How serious is a flattened cord?

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aleeya
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April 11, 2013 at 5:14 am

Post count: 2

#8397

Hi.
I am 41 years old and I have been diagnosed with Degenerative Disc Disease. I had an MRI done on my neck after neck pain, numbness in arm and hand and fingers asleep an hour or two even after I wake up. (I also had carpel tunnel surgery in the same hand to try to relieve some of the symptoms in the hand.)

The impression from the MRI reads as:

1 Multi-level disease with degenerated discs seen at all levels.
2 Left paracentral disc protrusion seen at C5-6 which effaces the cord.
3 At C6-7 large disc protrusion is seen that extends into the neural foramina and neural canal the displaces and flattens the cord.
4 normal marrow signal with bones in anatomic alignment.

To me this is greek.

The Dr that ordered the mri (pain management dr) did not have much to say about it other than an injection could help but eventually surgery will be the answer.

In another place of findings, the page also reads

Facet arthropathy is seen on the left at C3-4

C4-5 left neural foraminal narrowing is present with facet arthrosis. Small central disc protrusion is seen. There is no effacement of the cord.

C5-6 broad based left paracentral disc protrusion is noted. This effaces the cord and displaces it. The disc measures 10 mm in length. Neural foramen on the right is patent; the left neural foramen is encroached upon diffuse disc bulge.

At C6-7 left paracentral disc protrusion is present that extends partially into the neural foramen measuring 17mm in width. There is flattening, effacement, and displacement of the cord. Lifting of the posterior longitudinal ligament is seen on the sagittal images.

Could you help me understand what this impression means? Is this a very serious or common thing? (And to what degree?)

For 10+ years I had problems with back pain and eventually that lead to surgery (XLIF) on my back, and I am just hoping my neck is not too serious to need more surgery.

To my understanding this is not normal for my age.

I believe I posted this in the incorrect forum and I will try to move it to a different forum about reading mri’s.

ps: I Tried to figure out how to move this to a different forum, but I cannot figure out how. My apologies for posting in the incorrect forum.

Donald Corenman, MD, DC
Moderator

April 11, 2013 at 7:51 pm

Post count: 8660

#8402

“A flattened cord” could be only somewhat concerning or a significant finding that needs to be addressed surgically. This depends upon two things. The central canal space which is the entire space for the cord and your examination findings and symptoms.

The cord typically is shaped like a kidney bean when viewed on end. A bone spur or disc bulge can efface the cord and allow the cord to flatten at this area of stress. If there still is room for the cord behind the flatted area (which will be viewed as and area of white signal due to the CSF-water present), then the risk is not as great.

If there is no further room behind the cord, then this places the spinal cord in jeopardy. The reason is that the spinal canal changes in volume with neck position. When you bend your head backwards (extension), the spinal canal actually looses 30% of the volume. A fall onto the front of the head will force a quick backwards bend. This can pinch the cord and cause a central cord injury (find a description this on the website).

If there is still room in the back of the canal as noted on the MRI, the chances of this injury lessen.

The other problem that could occur with cord flattening is myelopathy (again-look on this website for description). This is a chronic malfunction of the spinal cord and has specific signs and symptoms that are associated with this disorder.

With either case (severe narrowing or presence of myelopathy), it is my opinion that this cord compression needs to be addressed surgically. If neither problem is present, then your risks of cord malfunction are lowered.

Your neck pain is most likely derived from degenerative disc or facet disease. You can find full explanations of these disorder on this website.

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.

aleeya
Member

April 12, 2013 at 4:13 am

Post count: 2

#8409

Thank you so much for your reply! It will help me a great deal in making future decisions. I appreciate your time and comment!
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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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