Myelogram vs. MRI post-ACDF (with plate)

Tagged: CT scan vs. MRI

Viewing 5 posts - 1 through 5 (of 5 total)

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drdave35
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September 13, 2012 at 12:49 pm

Post count: 5

#6940

Dear Dr. Corenman,

Thank you very much for your kind and wise advice regarding my previous surgeon having discharged me from care at 8 weeks post C5-6, C6-7 ACDF with allograft and plating.

It is worthwhile to note that I have been previously diagnosed with a chronic B-12 deficiency (treated with cyanocobalamin injections every month) and a vitamin D insufficiency (D level of “14” on pre-op lab results, for which I now take 5000 I.U. of D-3 daily). This is apparently due to an absorption problem caused by years of using proton pump inhibitors for sever GERD. Could be a factor in some of the neurological symptoms…I have a first neurology appointment coming-up in a few weeks, along with EMG/NCV’s scheduled for both upper and lower extremities.

I was lucky enough to have been accepted for care by another orthopedic spine surgeon last week.

He reviewed all of my findings, took plain x-rays, and my post-op diagnosis remains as Cervical foraminal stenosis, cervical myelopathy (based on clinical examination, etc.)

The physician recommended an immediate CT/Myelogram, and stated there was posterior lipping and possible spondylolisthesis of C6-7. He could not tell from the plain films if fusion had begun (11 weeks post-op).

When I mentioned the myelogram order to my internist, he told me that he thinks it is contra-indicated in my case, due to having had two previous lumbar surgeries (he felt the lumbar puncture would not seal, due to scarring of the dura), and that since I already have a diagnosis of myelopathy and multiple nerve root compression (symptoms have not resolved at all post-ACDF), that the myelogram dye may well leave me much worse-off than I am at present.

Aside from deep “bone-pain” type headaches every day which seem to be associated with neck position (replicable by tilting my head left or right, or turning my head to the right), I persist with: bilateral arm pain, bilateral arm numbness, rather severe muscle spasms in neck, shoulders, mid-back between shoulder blades, along with leg and arm spasticities (spontaneous painful contractures of toes, feet, fingers, and wrists which are intermittent, but which do release with manual re-positioning back to a neutral position), neck pain, radiating scalp and facial pain.

That said, I am SCARED TO DEATH of undergoing a myelogram.

Between the lumbar puncture, the potential (probable) spinal headaches, blood patches, CSF leaks, being bedridden, possible inflammatory nerve response, etc…I am highly unlikely to undergo the requested procedure…I am barely hanging-on here pain-wise, and I just can’t risk being in more pain or being any more disabled than I currently am.

So, I asked my new orthopedic spine surgeon for an alternative diagnostic (such as MRI). He had his P.A. call me and tell me there is no alternative to the myelogram “because you have had a cervical fusion”.

I understand that the titanium plate can cause artifact on MRI, but isn’t there something else he can order to obtain relatively clear visualization of the bone growth and/or nerve root and spinal cord compression without putting me through a myelogram?

I feel I am one again “stuck” in my treatment, as the doctor will not order a bone growth stimulator, P/T, or any other treatment until I undergo the myelogram, and only the myelogram.

Once again, I am not trying to be a “difficult” patient, but I honestly am not willing to put myself in a position to become (potentially) sick and further disabled from the myelogram.

Your valuable insight would be greatly appreciated, as to any alternative diagnostics you would recommend in this situation.

Thank You,

D.S.

SpinelessWench
Member

September 13, 2012 at 1:40 pm

Post count: 38

#6941

Dear D.S.,

As one cervically-fused patient to another, I too have been put in the position of electing for a myelogram, or “nothing”… I’m fused with dynamic stabilization instrumentation from C2 to T2, as well as L3 to S1… Just a few weeks ago, my orthopedic surgeon ordered a standard MRI of my lumbar spine, with gadolinium enhancement midway through via intravenous injection. The radiologist did note in his report a, “significant amount of artifact” obscuring any assessment of L4 down… I’m wondering if a myelogram would’ve provided better clarity in identifying stenosis at those levels. Given the artifact in my spine, I’m also wondering why my orthopedist didn’t elect for the myelogram to begin with.

Hopefully, Dr. Corenman can provide some insight… Good luck to you.

S.W., NC

Donald Corenman, MD, DC
Moderator

September 17, 2012 at 1:02 am

Post count: 8660

#6961

A myelogram is not the miserable test that you generally think of. I do use these tests when necessary and most patients do not have significant after-effects.

Part of the successful myelogram is the skill of the radiologist who performs the injection. If you have a skilled, meticulous radiologist with lots of experience, the injection can go very well with very little risk of dural leak. Prior lower back surgery does not preclude a myelogram as long as the L2-L3 level has had no prior surgery.

If you really are against the myelogram, you could first have an MRI of the cervical spine with an experienced radiology technician on a very good MRI machine. I typically will get an MRI as the first test when I work up a patient with prior surgery and it is unusual that these images can’t be interpreted.

If the images are good (the canal can be seen), then a plain CT scan by itself can be used to determine the status of the fusion and any bone in the canal. If the images obscure the canal, then a CT myelogram is necessary.

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.

wgreenlee
Participant

June 16, 2016 at 7:51 pm

Post count: 53

#22402

What dos a myelogram indicate that a MRI wouldn’t?

Donald Corenman, MD, DC
Moderator

June 16, 2016 at 8:15 pm

Post count: 8660

#22404

Generally, the MRI has more information than the myelogram and I am assuming that the myelogram is being performed with a CT scan. The only questions that the CT scan can answer are fusion status and if the MRI is obscured by metal artifact from prior instrument implantation, the MRI will reveal information about the canal that generally won’t be obscured.

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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