have had persistent pain under my shoulder blade since the start of my shoulder injury.
I am wondering if you could give me opinion of MRI imaging? I can share individual shots Or can I send you a copy to review?

I was diagnosed with cervical myelopathy in 2013. I had a strange presentation of symptoms at first and was tested for ALS and MS etc.
I had presented with weakness in my right arm and hand, muscle fasciculations widespread and problems with gait, spasticity, hyperreflexia, temperature control issues and my arms and wrists would bend up towards my chest when I was resting. (Like a weird form of posturing?)
The MRI of my cervical spine was done immediately, but misread for the first 6 months. Drs were thinking it was my previous shoulder injury and then possibly disease as my symptoms progressed.
Eventually another Dr discovered I had 2 ruptured discs that deformed my cord, so they scheduled my first surgery urgently.
I have never felt relief and the pain in my neck and upper back continues. The neck pain has gotten worse not better and There’s a burning across my thoracic and under my shoulder blade and constant tightness and fatigue in my muscles.

I of course am not asking for a diagnosis. I’m just curious about what you see in my latest cervical and thoracic images and what would do as the next step???
(and if you can tell me what that huge, long white blob, to the right side of my spine, COULD be in those MRI image.
Is it part of the circulatory system or denervated or fatty muscle?)

It’s the weekend and I haven’t received the written report yet not that I trust the radiologists at this point… ;)

It’s been almost 5 years since my iniury and I still feel like the Drs are not sure what’s wrong with me, exactly… and we are now discussing spinal cord stimulator.
But what if I have a braxial plexus injury or something they don’t see??
Could it be thoracic nerve entrapment or edema in the muscles??
I’m really at a loss and so tired of feeling this way.
For the record… I have been prescribed medical marijuana for the pain and spasticity and use baclofen when my spasms are bad.
I have a scripts for other stronger pharmaceutical meds, but prefer not to take them.
I have found much more relief from the pain, muscle fasciculations and spasms, using MMJ oil and tincture… than any pharmaceutical.

Thanks so much for any thoughts you may have. Happy holidays to you and yours.
Lila Worley

lila
Participant

December 17, 2017 at 7:20 pm

Post count: 9

#27091

lila
Participant

December 17, 2017 at 7:23 pm

Post count: 9

#27092

https://drive.google.com/file/d/1Hzb6mlhWuaJlgeWGpS5YLrBZtbcEvZ-gfg/view?usp=drivesdk

Donald Corenman, MD, DC
Moderator

December 23, 2017 at 4:35 pm

Post count: 8660

#27127

You actually had a 4 level ACDF and posterior fusion (from C3-C7). It sounds like you had cervical central canal stenosis with myelopathy. I am unclear why you did not have a diagnosis from that first MRI as it should have been obvious on the images. See https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/

Continued symptoms could be from cord injury as decompression surgery only takes pressure off the cord. The cord has to heal after decompression and that is Mother Nature. Continued symptoms could also originate from a pseudoarthrosis (lack of fusion) as a 4 level fusion has a much higher rate of pseudoarthrosis. Also, breakdown above or below has to be considered. New X-rays and possible CT scan could be warranted.

I can’t open images from a file on this website due to viruses.

You would have to call the office to find out if the Clinic takes NYC work comp.

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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