Making sense of my results

Tagged: long distance consultation

Viewing 5 posts - 1 through 5 (of 5 total)

Author

Posts
exspine
Participant

September 12, 2018 at 3:15 am

Post count: 3

#29325

Dear Dr. Corenman,

Three months ago I made an MRI of my cervical and lumbar spine, and the reason being that I knew that I had a small disc herniation at C5/6 (asymptomatic) and that I occasionally did get a ‘thrown back’, symptoms of which lasted for couple of weeks once and usually cleared within few days with every episode. I was mostly active and asymptomatic (running total of 8K five days before the MRI). When I say mostly asymptomatic, I did tend to get pins and needles in my hand, and some pins and needles in my pinky toe when flexing the foot inside.

To my great surprise these were the results of the MRI:

Cervical spine

– Straightened lordosis of cervical spine
– Initial spondyloarthritic changes in small intervertebral joints
– Disc degeneration C4/5, C5/6 and C6/7
– Compressive disc osteophyte complex c3/4 and c4/5 dorsomedial and right compressing thecal sac and medula spinalis but without myelopathy. Also compressing radixes bilaterally
– Also herniated discs C5/6 and C6/7 dorsomedial bilateral, with compression on radixes bilaterally, thecal sac and medula spinalis without myelopathy
– No foraminal stenosis
– No cervical stenosis

Lumal spine
– Stenosis of vertebral canal at L3/4, L4/5 and L5/S1
– Disc degeneration at L3/4, L4/5 and L5/S1 with Modic2 type changes
– L3/4 herniated disc with annular tear without compression
– L4/5 herniated disc with annular tear compressing radixes bilaterally and branches of cauda equina
– L5/S1 disc extrusion to the right with annular rupture. Herniated disc compressing radixes bilaterally and branches of cauda equina

I have been explained that this is a very bad MRI finding, and that I need surgery even though my sypmtoms are mild to moderate. I did develop some additional symptoms in last three months and to recap:

Cervical symptoms

– Very mild neck pain on the left side when performing Spurling manoeuvre
– Occasional mild tingling in fingers
– My hands do tend to get numb while I sleep but moving the position helps
– When bending left elbow suddenly I do tend to get mild electrical sensation
– No motor weakness

Lumbal symptoms
– Couple of weeks I got thrown back and could not get out of the bed for a day, but eventually recuperated and now only have very mild buttock pain that seems to be diminishing by the day, albeit slowly
– There is a patch of skin on my heel that went almost numb to sensation, but seems to get better
– I perform heel and toe walk without problems

I have been told by one neurosurgeon that I need an immediate surgery, but have been advised by second and thrid not to do it, since I have no symptoms.

My question is, how could I end up in a situation like this without knowing about it?
What could be the cause, since I am athletic, 6 foot tall and 190 lbs and been doing recreational sports almost my entire life?
How can I prevent further deterioration of my spine?
What are the chances of my rehabilitation, could I be able to run, hike, ski, drive a bicycle?

I know this is too much to ask, but I would just like your opinion about the matter.

Thanks.

exspine
Participant

September 13, 2018 at 3:05 am

Post count: 3

#29369

I have just now realised that I failed to mention some symptom specifics:

– Shock like sensation in the hand when bending the elbow is in mostly in the pinky finger
– Mild buttock pain I am referring happens when I bend forward and in the right leg
– Loss of sensation on the heel is on the right side, and is diminishing by the day

Donald Corenman, MD, DC
Moderator

September 15, 2018 at 2:02 pm

Post count: 8660

#29373

You don’t have to jump into surgery if you have no myelopathy (spinal cord dysfunction) or motor weakness. You have a genetic predisposition to degenerative disc changes. There is probably nothing in particular that you did to cause this but running increases wear on the discs and if you could find another exercise (cycling, swimming, hiking) that could reduce or eliminate your running, the advancing degeneration changes would be reduced.

Your complaints of “Shock like sensation in the hand when bending the elbow is in mostly in the pinky finger” and “When bending left elbow suddenly I do tend to get mild electrical sensation” is probably from ulnar nerve compression. See https://neckandback.com/conditions/cubital-tunnel-syndrome/.

Your findings of “L5/S1 disc extrusion to the right with annular rupture. Herniated disc compressing radixes bilaterally and branches of cauda equina” is probably causing your “Mild buttock pain I am referring happens when I bend forward and in the right leg”. As long as you don’t have problems with strength in your calf muscles (tip toeing), you probably are OK. See https://neckandback.com/conditions/home-testing-for-leg-weakness/

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.

exspine
Participant

September 16, 2018 at 12:26 am

Post count: 3

#29382

Thank you very much Dr. Corenman.

Is there any way for me to have you review the MRI images and provide a consultation for people living overseas?

I would like you to take another look at my images and give me the impression along with a brief discussion on the symptoms.

Best

Donald Corenman, MD, DC
Moderator

September 20, 2018 at 8:57 am

Post count: 8660

#29392

I have a program called a “long distance consult” in which I review all the films you send to me as well as my new patient intake form you fill out and call you for an over the phone consultation which can last from 20-40 minutes. I make suggestions and follow-up calls are included. You can contact Lori, my office manager at the number at the top of the page for further information.

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 5 posts - 1 through 5 (of 5 total)

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