comparing MRI results to previous MRI results ,yet minimally progressed

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glassman19
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September 4, 2020 at 7:35 pm

Post count: 1

#32959

MRI Lumbar Spine with and without Contrast Material, 06/05/2017

INDICATION: Chronic low back pain in patient with history of spinal fusion surgery.

COMPARISON: None.

TECHNIQUE: Sagittal T1, T2, and T1 post-contrast with fat saturation. Axial T1, T2, fat sat and
T1 post-contrast with fat sat.

FINDINGS: The alignment of the lumbar spine is notable for 5 mm anterolisthesis of L5 on S1 and 5
mm retrolisthesis of L3 on L4. There is normal alignment of the remaining levels. Vertebral body
height is maintained. Marrow signal is notable for edema which appear to be related to endplate
disc degenerative changes at the inferior endplate of T12 and the superior endplate of L3.

At T12-L1, there is a broad disc bulge with a small focal central protrusion, but no significant
central canal or neural foraminal narrowing.

At T12-L2, there is minimal disc bulge without significant central canal or neural foraminal
narrowing. There is some loss of normal disc water content and associated endplate disc
degenerative changes, especially anteriorly at the T12 inferior endplate.

At L1-2, the disc appears normal with no central canal or neural foraminal narrowing.

At L2-3, the disc is also unremarkable with no central canal or neural foraminal narrowing.

At L3-L4, adjacent to the fused L4-4/S1 segment, there is 5 mm degenerative retrolisthesis of L3
on L4, combining with facet arthropathy, to produce moderate to severe bottle lateral or foraminal
narrowing, and mild central stenosis. There is endplate edema as well as some edema associated
with the left-sided L3-4 facet.

The L4-5 and L5-S1 segments show a solid bony fusion with no hardware present at this time. There
is no central canal or neural foraminal stenosis at these levels. There is a 5 mm anterolisthesis
of L5 on S1, but this is in a solidly fused position and is not associated with significant
narrowing or impingement.

IMPRESSION: Chronic L4-5 and L5-S1 fusion. L3-4 disc disease likely related to adjacent segment
physiology because of the fused lower lumbar region putting greater stress on this level. There is
facet arthropathy, endplate disc degenerative change, and 5 mm degenerative retrolisthesis of L3 on
L4. There is associated moderate to severe bilateral neural foraminal narrowing.

At the L3-4 level, the moderately severe neural foraminal stenosis does appear to be associated
with impingement of the bilateral exiting nerve roots, which are directly effaced against the
degenerative facets without clear surrounding fat.
MR Lumbar Spine wo Contrast, 2/22/2019 15:15 PST

COMPARISONS: 01/08/2018

TECHNIQUE: Multisequence multiplanar imaging without intravenous contrast, by standard department
protocol.

FINDINGS:
Visualized kidneys: Normal

Curvature: Normal
Spondylolisthesis: L5-S1 anterolisthesis is unchanged as is L3-4 retrolisthesis.
Marrow: No marrow edema. Degenerative endplate changes at multiple levels most prominently at L3-4
with a large Schmorl’s nodes involving the inferior endplate of L3.
Conus: Normal

Near osseous fusion across the L4-5 and L5-S1 disc spaces is unchanged. Posterior decompression at
these levels is again seen.

T11-12 and T12 S1 disc bulges are partially profiled.

L1/2: Normal
L2/3: Mild facet hypertrophy without central canal or neuroforaminal stenosis.
L3/4: Disc osteophyte complex with facet hypertrophy and ligamentum flavum thickening result in
moderate central canal and likely severe bilateral neuroforaminal stenosis.
L4/5: Central canal is widely patent. No neuroforaminal stenosis is seen.
L5/S1: Central canal is widely patent. No neuroforaminal stenosis is seen.

IMPRESSION:
Multilevel degenerative changes in the lumbar spine, most prominent at L3-4 and minimally changed
from the prior MRI.
MR Lumbar Spine wo Contrast, 8/10/2020 14:32 PDT

COMPARISONS: MRI lumbar spine, 02/22/2019

FINDINGS:
Visualized kidneys: Normal
Curvature: Normal
Spondylolisthesis: 6 mm of retrolisthesis of L3 on L4 and 8 mm of anterolisthesis of L5 on S1,
unchanged.

Marrow: Multilevel degenerative endplate changes.
Conus: Normal, terminating at the lower T12 vertebral body level.
Visualized pelvis: Postsurgical change at the left iliac bone from prior bone graft harvest,
unchanged.

T11/12: Unchanged small disc bulge causing mild spinal canal stenosis.
T12/L1: Tiny disc bulge without spinal canal or neuroforaminal stenosis.
L1/2: Normal
L2/3: Minimal facet joint hypertrophy but no spinal canal or neuroforaminal stenosis, unchanged.

L3/4: Grade 1 listhesis with mild to moderate bilateral facet joint and ligamentum flavum
hypertrophy causing mild to moderate spinal canal stenosis and severe bilateral neuroforaminal
stenosis, unchanged.

L4/5: Postsurgical change of posterior decompression with disc fusion with mature osseous fusion
across this disc space level. No spinal canal or neuroforaminal stenosis.

L5/S1: Postsurgical change with anterior osseous fusion across the disc space level. Grade 1
listhesis is unchanged. No spinal canal or neuroforaminal stenosis.

IMPRESSION:
Unchanged exam with postsurgical changes L4 on L5 and multilevel degenerative changes. Up to mild
to moderate spinal canal stenosis at L3-4 with severe bilateral neuroforaminal stenosis, similar to
the prior exam.
Question is .How can these results be compared to each other yet none of them even resemble the other in how they are worded. Which makes it more than difficult to get any 2 neurosurgeon’s to give comparable recommendations .First one said nothing he could do because of potentially doing more harm. Second said he recommends surgery if other options failed IE , PT, acupuncture ,aqua therapy, prescription meds. Third one said ,not a problem recommended surgery as soon as he could get approved. decompression surgery.6-8 week recovery with 50-75 percent improvement.
IN 2000 I had a 2 level fusion l4-5-s1 which resulted in the anterolisthesis of l5 on s1 which to me is not how that was supposed to be right? If it was then why wouldn’t L4 be on L5 also. How can i get reports that are accurate and consistent ?

Donald Corenman, MD, DC
Moderator

September 5, 2020 at 10:14 am

Post count: 8660

#32962

These MRI findings have to be compared to your current symptoms and impairment. See this section and describe your symptoms: https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-lower-back-and-leg-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.
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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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