High Signal on Thoracic spine?

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Jellyhall
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August 19, 2017 at 5:02 am

Post count: 91

#26020

Dr Corenman,
I have several bulging/herniated discs in my thoracic spine. The worst discs are at T7/8 T8/9 and T9/10. the top and bottom disc of these 3 are compressing and indenting my cord, although this is mostly the subarachnoid space.

My question is that the spinal cord just above and below the T9/10 herniation, the spinal cord has a lighter/whiteish appearance very similar to your example of ‘high signal’ on the cord. Is it possible that this lighter part of the cord is due to something else?

I should also tell you that I suffer daily with spasticity which causes thightening spasms that cause both legs and feet to go stiff and the feet, especially the right foot, to turn inwards with the big toes sticking up. It also causes tightening around my abdomen which causes my back to arch up off the bed, making my head arch backwards. I get these spasms every day as I wake up and start to move. They also sometimes occur when I get up from a chair. they don’t last long (about 10 seconds) before relaxing off again. Sometimes they cause muscles to go into a cramp which is very painful.

I am hoping for your opinion on this and also hoping that you will reassure me.

Donald Corenman, MD, DC
Moderator

August 24, 2017 at 9:09 am

Post count: 8660

#26183

Cord signal change is generally an indication of a cord injury. The white signal in the normally dark cord on T2 images is the characteristic finding. Cord injury will cause “spasticity” as the spinal cord is normally a moderating influence on the motor nerves. That is, a cord injury will allow the muscles to become tight and spastic by the loss of the muting capacity of the cord.

You need a work-up to determine if these thoracic herniations cause your current symptoms.

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.

Jellyhall
Participant

August 24, 2017 at 10:37 am

Post count: 91

#26192

Thank you for your reply.
I do suffer with spastic spasms every day. Generally they are in the morning while I am still in bed. As I start to move, both my legs will go stiff and my abdomen goes tight causing my back to arch up off the bed and my neck to bend backwards. I have been getting this for years. I saw a neurologist to rule out MS and some other neurological diseases they didn’t name, who said I had damage to my cord that occurred before my ACDF, which was in 2012.

I think the doctors are assuming that is what is causing the spasms. A neurosurgeon saw me last month very briefly on the NHS, but he was rather vague and didn’t do a neurological examination or talk about my symptoms with me. The hospital has got very behind with appoointments and my referral was over a year ago. I did have a recent MRI scan for him to view, so I suppose what I can see is not high signal. Having been left for so long before my ACDF that I have cord damage, makes me rather worried about the symptoms I have and this light area on the cord. (It was on your advice that my neck needed attention that we decided to get another opinion and I had ACDF surgery about 3 weeks later!) The lighter area on the cord isn’t bright white, but a definate lighter area that runs for about three vertebral levels. Perhaps it is due to something else. Is that possible?

Donald Corenman, MD, DC
Moderator

August 24, 2017 at 10:43 am

Post count: 8660

#26193

A long white signal (three levels), could be from multiple disorders. This could be the beginning of a syringomyelia, a transverse myelitis (injury due to vascular or viral origin) or even a false finding (a glitch from the MRI machine).

If I remember correctly, you had cord compression in your neck which could also explain your current symptoms.

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.

Jellyhall
Participant

September 20, 2017 at 10:21 am

Post count: 91

#26407

Yes, I did have cord compression in my neck but that has been removed now during a two level ACDF.
I have been told that I have damage to my cord that occurred while I was waiting for this surgery.
If anything these spasms are becoming worse and more frequent now though.
Would that indicate that there is still something compressing the cord?

My neck is getting more painful now too and is developing some new, different sounds and a sense of slipping movement. I have posted a question to you about this in the neck section.

Donald Corenman, MD, DC
Moderator

September 20, 2017 at 7:55 pm

Post count: 8660

#26417

Your ACDF possibly did not solidly fuse. This could be one factor in your current pain. The other is if you have had a spinal cord injury, spasms could be from the injury itself or from syringomyelia, a cystic change in the cord that can occasionally enlarge (rare but needs to be looked for).

You certainly need at least new X-rays with flexion/extension views and possibly a CT scan.

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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