Help with MRI results

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cttennan
Participant

February 20, 2020 at 2:38 pm

Post count: 6

#32083

Hello Dr. Corenman,

I have been having back problems for a few years and it seems to be getting worse. My 1st MRI was done in July of 2018.
Technique: Sagittal T2, sagittal T1, sagittal STIR, axial T2.

There is a transitional lumbar sacral junction with partially
sacralized right L5 vertebral body. Vertebral height is maintained.

At L5/S1, no disc bulge or lateralizing disc herniation is present.

At L4/L5, no disc bulge or lateralizing disc herniation is present.

At L3/L4, there is mild disc space narrowing with small anterior
marginal osteophyte formation. There is a small 1.2 cm in height by 5
mm in AP by 5 mm in transverse dimension right subarticular inferior
disc extrusion extending to the mid L4 vertebral body (series 6,
images 7-8). Disc herniation causes mild narrowing of the right
lateral recess with mild impingement of the subarticular right L4
nerve root. Bulging disc causes minimal inferior foraminal
encroachment.

At L2/L3, there is disc desiccation with mild disc space narrowing and
small anterior marginal osteophyte formation. Bulging disc causes
minimal thecal impression and minimal inferior foraminal encroachment.

At L1/L2, there is disc desiccation with tiny Schmorl’s nodes and tiny
anterior marginal osteophyte formation. There is minimal posterior
bulging of the annulus. No limiting central or foraminal stenosis is
present.

At T12/L1, there is disc desiccation. Small left paracentral disc
protrusion causes mild thecal impression without neural impingement or
limiting central stenosis.

At T11/T12, there is a shallow central disc protrusion causing minimal
thecal impression.

The conus terminates at T12/L1 and is normal in signal and in caliber.

Localizer images demonstrate an indeterminant 2.5 cm in height right
lateral renal lesion possibly a renal cyst.

IMPRESSION: MRI lumbar spine.
1. Transitional lumbar sacral junction.
2. Small right subarticular inferior disc extrusion at L3/L4 causes
mild impingement of the subarticular right L4 nerve root coursing
through the right lateral recess.
3. Small left paracentral disc protrusion at T12/L1 and shallow
central disc protrusion at T11/T12 cause minimal to mild thecal
impression without neural impingement or limiting central stenosis.
4. Indeterminant 2.5 cm right lateral renal lesion possibly a renal
cyst. Correlation with patient’s outside abdominal imaging suggested.
If none are available then renal ultrasound could be performed to
confirm cystic nature.

I had a L3/L5 laminectomy August 2018 and that fixed the issue of drop foot and leg pain. December 2018 I was involved in a work accident where I was struck from behind and received whiplash. I had a cervical, and lumbar MRI to see if there was any further damage done and there was not and significant change. The cervical showed the resulting report.

From the skull base to T4 was imaged. There is mild cervical scoliotic
positioning convex towards the right. Vertebral height is maintained.

At C2/C3, minor left-sided uncovertebral joint hypertrophy is present
without causing significant foraminal encroachment.

At C3/C4, uncovertebral joint hypertrophy results in mild thecal
impression and minimal left foraminal narrowing.

At C4/C5, there is mild disc space narrowing with tiny anterior
marginal osteophyte formation. There is a broad-based disc osteophyte
complex effacing the ventral and dorsal subarachnoid space slightly
deforming the ventral cord. The central canal is narrowed to an AP
diameter of approximately 8.8 mm. Uncovertebral joint hypertrophy
results in severe bilateral foraminal stenosis.

At C5/C6, there is mild disc space narrowing with small anterior
marginal osteophyte formation. There is a bulging disc with
spondylitic ridging contacting the ventral cord. The central canal is
minimally narrowed to an AP diameter of approximately 9.6 mm.
Uncovertebral joint hypertrophy results in severe bilateral foraminal
stenosis.

At C6/C7, there is mild disc space narrowing with small anterior
marginal osteophyte formation. Bulging disc causes mild thecal
impression. Uncovertebral joint hypertrophy results in severe left
foraminal stenosis.

At C7/T1, bulging disc causes minimal thecal impression.

At T1/T2, small right paracentral disc protrusion causes mild thecal
impression without cord impingement.

At T2-T3, shallow right paracentral disc protrusion causes minimal
thecal impression.

