Cervical MRI reading

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riclach
Participant

October 19, 2014 at 7:35 am

Post count: 20

#11557

Dear Dr. Corenman,

thank you so much for giving your time to this wonderful site!!!
I would like to ask your opinion of my cervical MRI which was done last week.
I have uploaded the images on a Youtube slideshow but I don’t think I’m allowed to post the link here. So I sent it to you via the contact form.

A little background –

I’m a 48 year old female.
Diagnosed with Ankylosing Spondylitis in 2010 but I’ve had pain since age 19. My spine is not fused. I have sacroiliac inflammation and enthesitis in many places of my body.
I’ve had neck pain since 10 years. I also suffer from migraines.
Five years ago, a cervical MRI showed bone spurs but no stenosis.
For the past months, I’ve been having tingling and numbness down my right arm into my hand and fingers as well as electrical shooting pains down my right shoulder blade. I also have Carpal Tunnel.
I’m right-handed but I feel I have more strength with my left side.

Two weeks ago I had a Nerve Conduction Study and EMG that resulted in mild right median nerve entrapment across wrist/carpal tunnel and mild right C7 radiculopathy. Needle EMG demonstrated chronic denervation along with ongoing reinnervation. Physical examination demonstrated hyporeflexia of the right biceps/brachioradialis muscle stretch reflexes.

The Cervical MRI I just had done reported the following –

C1-C2 Mild degenerative changes present.

C2-C3 No significant central canal or neural foramina stenosis

C3-C4 Right greater than left uncovertebral hypertrophy resulting in mild right neural foramina stenosis.

C4-C5 Diffuse disk bulge and bilateral uncovertebral hypertrophy. These result in mild bilateral neural foraminal stenosis. The ventral thecal sac is effaced and there is minimal cord contact. No cord edema or myelomalacia. No cord deformity.

C5-C6 Bilateral uncovertebral hypertrophy in addition to a diffuse disk bulge. There is moderate bilateral neural foraminal stenosis and effacement of the ventral thecal sac with probable cord contact. No evidence of abnormal cord signal. No cord deformity.

C6-C7 Bilateral uncovertebral hypertrophy resulting in moderate left and mild right neural foramina stenosis. There is minimal effacement of the ventral theca sac by a diffuse disk bulge without cord contact.

C7-T1 No significant central canal or neural foramina stenosis.

Impression: 1. Multilevel degenerative disk disease with disk bulges resulting in cord contact at C4-C5 and C5-C6. No significant cord deformity or abnormal cord signal intensity. 2. Low-to-intermediate grade multilevel neural foraminal stenoses are present bilaterally.

Does cord contact mean some cord compression?
Do I have stenoses with myelopathy?
Finally, is this a progressive situation where, eventually, surgery will be needed?

I will be doing an epidural injection and physical therapy. My doctor also gave me a referral to go talk to a spine neurosurgeon.

THANK YOU!!!!!!

Claudia

Donald Corenman, MD, DC
Moderator

October 20, 2014 at 12:17 am

Post count: 8660

#11558

Ankylosing spondylitis (AS) can cause spine pain but no arm or leg pain so we can rule that out as a cause of your “tingling and numbness down my right arm into my hand and fingers as well as electrical shooting pains down my right shoulder blade”. The cervical spine can degenerate regardless of the presence of AS and that appears to be the source of your symptoms.

Carpel tunnel syndrome (CTS) can cause tingling and numbness (paresthesias) from the wrist into the hand and even up the arm somewhat. CTS does not cause shoulder symptoms. See the section on CTS here on the website to understand this disorder more completely.

The C6 nerve exits between C5-6 and C7 exits between C6 and 7. Check the section “symptoms of cervical nerve injuries” to understand what type of symptoms each nerve can generate.

“Moderate bilateral neural foraminal stenosis” at C5-6 and C6-7 more likely can be the source of your symptoms. An increase of the paresthesias in your arm with neck extension would be the typical findings with the origin from your neck.

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.

riclach
Participant

October 20, 2014 at 1:46 am

Post count: 20

#11561

Thank you so much for your reply, Dr. Corenman.

Does cervical cord contact usually lead to cord compression?

Thank you!

Claudia

Donald Corenman, MD, DC
Moderator

October 20, 2014 at 7:34 pm

Post count: 8660

#11564

Cord contact does not always lead to cord compression. The entire canal normally has to be narrowed for cord compression.

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.

mial33
Member

February 9, 2015 at 11:55 am

Post count: 1

#12166

Dr. Corenman,

I don’t totally know what all this means but is there a chance that the issues found in this exam could cause migraines, lightheaded and numbness in just one part of a body? By that I mean just going numb from the wrist to the finger tips! If you could please explain this to me!
Exam: CT cervical spine without contrast.

Technique: Computed tomographic imaging of the cervical spine was performed without contrast.

Findings:

There is no evidence of acute fracture. There is straightening of the cervical lordotic curvature which may be positional or due to muscle spasm. The vertebral bodies are normally aligned. No facet joint dislocation is evident. Small endplate osteophytes
are seen at several levels are seen at the C6-C7 level. Intervertebral disk spaces and vertebral body heights are grossly preserved. Cervical soft tissues show no abnormality. Visualized lung fields are clear other than probable minimal apical scarring.

Impression:

No cervical spine fracture or malalignment.

Thank you for your time!

Mia

Donald Corenman, MD, DC
Moderator

February 10, 2015 at 2:38 am

Post count: 8660

#12177

The CT scan is not the best study to look for migrane or lightheadedness origins but if there are degenerative facets in the upper cervical spine, these might show up on this scan. There is no report of these findings.

“Going numb from the wrist to the finger tips” sounds more like carpel tunnel syndrome (see website) than cervical origin.

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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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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