How bad is this MRI?

Tagged: Cervical MRI

Viewing 4 posts - 1 through 4 (of 4 total)

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sjps
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July 21, 2018 at 9:35 am

Post count: 2

#28801

I am a 49 yo female and work as an engineer. My work requires me to climb up and down sides of buildings and crawl around in mechanical rooms. I am concerned about the dangers involved in my employment and what the future may hold. Also.. I’m not sure how bad this MRI really is. To me, it looks really bad. Am I headed to surgery?
I have had shoulder pain for over 5 years. I never had it looked at until 2 weeks ago when a began to have extremely painful twinges in my left arm that radiate to my pinky and ring fingers. This is followed by tingling and numbness. It subsides until I move my arm the wrong way again.

Here is what my MRI says:
Findings:
There is straightening of cervical spine. No Marrow infiltrative process present.
The invertabral disks are diffusely dissected in the cervical spine. There is marked decreased disk height at C5-6 and C6-7 levels. There is mild type I Modic endplate degenerative changes present at the C5-6 level.

At C3-4 level, there is disk bulge with 1 mm central disk protrusion causing slight anterior thecal and cord inentation. There is no spinal canal narrowing. There is marked left facet hypertrophy present with moderate left neural foraminal stenosis.

At C4-5 level, there is a small 1 mm central disk protrusion with subtle anterior thecal and cord indentation. There is no spinal canal or foraminal narrowing. Left facet hypertrophy is present.

At C5-6 level, there is 1.5 mm posterior disk osteophyte complex causing anterior thecal and cord indentation with mild to moderate canal narrowing. There is mild unconvertebral and facet hypertrophic changes noted. The neural foramina appear patent.

At C6-7 level, there is a posterior disk osteophyte complex causeing thecal effacement with spinal cord indention and moderate canal stenosis. Unconvertebral and facet hypertrophic changes are present with mild to moderate left foraminal narrowing.

At C7-T1 level there is a disk bulge with a 1.5 mm central to left paracentral disk protrusion. Associated unconvertebral and facet hypertrophic changes are present. There is thecal as well as left anterolateral cord indention present with minimal spinal canal stenosis. There is also mild left foraminal narrowing.

Impresssion:
1. Straightening of cervical spine with maintained vertebral height and allignment. There is marked facet hypertrophy on the left side of the C3-4 level.
2. Multilevel spondylotic changes with moderate spinal canal narrowing at C6-7 level, mild to moderate spinal canal stenosis at C5-6 level and mild spinal canal narrowing at C7-T1 level.
3. Multilevel left sided foraminal narrowing described at C3-4, C6-7, and C7-T1 levels. Foraminal stenosis appears worse at C3-4 level.

Thanks for any input. I went to Orthopedic surgeon first and he gave me this and didn’t say much and referred me to a spine doctor. I am waiting to get an appointment.

Donald Corenman, MD, DC
Moderator

July 22, 2018 at 10:55 am

Post count: 8660

#28806

You have moderate to significant degenerative changes of the discs of your cervical spine. The worst disc appears to be C5-6 with C6-7 close behind (“There is marked decreased disk height at C5-6 and C6-7 levels. There is mild type I Modic endplate degenerative changes present at the C5-6 level”). These can cause neck pain that can radiate into your shoulders.

Your complaints of arm pain “began to have extremely painful twinges in my left arm that radiate to my pinky and ring fingers. This is followed by tingling and numbness. It subsides until I move my arm the wrong way again” could be from either your neck or your arm itself. If the symptoms occur with head position (extending the neck or bringing the head backwards) without arm motion, you probably have a cervical radiculopathy, most likely at C7-T1. This head position would be quite common when crawling into narrow spaces as you have to extend the neck to look forward while on your hands and knees.

If however, the neck position does not prompt these arm symptoms, more likely than not you either have thoracic outlet syndrome or cubital tunnel syndrome, both of which would cause numbness into the ulnar side (pinky side) of the hand. See https://neckandback.com/conditions/cubital-tunnel-syndrome/ and https://neckandback.com/conditions/thoracic-outlet-syndrome/.

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.

sjps
Participant

July 22, 2018 at 11:43 am

Post count: 2

#28808

Thank You for the response Dr. Corenman,
Neck position does not effect my pain. As a matter of fact, I don’t have any neck pain (maybe a little stiffness) and I thought the Orthopedic Surgeon was wasting my time when he ordered the neck MRI.
Of the two syndromes, I think it may be the Thoracic Outlet syndrome. I did not mention that the motion that gives me the most pain is putting on a bra where I make all of the motions in a series that your description mentions as being troublesome.
I really appreciate your help!

Donald Corenman, MD, DC
Moderator

July 22, 2018 at 12:02 pm

Post count: 8660

#28810

Please let us know how you progress.

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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