MRI, CT and XRay results

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Donnakruis
Participant

January 12, 2020 at 9:07 pm

Post count: 4

#31907

Hello,
I have had Two fusions.
ACDF 2011. C7-T1
ACDF 2013, C5-C6

For more then a year I have been experiencing sharp pains in right elbow, right shoulder and right clavicle. Also experiencing balance issues.
I am in a new state since prior surgeries so I have new doctors.
Neurologist ordered Cervical MRI and XRays. Referred to neurosurgeon. First appt was with his PA, who also ordered a CT scan.
Referred me to Pain management and PT. Epidural is scheduled for this Tuesday Jan 14th.
Below are my test results.
Any input would be greatly appreciated

CT Scan:
Anterior subluxation of the inferior most aspect of the plate by approximately 3mm at the level of C7-T1. Otherwise hardware is intact. Anterior fusion construct demonstrates osseous bridging of the vertebral bodies
Adjacent segment degenerative changes at C4-C5

X-RAY:
Minimal lucency surrounding the superior most screw the C5 veteran body.
No evidence of left-sided foraminal stenosis.
There is severe right sided foraminal stenosis at C4-C5. Moderate right foraminal stenosis at C5-C6
Degenerative changes are visualized at C4-C5.

MRI:
Moderate to severe right sided foraminal stenosis at C4-5 which have progressed in comparison to the prior study

In your opinion, will PT help with any of these issues?

Donnakruis
Participant

January 12, 2020 at 9:33 pm

Post count: 4

#31908

Edit: other symptoms include right pinky and ring finger numbness. Right arm weakness.
In addition to balance issues, both legs feel weak and heavy.
Coughing/sneezing causes extreme clavicle pain. Symptoms seem to be progressing quickly.

Donald Corenman, MD, DC
Moderator

January 15, 2020 at 9:54 am

Post count: 8660

#31918

You have had an ACDF 2011 of C7-T1 and an ACDF in 2013 of C5-C6. This means that the C6-7 level is sandwiched between two fusions which can cause some increased stress of this level.

The CT report is curious. “Anterior subluxation of the inferior most aspect of the plate by approximately 3mm at the level of C7-T1. Otherwise hardware is intact. Anterior fusion construct demonstrates osseous bridging of the vertebral bodies Adjacent segment degenerative changes at C4-C5”.

There is no mention of the fusion at C5-6, no comment of the health of C6-7, a cryptic comment about the inferior plate and no mention of foraminal stenosis at any level where the X-rays have a notation about foraminal stenosis (“There is severe right sided foraminal stenosis at C4-C5. Moderate right foraminal stenosis at C5-C6”). There is much confusion here.

Do you have an 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.

Donnakruis
Participant

January 15, 2020 at 3:12 pm

Post count: 4

#31920

Dr Corenman,

I was able to pull up more details from my reports
Thank you so much for your time.

CT C Spine w/o contrast:

Acdf changes visualized between C5 and T1. Anterior subluxation of inferior most aspect of the plate by approximately 3mm, anterior to the C7 and T1 vertebral bodies.

There is osseous bridging across the anterior portion of the fusion construct.

There is no evidence of fracture, there is straightening of the usual lordosis with reversal of usual cervical lordosis between C2 and C4.

Crainocervical junction is intact.
Visualized intracranial structures are unremarkable.
Lung apices are clear

C2-3 unremarkable
C3-4 Unremarkable
C4-5 Loss of disc height. Central disc osteophyte with mild canal stenosis. Left foramen patent. Right uncovertebral hypertrophy with moderate to severe right foraminal stenosis.
C5-6 No evidence of canal stenosis. Right uncovertebral hypertrophy with moderate to severe right forminal stenosis. Left foramen patent.
C6-7 no evidence of canal stenosis. Right neural foramen patent. Left neural foramen patent.
C7-T1. No evidence of canal or foraminal stenosis.
Acdf between C5 and C7 as above.
Ajacement segment degenerative changes at C4-5

MRI C Spine w/o contrast
Redemonstration of Acdf between C5 and T1
C1 dens interval is maintained
C2-3 unremarkable
C3-4 unremarkable
C4-5 broad central protrusion resulting in mild ventral dual compression and canal stenosis. Right uncovertebral hypertrophy contributes to severe right foraminal stenosis. This has progressed slightly to the prior study. Foramen patent. Facet joints unremarkable.
C5-6 no evidence of canal or left foraminal stenosis. Small right foraminal disc osteophyte with mild right foraminal stenosis.
C6-7 no evidence of canal or foraminal stenosis
C7-T-1 no evidence of canal or foraminal stenosis.

MRI T-spine:

Limited visualization of anterior cervical discectomy fusion at the mid to lower cervical spine.
C5-T1 the alignment, bone marrow signal and vertebral body heights are normal. There is no bone marrow edema or bone marrow replacement identified.
No cord edema identified. Multilevel facet arthropathy present with mild to moderate bilateral neural foraminal narrowing from T2-T3 through T4-5. There is a small central disc protrusion T8-T9 with mild ventral impression on the subarachnoid space. No cord enhancement noted.

Donald Corenman, MD, DC
Moderator

January 18, 2020 at 1:35 pm

Post count: 8660

#31936

You did have a fusion between C5 and T1 (three levels). “Acdf changes visualized between C5 and T1. Anterior subluxation of inferior most aspect of the plate by approximately 3mm, anterior to the C7 and T1 vertebral bodies”. It sounds like the fusion plate is 3mm “proud” from the anterior bony surface of the T1 vertebral body. This can occur from the initial implantation during surgery where the plate is left “proud” or if there is a subsequent lack of fusion and then the plate displaces.

There is discrepancy between the statement “Acdf changes visualized between C5 and T1” and the last statement “Acdf between C5 and C7 as above”. This of course makes no sense unless it is a missed dictation.

It sounds like you have breakdown at C4-5 with severe foraminal stenosis compressing the C5 nerve root (“C4-5…Right uncovertebral hypertrophy contributes to severe right foraminal stenosis”). See this and look at symptoms from the C5 nerve root to see if it fits your symptoms. https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/

There is no mention of solid fusion at C5-T1 (or not).

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.

Donnakruis
Participant

January 19, 2020 at 7:29 am

Post count: 4

#31939

Thank you so much for your response.
I read the link you provided and do indeed have many if not all of the symptoms.

In your opinion,
Would this need to be fixed surgically?
Epidural at C4-5 last week has done little to ease my discomfort as has Physical therapy but I’ve only had 5 Physical therapy sessions thus far.
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Donald Corenman, MD, DC

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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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