MRI Cervical Spine is surgery the only answer

Tagged: cervical nerve root and spinal cord compression

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

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Glow
Participant

November 1, 2020 at 2:25 am

Post count: 3

#33327

Hi Dr Corenman,
I am wondering if surgery is the only answer for my problem. I started having mild pain and tingling in my left arm in April. In July, it became much worse and I went to my GP. He ordered an x-ray and gave me two weeks of prednisone and a week of flexeril. This did not help my symptoms, so we proceeded with an MRI. Here are the results of the MRI:

Narrative and Impression

MRI Cervical Spine without contrast

Image quality: Diagnostic

Findings:

Alignment Straightening of normal cervical lordosis. No fracture or subluxation.

Marrow signal: Normal marrow signal is identified within the visualized bony structures No discrete marrow lesion.

CERVICAL AND VISUALIZED THORACIC Cord is compressed at several levels notably C5-C6 and C6-C7 Cord edema/gliosis present at the C-6 level.

Prevetebral and Paraspinal Soft Tissues: Normal

Visualized Posterior Fossa: The visualized Posterior Fossa demonstrates no abnormal signal.

NARRATIVE AND IMPRESSION

Cervical Disc Spaces:
C2-C3: Bilateral facet arthrosis, small right posterolateral disc osteophyte without significant stenosis.

C3-C4: Decreased disc height marginal osteophytes with small central protrusion. The cord is slightly flattened, AP dimension of the sac reduced to 5-6mm.

C4-C5;. Circumferential bulging of the disc broad-based left posterolateral disc osteophyte. AP dimension of the sac reduced centrally to approximately 6-7mm. Minor flattening of the cord, foramen are patent.

C5-C6:. Circumferential bulging of the disc extending asymmetrically to the left, AP dimension of the sac reduced to 4-5mm. Right greater than left facet arthrosis, foramen patent

C6-C7:. Broad-based posterior protrusion present. AP dimension the sac 3-4mm. Disc extends asymmetrically to the left. Correlate for myelopathy and left C7 radiculitis.

C7-T1:. Minor bulge, no critical stenosis.

Upper thoracic disc space: Normal

IMPRESSION

Multifocal spondylosis and osteoarthritis with cord compression present to varying degrees from the C3-C4 to the C6-7 level inclusive. Most severe stenosis at C6-C7, 3-4mm, where broad-based left posterolateral protrusion is present. Correlate for myelopathy and left C7 radiculitis.

Cord edema/gliosi C-6 level

When the MRI was ordered, I was put on Gabapentin 3 times a day. After the MRI results came back, my GP said to see a neurosurgeon and if surgery was suggested, I should get a second opinion. Surgery was suggested as one option and the other option was to try ESI and physical therapy. I had one ESi with no relief and I went to physical therapy and after her assessment, she said I needed to go back to the neurosurgeon. I called the neurosurgeon office and had my follow up appointment moved up to November 10. Do you have any recommendations for me? Please help as time is very short for me to make a decision.

Thank you for your time.
Gloria

Donald Corenman, MD, DC
Moderator

November 1, 2020 at 9:11 am

Post count: 8660

#33331

You note; “I started having mild pain and tingling in my left arm in April. In July, it became much worse”. I’m not sure what “worse” means (pain, increased pins and needles, weakness??) but I’ll continue.

Your imaging findings are significant; “Multifocal spondylosis and osteoarthritis with cord compression present to varying degrees from the C3-C4 to the C6-7 level inclusive. Most severe stenosis at C6-C7, 3-4mm, where broad-based left posterolateral protrusion is present….Cord edema/gliosis C-6 level”.

This means that your central canal where the spinal cord occupies this space is very narrowed. Normally the canal minimal diameter is 14mm and yours is 3-4mm, very narrowed with indication of cord injury “edema/gliosis C-6 level”. This will cause myelopathy. See this section https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/

Your symptoms which initially drove you to the doctor (left arm symptoms) are most likely generated from the compression of the C7 nerve root at the C6-7 level (“broad-based left posterolateral protrusion”) causing foraminal stenosis. See this section https://neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/

In my opinion, you need surgery sooner than later.

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.

Glow
Participant

November 1, 2020 at 9:23 am

Post count: 3

#33332

When I say it became worse in July, ran the pain and tingling were worse in intensity and almost constant. Prior to July, I had mild pain and mild tingling that would only happen intermittently.

Also, since I have seen the physical therapist, the pain has become unbearable.
I get very little relief. I called pain management and they increased the gabapentin from 100 mg 3 times a day to 300 mg 3 times a day.

I would like to thank you very much for your feedback and I will be scheduling surgery when I see the neurosurgeon November 10. The neurosurgeon didn’t know what type of surgery could be done and sent me for a flexion extension x-ray. He said it would either be disc replacement or ACDF. The only thing on my flexion extension x-ray is retrolisthesis at C5 + C-. I’m hoping for disc replacement but I won’t find out until November 10. Any other opinion on this would be greatly appreciated.

Thank you again.
Gloria

Donald Corenman, MD, DC
Moderator

November 2, 2020 at 5:30 am

Post count: 8660

#33336

For a level of central stenosis, I recommend against an artificial disc replacement and advocate for an ACDF.

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.

Glow
Participant

November 2, 2020 at 12:17 pm

Post count: 3

#33339

Thank you so much for your feedback. I sincerely appreciate your feedback and the fact that you offer this forum.
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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.

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