Indentions, Compressions, and Confusions

Tagged: cspine, NECK

Viewing 6 posts - 1 through 6 (of 17 total)

1 2 3 Next

Author

Posts
niki
Participant

November 15, 2019 at 12:17 am

Post count: 10

#31474

Thank you Doc for your efforts in demystifying MRIs for the betterment of us confused and pained people of the internet. It really means a lot.

Symptoms: That being said, I’ve had chronic, all over pain for 16 years. 8 years ago, random pain in my right hip put me in a wheelchair for 1 year, then magically resolved. I’m 33 now, and for the last 3 years I have had back spasms 3 times monthly that I attempt to manage with medications, rest but was otherwise stumped. My left arm has been numb permanently and lost motor skills that seems to have a transient severity. I always have pins and needles in my hands and feet, and my muscles tire easily.

I have a positive HLA-B27 gene, but we’ve ruled out a lot of rhuemtological, neurological symptoms.

—- Here are my MRI results from Stanford Imaging, I’m happy to report my Thoracic and Lumbar Spine are completely “Normal” — Now it’s time for my pain in the neck!

1. Mild multilevel degenerative changes of the cervical spine as described above. Minimally increased prominence of the small posterior central disc protrusion at C5-C6, possibly related to differences in scan technique, otherwise cervical spine is stable from 4/17/2018 MRI. No significant neural foraminal or spinal canal stenosis.

2. Normal MRI of the thoracic spine.

CLINICAL HISTORY: 33 years of age, Female, cervical radiculopathy.

COMPARISON: MRI 4/17/2018.

PROCEDURE COMMENTS: MRI of the cervical and thoracic spine was performed without IV contrast at 3 Tesla. The following MR sequences were obtained: 3 plane localizer SSFSE, sagittal T2, sagittal T1, sagittal STIR, axial T2, and axial MERGE.

FINDINGS:

Localizer image: No visible abnormality.

Alignment: Straightening of the normal cervical lordosis.

Bone marrow: Normal for age. Vertebral body heights are preserved.

Discs: Disc desiccation and mild disc height loss from C4-C7. Thoracic disc heights are preserved.

Vertebrae: Multi-level degenerative changes as follows:

Cervical spine:

C2-C3: Mild facet hypertrophy. No significant neural foraminal or spinal canal stenosis.

C3-C4: Left asymmetric mild uncovertebral and facet hypertrophy which result in mild left neural foraminal stenosis. No significant spinal canal stenosis.

C4-C5: Broad-based posterior disc osteophyte complex, left asymmetric mild uncovertebral and facet hypertrophy which result in partial effacement of the ventral thecal space without significant spinal canal stenosis. No significant neural foraminal stenosis.

C5-C6: Small posterior central disc protrusion, mild uncovertebral and facet hypertrophy which result in near-complete effacement of the ventral thecal space with mild indentation of the ventral spinal cord and mild spinal canal stenosis. No significant neural foraminal stenosis.

C6-C7: Broad-based posterior disc osteophyte complex, mild uncovertebral and facet hypertrophy which result in partial effacement of the thecal space without significant spinal canal stenosis. No significant neural foraminal stenosis.

C7-T1: Mild facet hypertrophy. No significant neural foraminal or spinal canal stenosis.

Thoracic spine: No significant degenerative changes, neural foraminal or spinal canal stenosis.

Cord: Normal.

Extra-vertebral soft tissues: Normal.

Visualized brain: Normal.

Visualized chest: Normal.

Additional comment: None.

There is no component information for this result.
—–

Thanks so much again for all your help to us!

Donald Corenman, MD, DC
Moderator

November 17, 2019 at 9:57 am

Post count: 8660

#31479

You note “I’ve had chronic, all over pain for 16 years. 8 years ago, random pain in my right hip put me in a wheelchair for 1 year, then magically resolved”.

You also note “My left arm has been numb permanently and lost motor skills that seems to have a transient severity. I always have pins and needles in my hands and feet, and my muscles tire easily”

This sounds somewhat like an inflammatory disorder like MS or polymyalgia rheumatica but your tests are normal (I assume labs are normal too). Your neurological symptoms “pins and needles in my hands and feet, and my muscles tire easily” need to be looked into as they cannot be generated by your spine based upon your report. Have you had a neurological consultation and EMG/NCV test?

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.

niki
Participant

January 2, 2020 at 3:50 am

Post count: 10

#31850

Hi Doc! My apologies, I didn’t expect for you to write back so quickly.

That’s a great question. I’ve seen a Mayo clinic nuerologist and they don’t believe it’s Ms. I’ve had multiple brain MRIs as well as 2 EMGs. (those are not fun, by the way!)

That’s good to hear about my spine, thanks! So is it rather normal for a 33 year old woman to have those results with all those osteophytes? I have a positive HLA-B27 for aclondysis spondylitis but not sure where to go or look for there since it’s just a marker.

My symptoms are the worst and have really affected my quality of life, sadly.

I know I said this last time, but truly.. Thank you for your help.

Donald Corenman, MD, DC
Moderator

January 3, 2020 at 7:36 pm

Post count: 8660

#31856

You need the best, most experienced neurologist you can find. The Mayo is a good clinic but most individuals see “lower-rung” department members who don’t have the experience you need. Research the names on PubMed papers that have written about your condition and then pick the most-senior author as the one you should see.

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.

niki
Participant

January 14, 2020 at 3:18 am

Post count: 10

#31911

Thanks Doc, so I’ve reached out to additional nuero but it does seem hard for me to be heard. I also wanted to ask if you had experience with ankylosing spondylitis?

I didn’t mention I my positive gene marker for AS and mild degenerative changes along my labrum of my hip and “increased signal along sciatic nerve”

Is it possible that the MRI issues with my neck could cause all over pain and hand tingling? is there any osteo type imaging that could rule out AS?

When I went down this path they suggested Humira out steroids as a trial and I just really wanted to make sure our diagnosis was right with images needed.

Best,

Niki

Donald Corenman, MD, DC
Moderator

January 15, 2020 at 9:40 am

Post count: 8660

#31914

Ankylosing Spondylitis can cause migrating pains but generally announces itself with spinal ligament ossification and sacroiliac involvement. Did you have an MRI of the SI joints?

They probably do not have a diagnosis currently and may be advocating for Humira as a trial. Have you seen a rheumatologist?

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.
Author

Posts

Viewing 6 posts - 1 through 6 (of 17 total)

1 2 3 Next

You must be logged in to reply to this topic.

Donald Corenman, MD, DC

Average rating:

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel