Help interpreting MRI: Lordosis straightening and paracentral/stenosis

Tagged: MRI findings with cervical and shoulder pain

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lilikath00
Participant

October 23, 2019 at 5:24 am

Post count: 2

#31352

Good Morning,

Thank you for all of the support you provide to us and our interpretation of results.

I am hoping you can help me understand the true impact of these MRI results. I was recently hit by a stolen four door truck, only after the driver jumped out and accelerated upon doing so. I was stationary (parked in front of my home). When all was said and done it was a five car pile up as he hit me hard enough to force me into the three cars (parked with a cars length distance between each). My vehicle was totaled. I have been in PT since June and am having chronic pain in neck and back, clavicle and right rib cage. My rib cage and collar bones are offset. What my PT called a lateral ring rib shift. I suffer shoulder blade pain (dominate right) and other symptoms I did not used to suffer. Weakness in hands and legs, and sometimes I still feel as if my brain is thinking like it did while concussed. Just a bit off.

I am to receive a spinal epidural so long as the MRI results are not prohibitive in hopes it provides relief to neck back and shoulders.

Do you think this is a proper way to treat? How do I mitigate the pain and weakness that is attributed to the findings, and does the straightening of the natural cervical lordosis explain blurry vision, lightheadedness and almost a bobble head kind of feeling? I have been largely unable to be active since being hit and am hoping to regain some mobility and relief in my neck and back with the proper treatment.

Since being hit my neck and back (as well as hips) have become quite bothersome. Any feedback is appreciated as reading through your forum I learned a tremendous amount.

This is my 3rd MRI since 2011 however c6-c7 showed only mild DDD at time of last scan. I did have a CT scan at the hospital following the accident. Will an epidural provide relief?

Thank you.

FINDINGS:

Marrow signal: Within normal limits.

Alignment: Mild straightening of the normal cervical lordosis without
subluxation.

Cervical cord: Normal in signal and morphology.

The C1-C2 relationship is maintained.

C2-3: Unremarkable.

C3-4: Unremarkable

C4-5: Unremarkable

C5-6: Mild degenerative disc disease with small bilateral
uncovertebral joint osteophytes without significant stenosis

C6-7: Moderate size Right paracentral Broad-based disc extrusion which
migrates about 3 to 4 mm superiorly and 4 mm inferiorly. This is
causing proximal right foraminal stenosis and moderate right central
stenosis.

C7-T1 T1-2 and T2-3 and T3-4 are unremarkable

IMPRESSION:

C6-7 shows a right paracentral moderate-sized broad-based disc
extrusion, described above, causing proximal right foraminal stenosis
and moderate right central stenosis.

C5-6 shows mild degenerative disc disease

lilikath00
Participant

October 23, 2019 at 6:41 am

Post count: 2

#31353

Apologies. Perhaps to provide previous scans may be beneficial:
Examination: MR C SPINE WO CON – 3221161 – Aug 16 2011 1:18PM
Accession No: 9793659
Reason: EVAL FOR MS
REPORT:
INDICATION: Chronic pain and intermittent numbness and tingling.
COMPARISON: MRI brain on 11 2011
TECHNIQUE: Axial T1 and T2 and sagittal T1, T2, and STIR
noncontrast MRI of
the cervical spine .
FINDINGS: Alignment is within normal limits. Normal bone marrow
signal. No
compression deformity. Normal disc signal.
Cervicomedullary junction is within normal limits. Signal and caliber
of the
cervical spinal cord are within normal limits.
Paraspinal soft tissues are within normal limits.
The C1-C2 relationship is within normal limits.
C2-C3: No herniation or stenosis.
C3-C4: No herniation or stenosis.
C4-C5: No herniation or stenosis.
C5-C6: No herniation or stenosis.
C6-C7: Posterior disc osteophyte complex. Mild central spinal canal
stenosis.
C7-T1: No herniation or stenosis.
IMPRESSION:
1. C6-C7 mild central spinal canal stenosis.
2. Normal cord signal.

2015:
INDICATION: Chronic neck pain, fibromyalgia, neuropathy, bilateral
decreased
sensation of arms and hands, intolerable arm pain, burning and
tingling,
TECHNIQUE: Sagittal T1, T2, STIR and axial T1 and T2-weighted
images of the
cervical spine were obtained. Following 6 mL intravenous Gadavist
gadolinium
repeat sagittal and axial T1-weighted images.
COMPARISON: MRI cervical spine 8/16/11
FINDINGS:
Cervical vertebral alignment has been adequately maintained.
The craniocervical junction is unremarkable.
C2-C3: No disc bulge or stenosis.
C3-C4: No disc bulge or stenosis.
C4-C5: No disc bulge or stenosis.
C5-C6: Minimal disc bulge and endplate hypertrophy. Minimal
stenosis. No
cord compression.
C6-C7: Small broad-based right posterior lateral disc protrusion. Mild
stenosis with minimal if any cord compression/displacement.
Findings are
similar to 8/16/11..
C7-T1: Minimal central bulge without stenosis.
T1-T2: No disc bulge or stenosis.
The cervical spinal cord has normal signal. No abnormal intradural
enhancement.
IMPRESSION:
1. C6-C7 small broad-based right posterior lateral disc protrusion
with mild
stenosis, minimal if any cord compression and no significant change
since
August 2011.
2. No abnormal signal or abnormal enhancement in the cervical
spinal cord.

My other question is is this something, based on the seemingly progressive nature, that i can expect to continue to get worse. Or is it simply case by case and I do my best to mitigate pain and any further injury? I know I was not in a tremendous amount of discomfort prior to being hit in may and the right side of my body is out of whack. Truly would just love a professional set of eyes and a conclusive opinion, in vernacular. Although a scientist, I have a hard time fully comprehending the scans, over the plane of time, and with MVA now in consideration.

Lastly, I have been experiencing terrible hip pain (almost feels like plantar fasciitis but in my right hip bone). My PT states my hip flexors are terrible and that if i am able to rebuild core strength I should lessen the pain associated with chronic chostochondritis and whiplash. Is the hip pain something i should have checked while working with my neurologist? It recurs intermittently, as does the foot pain, and is miserable in the moment, but tends to subside. No body part is exempt from a twitch, muscle cramp, going numb, or a stabbing sharp pain.

Again. Thank you so very sincerely. Of the multitudes of doctors i have interacted with, to see your replies, and resulting knowledge means so much to so many of us.

Donald Corenman, MD, DC
Moderator

October 24, 2019 at 10:51 am

Post count: 8660

#31360

Your symptoms could to be referral pain from either disc or facet origin or from a radiculopathy (“chronic pain in neck and back…shoulder blade pain (dominate right)… I still feel as if my brain is thinking like it did while concussed”). Your change in mentation is most likely from your concussion.

Your MRI notes a herniation at right C6-7 and a degenerative disc at C5-6 (“C6-7 shows a right paracentral moderate-sized broad-based disc extrusion, described above, causing proximal right foraminal stenosis
and moderate right central stenosis…C5-6 shows mild degenerative disc disease”). This could explain your shoulder blade pain on the right. Find a reputable spine surgeon who can diagnose your condition and then recommend a selective nerve root block for both diagnosis and possible treatment.

I cannot explain your hip or foot symptoms from the information provided.

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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