Abnormal signal in C-spine

Tagged: Cord signal changes

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micheledom
Participant

November 16, 2016 at 12:49 am

Post count: 9

#23449

Hi Dr. Coreman,

I’m giving you an update….I am now in Colorado with actual healthcare. Anyway,my MRI one year later now shows abnormal signal from C2-C7!

Donald Corenman, MD, DC
Moderator

November 17, 2016 at 6:09 am

Post count: 8660

#23454

You do need a workup to determine why you have this abnormal signal. I would recommend a neurologist to start.

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.

micheledom
Participant

April 15, 2017 at 8:24 pm

Post count: 9

#24661

Hi there Dr. Corenman,

Well, you asked for me to keep you informed and here it is: I am now in Colorado specifically to get diagnosed. My neurological symptoms have increased tremendously such as falling, tripping, coordination issues, balance issues, and sometimes I’ll take a step and my leg simply is not there. I have speech problems, slurred speech.
Blurred vision, nausea, vomiting, short term memory problems that not only have me very concerned, but my family.
I forget conversations I just had, I not only forget what I was saying, but forget the subject we were even talking about. I have dizziness and lightheadedness, I forget my words, and sometimes I simply give up on trying to speak completely. I also have horrible mood swings out of frustration and my patience I once had is simply gone. I have had weight gain, but I don’t have an appetite and do not eat much. My weight is disproportianate. It is mostly centered in the middle.

A new MRI of my cervical spine now shows

Alignment: Straightening of the cervical spine. Anterior cervical fusion and discectomy at C4-C5. Vertebral body height and alignment are preserved.

Marrow signal: No marrow signal abnormality

Spinal cord: Small focus of increased cord signal in the posterior central aspect of the cord at C2-C3. Similar small focus of central increased linear signal in the posterior cervical cord extending from the level of C3-C4 to C7.

Intervertebral discs: Disc desiccation throughout the cervical spine. Disc heights are preserved.

Post-contrast images: No abnormal enhancement
Findings by level as follows:

C2-C3: No spinal stenosis or foraminal impingement.
C3-C4: No spinal stenosis or foraminal impingment. Mild right uncovertebral hypertrophy.
C4-C5: Anterior fusion. No canal stenosis. Left uncovertebral and facet hypertrophy with moderate left foraminal stenosis.
C5-C6: Disc Bulge. No spinal canal stenosis. Moderate to severe left facet hypertrophy with left uncovertebral hypertrophy resulting in moderate left foraminal stenosis.
C6-C7: Mild disc bulge. No spinal canal stenosis. Neuroforamina are patent.
C7-T1: No spinal stenosis or foraminal impingement.

IMPRESSION:

1. Small linear abnormal cord signal in the posterior aspect of the cord at C2-C3 and from C3-C4 to C7. Morphology is most suggestive of minimal single hydromyelia. (OF NOTE: The radiologist did not know about the previous MRI the year prior that showed abnormal signal).
2. No additional abnormal cord signal. No abnormal enhancement.
3 Multilevel degenerative changes as above. No significant spinal canal stenosis. moderate left foraminal stenosis at C4-C5 and C5-C6.
4. C4-C5 ACDF

Soooo…..hmmmm…..what do you think? Is it a lesion that tripled in size? Or something completely different?

I should also mention that in October I was diagnosed with aseptic meningitis for the fifth time and CSF was negative for HSV1 & 2 virus…also, the opening LP pressure was 28 cm/H2O and I had another LP in February due to meningitis symptoms and my head felt like it was going to explode. I was negative for meningitis, but the opening LP pressure was 41 cm/H2O.

An MRI of my brain’s dated October when I was dx with meningitis. IMPRESSION: A few scattered nonspecific deep and periventricular white matter small signal abnormalities. Diagnostic considerations include demyelinating process, sequela postinfections or inflammatory process, or early chronic small vessel ischemic change.

I appreciate any and all information you’re able to give me. I have learned that I need to be my own advocate and seek advice where I can get it.

Also of note, my neurologist here in Arvada thought I could have NMO and referred me onto University of Colorado Health MS/Neuroimmunology Dept and I had my first visit on April 13th and they are doing some more tests and doing some information gathering. He did say the lesion is not consistent with NMO because it is thin and he said NMO lesions are thicker. He has not looked at my brain MRI yet and is anxious to look at that due to the report.

I was just really wanting your thoughts on this as well.

Thank you so much and I hope you and your family have a blessed Easter.

Michele

micheledom
Participant

April 15, 2017 at 8:31 pm

Post count: 9

#24662

I am so sorry to have bothered you with my last question. I just saw that I’ve already told you about the abnormal signal on the new MRI. I have no memory of that at all.

Donald Corenman, MD, DC
Moderator

April 16, 2017 at 10:38 am

Post count: 8660

#24663

You have multiple issues going on. The imbalance and incoordination are explained by the cervical cord disorder (“Small focus of increased cord signal in the posterior central aspect of the cord at C2-C3. Similar small focus of central increased linear signal in the posterior cervical cord extending from the level of C3-C4 to C7”).

However, your memory problems would not be explained by cervical involvement only. The brain MRI findings are general and non-specific. You could have a process like multiple sclerosis (MS) but you do not have a “typical” case of MS as far as I can tell. My understanding is that if you have NMO, your vision would be failing, not “blurry”.

I am unclear what disorder you have but the process could be autoimmune (MS like), infectious (anything from viral to Lyme disease to even syphillus) to metabolic (vitamin deficiency). Please keep us informed of your diagnostic progress.

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.

micheledom
Participant

April 11, 2018 at 6:56 pm

Post count: 9

#28063

Just a quick update LOL…my neurologist at CU feels the lesions in my brain are due to microvascular disease. They are following me symptom-wise every 3 months with an annual MRI of my brain, which will be August. They don’t seem to feel I need to be followed with a C spine MRI annually though, which does not make sense to me when there was so many changes in just a year…my PCP is sending me onto neurosurgery though so I’ll see what that dr says…

Thank you so much for all you do on here for people!
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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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