At T3/T4, bulging disc with spondylitic ridging contacts the ventral
cord. The dorsal subarachnoid space is maintained.

No intrinsic cord signal abnormality is identified. Cervical medullary
junction appears unremarkable. Paraspinal soft tissues appear
unremarkable.

IMPRESSION:Noncontrast MRI cervical spine.
1. Cervical scoliotic positioning convex towards the right.
2. Mild cervical and proximal thoracic spondylosis.
3. Small disc osteophyte complexes cause mild thecal impression with
minimal to mild narrowing of the central canal at C4/C5 and at C5/C6.
No evidence for underlying cord signal abnormality.
4. Uncovertebral joint hypertrophy results in prominent bilateral
foraminal stenosis at C4/C5, bilaterally at C5/C6 and on the left at
C6/C7 with neural impingement.
I did 8 weeks of PT and several months of Chiropractic which helped but I am still having cervical issues. Below is the 2nd cervical MRI report

From the skull base to the mid T4 vertebral body was imaged. There is
mild cervical scoliotic positioning convex towards the right.
Vertebral height is maintained.

At C2/C3, minor left-sided uncovertebral joint hypertrophy is present
without causing significant foraminal encroachment.

At C3/C4, there is a shallow left paracentral disc osteophyte complex
contacting the ventral cord. The dorsal subarachnoid space is
maintained. Uncovertebral joint hypertrophy results in minimal left
foraminal narrowing, unchanged.

At C4/C5, there is mild disc space narrowing, tiny Schmorl’s nodes and
tiny anterior marginal osteophyte formation. There is a broad-based
disc osteophyte complex effacing the ventral and dorsal subarachnoid
space slightly deforming the ventral cord. The central canal is
narrowed to an AP diameter of approximately 8.6 mm compared with 8.8
mm, previously. Uncovertebral joint hypertrophy results in severe
bilateral foraminal stenosis, unchanged.

At C5/C6, there is mild disc space narrowing with small anterior
marginal osteophyte formation. There is a broad-based disc osteophyte
complex slightly eccentric towards the right contacting the ventral
cord. The dorsal subarachnoid space is maintained. The central canal
is minimally narrowed to an AP diameter of approximately 9.6 mm,
unchanged. Uncovertebral joint hypertrophy results in severe bilateral
foraminal stenosis, unchanged.

At C6/C7, there is mild disc space narrowing with small anterior
marginal osteophyte formation. Bulging disc causes mild thecal
impression without cord impingement or limiting central stenosis.
Uncovertebral joint hypertrophy results in severe left foraminal
stenosis, unchanged.

At C7/T1, bulging disc causes mild thecal impression.

At T1/T2, small superior right paracentral disc extrusion causes mild
thecal impression without cord impingement. Disc herniation has
slightly increased in size when compared to previous examination.

At T2/T3, shallow right paracentral disc protrusion causes minimal
thecal impression, unchanged.

At T3/T4, bulging disc with spondylitic ridging contacts the ventral
cord. The dorsal subarachnoid space is maintained.

No intrinsic cord signal abnormality is identified. Cervical medullary
junction appears unremarkable. Paraspinal soft tissues appear
unremarkable.

IMPRESSION:Noncontrast MRI cervical spine.
1. Mild cervical scoliotic positioning convex towards the right be
secondary to muscular spasm or patient positioning.
2. Stable cervical spondylosis with small disc osteophyte complexes
causing minimal cord impingement and narrowing of the central canal at
C4/C5 greater than than at C5/C6. Central canal stenosis has slightly
increased at C4/C5. No evidence for underlying cord signal
abnormality.
3. Slight interval increase in size of right-sided disc herniation at
T1/T2 causing mild thecal impression without cord impingement.
4. Uncovertebral joint hypertrophy again results in multilevel
prominent foraminal stenosis, unchanged.

I have the follow up with the neurologist next month to discuss the next steps. I have been having headache’s with the pain throughout my neck, that runs into the left shoulder, and forearm. I have had numbness in the hand also. Along with dropping things, and problems picking up small items. I have also been experiencing some pain in my chest on the left side. My thoracic spine feels like it in constant spasm and the only position that I feel comfortable is on my back with my legs up. Can you please help me understand what is going on and your opinion on what the plan of care should be? I will be 48 years old next month and am good health other than my spine.

