MRI C2 abnormalities meaning

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momof1
Participant

April 28, 2022 at 12:15 pm

Post count: 4

#35028

Hi,
Quick question on a MRI report it stated:
“There is abnormal developmental safe posterior elements of
the C2 vertebral body with deformity of the lamina of C2 which extends through medially into the
central spinal canal. There is mild impression on the posterolateral aspect of the cervical cord on
the left. This creates a mild left sided stenosis of the spinal canal.”
“Abnormal posterior elements of C2 with mild impression on the posterior left aspect of the cord by
the lamina. No evidence of myelopathy.”

Of course I have no idea what that means. I have had pain/weakness etc neck & left arm for 4 months with 0 improvements with physio/massage/heat/traction .. you name it!
Is it possible this will resolve on its own?
Thanks! Heather

Donald Corenman, MD, DC
Moderator

April 28, 2022 at 3:47 pm

Post count: 8660

#35029

His dictation “abnormal developmental safe posterior elements of the C2 vertebral body with deformity of the lamina of C2 which extends through medially into the central spinal canal. There is mild impression on the posterolateral aspect of the cervical cord on the left. This creates a mild left sided stenosis of the spinal canal” is hard to understand. If we take out the term “safe”, you have an abnormal bony protrusion that projects into the canal at C2 causing minor narrowing of the canal. There is no evidence of cord injury or significant compression.

It would be quite unlikely that this is causing your “pain/weakness etc neck & left arm for 4 months”. There must be more finding from different levels from your MRI report. Please paste them here.

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.

Donald Corenman, MD, DC
Moderator

April 28, 2022 at 3:47 pm

Post count: 8660

#35030

His dictation “abnormal developmental safe posterior elements of the C2 vertebral body with deformity of the lamina of C2 which extends through medially into the central spinal canal. There is mild impression on the posterolateral aspect of the cervical cord on the left. This creates a mild left sided stenosis of the spinal canal” is hard to understand. If we take out the term “safe”, you have an abnormal bony protrusion that projects into the canal at C2 causing minor narrowing of the canal. There is no evidence of cord injury or significant compression.

It would be quite unlikely that this is causing your “pain/weakness etc neck & left arm for 4 months”. There must be more finding from different levels from your MRI report. Please paste them here.

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.

momof1
Participant

September 19, 2022 at 1:04 pm

Post count: 4

#35308

Thank you for your reply.
This is the full report. I have been on 40 mg of Nortriptylene for nerve pain, which helped relieve approx 85% of the pain. However, in the last few days/week I am back to square 1 with pain in L Arm/Shoulder.

TECHNIQUE
Sagittal T2; sagittal T1; axial medic; axial T2 space.
FINDINGS
The cervical vertebral bodies are normal in height. The posterior alignment is maintained. The
intervertebral disc spacing is normal. There is abnormal developmental safe posterior elements of
the C2 vertebral body with deformity of the lamina of C2 which extends through medially into the
central spinal canal. There is mild impression on the posterolateral aspect of the cervical cord on
the left. This creates a mild left sided stenosis of the spinal canal. There is no T2 signal abnormality
within the cord to suggest myelopathic changes. The significance of this finding is uncertain. There
are no right-sided findings to account for the bilateral symptoms.
Cervical cord is otherwise normal in size and shape. There is no T2 signal abnormality within the
cord.
IMPRESSION
Abnormal posterior elements of C2 with mild impression on the posterior left aspect of the cord by
the lamina. No evidence of myelopathy.

Donald Corenman, MD, DC
Moderator

September 20, 2022 at 8:04 am

Post count: 8660

#35311

I’m not clear what has caused the “abnormal developmental safe posterior elements of
the C2 vertebral body with deformity of the lamina of C2 which extends through medially into the
central spinal canal”. Is this a developmental error that is stable and benign or something that is an active process? If it hasn’t changed in size or appearance in years comparing serial MRIs, there is probably no significant worry. I’m not too worried about the “mild impression on the posterolateral aspect of the cervical cord on the left. This creates a mild left sided stenosis of the spinal canal” as the canal at C2 is double the normal size of the spinal cord meaning there is lots of room for the cord.

The symptoms of “nerve pain” could be from something completely different. Can you go over your symptoms using this guide?

https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-neck-shoulder-and-arm-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.

momof1
Participant

September 21, 2022 at 11:37 am

Post count: 4

#35312

Hi Dr Corenman,
This is the first MRI on my neck. Dec 21 I experienced sudden L arm weakness, pain retrieving an item appox 5lb from an overhead position. (Dropping the item) Initial symptoms mimicked a heart attack.. chest pain straight across L chest, numbness down L arm and was a 9.
Since then, I have been doing 2x/wk chiro (but unable to do physical adjustment of spine as everything neck/shoulder/arm is so tight. 1x/biweekly massage therapy.

So, the pain is currently an 8 with movement, I put my L arm in a sling to help relieve some pressure.
Without movement, things feel around a 2. Nortiptylene 40mg was good for a little over a month keeping pain at a 2/3 but increased activity.
Pain centre of neck in back currently at 3. burning/ prickling pain radiates down shoulder blade down the back.
L shoulder currently at 8 with movement with pain near armpit and top of bicep at 9/10 with movement. Pain runs down inside of L arm to inside of elbow as well. Stabbing, sharp pain. 80% shoulder/arm/20% neck.
Same pain in R armpit, bicep but more of a dull ache pain at 2.
L arm if extended (very painful) leaves almost 0 strength in grip/torque. For example, grabbing a coffee at a drive thru causes pain to shoot to 10, and I still dropped the cup.
Mild dizziness last 2 weeks, could be a coincidence with resurgence of symptoms occurring last 2 weeks as well. Sitting to standing position as well as when I turn my head left (shoulder check while driving for example) .. dizziness is not a spinning, more of a floating and happens when I bring my head back to centre.
Currently on a leave from work (merchadiser/sales), unable to do most activities outside of walking. In 10 months I am on my 3rd Flare up and they seem to get worse each time.

Heather
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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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