Help Understanding MRI

Tagged: MRI Assistance

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thwebb80
Participant

December 18, 2019 at 2:44 pm

Post count: 3

#31724

I am in my late 30s and have dealt for ten years with intermittent mild/moderate mid-back pain. It has never fully resolved but has generally been effectively managed through exercise, stretching, massage, warmth, and pain killers.

Every medical professional I’ve seen about it until recently has said an MRI is unnecessary given that I don’t have any symptoms beyond mild/moderate pain. In the past two months, however, I’ve been having intermittent numbness in my right foot. No weakness–I can still go to the gym, run, and ride a bike–but it at times feels somewhat numb. As a result, my GP referred for an MRI.

The MRI findings, below, showed the what I now know is relatively unusual finding of two herniated discs in my thoracic spine, accompanied by diffuse DDD:

FINDINGS: The bony alignment and marrow signal are normal. Loss of disc height and signal at all levels. Endplate Schmorl’s nodes herniation at multiple levels. The lesion in T11 vertebral body decreased on T1 with minimal central areas of increased signal intensity. This has vascular flow-voids of T2 and STIR-weighted images likely atypical hemangioma. Scattered typical hemangiomas present. The spinal cord is normal in size, shape and signal intensity.

At the T5-T6 level, central to right paracentral disc bulge. Neuroforamina patent. Spinal canal is unremarkable.

At the T6-T7 level, minimal diffuse disc bulge. Neuroforamina patent. Spinal canal is unremarkable.

At the T8-T9 level, central disc herniation. The herniated material measures a 1.2 cm superior-inferior by 1.2 cm transverse by 0.6 cm AP. The herniation effaces the anterior CSF and impinges on and flattens anterior aspect spinal cord at this level. Neuroforamina patent.

At the T9-T10 level, minimal diffuse disc bulge. Neuroforamina patent. Spinal canal is unremarkable.

At the T11-T12 level, left paracentral disc herniation. The herniated material measures 1.4 cm inferior superior-inferior by 1 cm transverse by 0.4 cm AP This effaces the anterior CSF and impinges on the spinal cord. There is flattening of the left anterolateral aspect spinal cord at this level. Neuroforamina patent.

At the T12-L1 level, small left paracentral disc protrusion.

QUESTIONS:

What is “flattening” and “impingement” of the spinal canal? Is this the same as spinal cord compression, or a different finding? Is the the likely cause of my numbness?

Does a left paracentral herniation effect the left side of the body, and therefore would not be the cause of right foot numbness?

Given my the findings and current symptoms, would surgery be an option, or is conservative treatment still recommended? I understand thoracic surgery is somewhat more complex that lumbar.

thwebb80
Participant

December 19, 2019 at 7:56 am

Post count: 3

#31728

For what it’s worth, here is my lower back MRI, which seems less remarkable other than to confirm that I have what you have described in other threads as Crappy Back Disease. Despite all the arthritis I have only mild problems with my lower back–occasional aches and pains, but nothing more.

HISTORY: 37 year old male, script states: chronic back pain. Patient states: back pain for over 10 years with intermittent numbness in right foot.

TECHNIQUE: Using a 1.5 Tesla magnet, multiplanar T1 and T2 weighted images were acquired.

COMPARISON: None.

FINDINGS: For the purposes of this dictation the lowest-most independent vertebra body is labeled as L5. The vertebral body heights are maintained. Disc heights are preserved. Endplate Schmorl’s nodes herniations at L1-2. The bone marrow is of normal signal intensity.

Visualized lower thoracic levels and the conus medullaris: Normal.

L1-L2: Minimal disc bulge. Facets appear unremarkable. Neuroforamina appear patent. Spinal canal appears unremarkable.

L2-L3: No disc bulge or herniation. Facets appear unremarkable. Neuroforamina appear patent. Spinal canal appears unremarkable.

L3-L4: No disc bulge or herniation. Moderate bilateral facet disease. Neuroforamina appear patent. Spinal canal appears unremarkable.

L4-L5: Minimal disc bulge. Moderate bilateral facet disease. Neuroforamina appear patent. Spinal canal appears unremarkable.

L5-S1: Minimal disc bulge. Severe bilateral facet disease. Neuroforamina appear patent.Spinal canal appears unremarkable.

Visualized portion of the sacrum: Normal.

Paravertebral/Prevertebral soft tissues: Normal.

IMPRESSION:
Minimal disc bulges L1-2, L4-5 and L5-S1. There is moderate to severe facet disease L3-4 and L5-S1 as detailed above. No disc herniations. Neuroforamina are patent. No central canal stenosis.

thwebb80
Participant

December 19, 2019 at 8:48 am

Post count: 3

#31729

And finally, the numbness seems to disappear when lying down, be negligible when standing (I use a sit/stand desk), and worsen with sitting.

Donald Corenman, MD, DC
Moderator

December 19, 2019 at 9:07 am

Post count: 8660

#31730

Your MRI impression of our lumbar spine: “Minimal disc bulges L1-2, L4-5 and L5-S1. There is moderate to severe facet disease L3-4 and L5-S1 as detailed above. No disc herniations. Neuroforamina are patent. No central canal stenosis”.

Your MRI summary of your thoracic spine is “At the T8-T9 level, central disc herniation. The herniated material measures a 1.2 cm superior-inferior by 1.2 cm transverse by 0.6 cm AP. The herniation effaces the anterior CSF and impinges on and flattens anterior aspect spinal cord at this level. Neuroforamina patent. and At the T8-T9 level, central disc herniation. The herniated material measures a 1.2 cm superior-inferior by 1.2 cm transverse by 0.6 cm AP. The herniation effaces the anterior CSF and impinges on and flattens anterior aspect spinal cord at this level. Neuroforamina patent”.

Your lower back pain is probably generated by the degenerative discs and especially by the degenerative facet disease. The thoracic herniations could cause local thoracic pain which you do not complain of and can cause spinal cord compression symptoms such as imbalance, bowel and bladder malfunction and lack of coordination in your legs. If you don’t have those symptoms, these herniations can be simply watched.

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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