Desperately need an opinion of my MRI

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brianyzf
Participant

August 15, 2016 at 5:46 pm

Post count: 3

#22785

Hi Dr. Corenman,

I love your website. I’ve already become so much more educated about my condition just from browsing it. Now for my issue. I had an ACDF at C5-C6 back in 2003 and was pain free until around 2009 when the usual pain down my right arm and tingling in both my right and left hands began. These symptoms progressed until about 2 months ago the pain became almost unbearable and my hands were numb and tingling the majority of the time. My neck and shoulders are also extremely stiff and sore which leads to major headaches. Here are the readings of my MRI on 7/5/2106:

Indications: Chronic cervical pain with headache and bilateral upper extremity radiculopathy. Previous fusion at C5-6.

Findings: Intrinsic bony signal reveals no subacute compression fracture pattern. There is no marrow infiltrating process. There is no anterolisthesis or retrolisthesis any level. Susceptibility artifact at C5-6 is relating to the anterior cervical discectomy with plate and screw apparatus. The intrinsic cord signal reveals no intrinsic cord widening or narrowing. Mild cervicothoracic scoliosis noted. Craniocervical junction is normal. The C1-2 relationships are normal.

Regarding disc levels, C2-3 is normal with no herniation of disc or foraminal stenosis. C3-4 demonstrates mild bilateral disc and spur complex with minimal encroachment of the neural foraminal levels. No herniation or significant foraminal stenosis is seen.

C4-5 demonstrates no evidence of disc herniation. There is very mild left neural foraminal encroachment noted from uncovertebral hypertrophic change. Facets are normal.

C5-6 demonstrates significant susceptibility artifact from the anterior metallic plate and screw fusion apparatus. Foraminal levels are intact and there is no focal herniation at this level. There is degenerative disc narrowing.

C6-7 demonstrates significant disc narrowing with endplate degenerative signal changes with prominent low signal posterior disc and spur complex with marked bilateral neural foraminal low signal encroachment suggestive of uncovertebral hypertrophic changes/spurs. No focal protrusion of disc is seen. There is some degree of anterior posterior cord effacement, however this could be artifact related to local susceptibility from metallic plate and screw fusion apparatus. The C7-T1 and T1-2 levels are normal.

Conclusion:
1.C3-4 mild posterior disc and spur complex with minimal foraminal encroachmnent.
2.C4-5 very mild left neural foraminal encroachment secondary to uncovertebral hypertrophic change.
3. C5-6 anterior metallic plate and screw fusion with degenerative disc narrowing but no significant herniation or stenosis.
4. C6-7 marked degenerative disc disease with prominent anterior and posterior spurs with disc and spur complexes significantly encroaching the central canal and neural foramina bilaterally.

I also recently had EMG/NCV on both arms that showed “chronic but not ongoing” nerve damage on the right side.
I’ve tried so many different meds, physical therapy, myofascial release therapy. Is this leading to another surgery and if so, will my old hardware be removed and replaced with a longer plate and more screws?

Thank you so much for listening. And thank you for running this forum.

Brian

brianyzf
Participant

August 16, 2016 at 7:32 am

Post count: 3

#22787

Some more info that I forgot when I made my original post. I am a 47 year old male, very fit and athletic. Hardcore mountain biker and hockey player up until about 5 years ago when I became addicted to running. Ran 2 marathons per year up until last year when I decided that one per year would be enough. Is my running, specifically all of the miles I put in during training, possibly making my condition worse. I actually feel better overall when I’m training.

Donald Corenman, MD, DC
Moderator

August 20, 2016 at 12:53 pm

Post count: 8660

#22825

A number of points to make.

First is that with a prior need for an ACDF (fusion), your genetics predispose you to other level problems. Your symptoms fit with a C6-7 level problem (symptoms seem to be C7 root- see https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/).

EMGs are generally not too helpful for cervical radiculopathy as pain symptoms will not show up on this test and motor weakness is easily found on a physical examination so the test would only confirm what is obvious on exam.

Running requires impact which can increase wear of any disc. There is no rule not to run but think of a disc like the shock absorber on a car. The disc can withstand repeated impacts but eventually can wear out with extended use. You would be better off as a swimmer, biker or gym rat (treadmill or even better-elliptical) with your neck. I don’t want you to stop but understand the repercussions of your actions.

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.

brianyzf
Participant

August 20, 2016 at 1:34 pm

Post count: 3

#22827

Thanks for your reply. I do understand the consequences of my running in conjunction with my genetics. I’m trying to balance things so that I can still run while not overdoing things. I’m really interested in your opinion as to whether I’m a candidate for another surgery, and what type of procedure seems appropriate since I’m tiring of the conservative approach. I’m just not seeing any encouraging results.

Donald Corenman, MD, DC
Moderator

August 20, 2016 at 1:48 pm

Post count: 8660

#22828

If you have continued pain that is disabling or impairing (stops/reduces your activity level or stops your thought process on occasion) and have failed conservative care, you are probably a candidate for surgery. If the disc level is highly narrowed (greater than 50% of disc height loss as probably noted by your MRI report-“marked degenerative disc disease with prominent anterior and posterior spurs”), then an ACDF would be indicated. If there is good disc height remaining (unlikely), an artificial disc replacement can be considered along with an ACDF.

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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