Scared about MRI results

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ChelB
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February 10, 2013 at 1:49 am

Post count: 8

#7955

Dr. Corenman,

I had an MRI 2 weeks ago with the following results:

The craniocervical junction is unremarkable. No significant disc herniation seen at the c2-3 and c3-4 levels. At the c4-5 level, there is a large broad based central and right paracentral disc herniation noted attentuating the ventral thecal space and impinging on the exiting nerve root and causing some narrowing of intervertebral foramina on the right at this level.

At the c5-6 level there is a very large broad based herniation extending posteriorly and causing compression of the cord with the AP diameter of the spinal canal reduced to approximately 5 to 6 mm at this level, There is some increased signal in the cord suggestive of myelomalacia.

At the c6-7 lever, there is a moderately large central and right paracentral disc herniation also noted attentuating the ventral thecal space and abutting onto the ventral aspect of the cord. The cord is tilted slightly to the left.

The neurosurgeon that I saw recommended 6 weeks of physical therapy and traction. I just had an EMG test done this week and the neurologist thinks that herniations as large as mine will not resolve without surgery. She told me a fall or accident could be very bad. Needless to say, I am terrified. Also, my blood pressure is through the roof – 158/80 the last time it was checked. I have asked my primary to send my information to a different doctor for a second opinion. Do you think it will take long to get in to the second doctor? Should I be scared? I have 2 young children. I want to be fully active in their lives.

Thanks,
Michele

Donald Corenman, MD, DC
Moderator

February 10, 2013 at 5:27 am

Post count: 8660

#7958

You have significant narrowing of the spinal canal with some evidence of cord injury from this compression, especially at C5-6. The neurologist is correct in thinking that a bad fall could cause you further injury to the cord. In my opinion, cord signal change necessitates consideration of surgery to prevent further cord injury.

Blood pressure can increase from genetics, pain or stress. This increased pressure should be controlled with medications. Get into your primary care doctor to get this under control.

You should be OK until you see the second surgeon as long as you do not place your neck at risk (skiing, mtn biking, ect…) or take a blow to the head.

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.

ChelB
Member

February 10, 2013 at 9:42 am

Post count: 8

#7959

Thanks so much for your reply. I have an appointment this Monday with my primary and I will talk to him about my blood pressure. I forgot to give details about myself earlier. I am 38, mother of a 7 year old and 4 year old, work full time at a desk and up until now, very active. I ran 3 half marathons last year, a 15K, and plenty of 10 & 5 K’s. I also was working out with kettlebells and had worked up to a 25 lb bell. If I need surgery, will I ever be able to go back to the level of running I was at? I am currently registered for a half in June and a 15K in July. I probably won’t be doing those, will I? I can live with that if I know in the future I can return to it. Will I be able to return to kettlebells and incorporate some strength training back in? I miss both so much.

Donald Corenman, MD, DC
Moderator

February 11, 2013 at 12:00 am

Post count: 8660

#7966

If you had surgery in the near future, you should be able to run the both races that you mention in my opinion. You also should be able to return to gym workouts without restriction.

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.

ChelB
Member

February 24, 2013 at 8:19 am

Post count: 8

#8073

Dr. Corenman,

I saw my 2nd neurosurgeon this week. He said the only way for this to get resolved is with surgery. He also told me I shouldn’t run again…that it is too much on the spine. He told me I should find exercise that has less impact than running. Part of me understands this and part of me doesn’t want to believe this. If I were to pick up running again after surgery (which he said he would do ACDF on c4-7), would I really be putting myself at risk to herniate discs above and below the fusion? Obviously, this is not what I want to do. In the big scheme of life, I have two kids that I want to be healthy for but I am having a hard time with the thought of never running again. I enjoy it with every fiber of my being. If you could shed some light I would be so grateful.

Thanks.

Donald Corenman, MD, DC
Moderator

February 25, 2013 at 9:59 am

Post count: 8660

#8081

If you had a surgery (ACDF) at C4-7, I would agree that running should be curtailed. Biking, swimming, gym workouts and skiing would be OK in my book. You might find that cycling will fill that need. You would be amazed what a hard 40 mile climbing ride would do for you.

You could continue running but there is a toll to be taken on the discs above and below a three level fusion. Don’t forget that your genetics predisposes you to degenerative disc changes.

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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