Many thanks
Craig

Donald Corenman, MD, DC
Moderator

February 20, 2020 at 7:15 pm

Post count: 8660

#32084

You have to describe your symptoms to go along with the MRI findings and the surgeries. Also, how did the symptoms change after the surgeries? See these two symptom description instructions. https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-neck-shoulder-and-arm-pain/
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.

cttennan
Participant

February 21, 2020 at 6:19 am

Post count: 6

#32086

Update for MRI results. The original lumbar spine MRI was a result of severe hip, and calf pain that happened after carrying a large suitcase down a flight of stairs. It started with a cramp in my hip and started traveled into the side of my calf a few days later. After a week it became difficult to sit for any period of time. I did not have any back pain. I would get a shock like jolt when I would stand up or turn at the waist. I developed weakness in the right leg along with drop foot and it became more difficult to walk. I thought I was having a problem with my hip and had no idea it was my back causing the problems. The pain level was about an 8. I went to the chiropractor to get an adjustment. I explained my symptoms to the chiropractor and he tried to adjust me. As soon as he positioned me a had the electric shock pain shooting down the right side. I decided it was time to visit the orthopedic for further evaluation. The Dr. immediately recognized the symptoms and referred me for a MRI and neurologist follow up. 2 weeks later none of the symptoms changed and I went to my neurologist appointment and was immediately scheduled for surgery. I had nerve compression at L3/L4 that was causing the problems. After surgery I had instant relief of the pain and symptoms. that was August 2018.

December 2018 my back felt better that it had in years. I was on a forklift at work moving some pallets and had stopped to let another forklift pull out of an aisle when I was struck from behind by another forklift. I immediately felt pain from my neck down to my tailbone. I was taken to the hospital for evaluation and a CT scan. The CT scan did not show any major trauma. For the next 2 weeks I was in a considerable amount of cervical and lumbar pain 8-10 when walking around and a 5-6 at rest. I started to lose sensation in my hands and had numbness in my fingers and thumb. The pain in the neck was dull aching pain with some shock pain when turning my head. I made an appointment with my surgeon for evaluation. I had some hyperflexia and tested positive for Hoffmans sign. I went for the 2nd MRI. After going over the results my surgeon said there was nothing that needed immediate surgical repair. I had several bulging disc without cord impingement. I was referred to PT and chiropractic care. I did the 8 weeks of PT and several months of Chiro care. The pain and numbness slowly got better but i never recovered completely. I still had numbness in my hands and electric shocks that ran down my arms. I was having stiff neck and mid back spasms daily. The pain was mainly dull and achy with some sharp pains 6-8. Over the past 3 months the intensity has increased and the duration has also increased. I noticed that I would drop thing from my left hand and my fingers were numb mainly in the pointer finger and thumb. It started to become difficult to sit at my desk and work and driving made me uncomfortable. The pain is a 6-8 and I would get relief when I would lay down. I went back to my surgeon for evaluation. I showed the same symptoms as before, hyperflexia and positive Hoffmans left and right. I have had the 2nd cervical MRI and am waiting to follow up with the surgeon March 3rd. As I am sitting here typing this my hands are becoming more numb and my thoracic spins is starting to ache more along with my neck.

Please let me know if you need any more information to assist you with evaluation. I need to find somewhere to get horizontal for a few minutes. Thank you very much for your time and expertise. I greatly appreciate anything you can do to help me.

Donald Corenman, MD, DC
Moderator

February 22, 2020 at 9:17 am

Post count: 8660

#32094

Cut and paste all imaging studies of your cervical, thoracic and lumbar spines here so we can dissect them.

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.

cttennan
Participant

February 24, 2020 at 8:22 am

Post count: 6

#32123

Is there an easy to do that? The portal with my images do not let me copy and paste. I have to snip every image and save it to a folder. Do you have a way to send me a private message and I can give you access to my Shields MRI portal?

cttennan
Participant

February 24, 2020 at 9:47 am

Post count: 6

#32124

Is there an easy way to do that? The portal with my images do not let me copy and paste. I have to snip every image and save it to a folder. Can you send me a private message and I can give you access to my Shields MRI portal?
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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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