mri explanation please

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Abbeygirl
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July 5, 2011 at 1:20 am

Post count: 40

#4690

Hi Doctor i am writing again i was wondering if you could please explain my mri results to me please findings in the supline scanning position alignment is anatomic the tip of the conus lies at L1 and has normal morphology and signal intensity. L5/S1 laminectomy noted. NO pseudomeningocoele or changes to suggest infectious discitis. The lumbar nerve roots at the L4/5 level appear more clumped than on the previous scan raising the possibility of developing adhesive arachnoiditis. no generalised nerve root enhancement to support this
At L5/S1 there is disc degeneration with loss of disc height and hydration. the previously documented asymmetric posterior disc/ridge complex more pronounced on the left is again noted this with the epidural and perineural enhancing granulation tissue combines to displace and slightly compress the left s1 nerve root as it crosses the disc the left s1 nerve root is swollen and shows asymmetric enhancement.there is only minimal right s1 lateral recess compromise. no significant L5 foraminal stenosis seen mild L5/S1 facet joint degenerative change noted.
no other potential compresive neural lesion seen in the lumbar or lower thoracic spine the prominent schmorls node at the inferior endplate of l1 is noted no para vertaebral abnomality seen.
comment
the subtle clumping of the lumbar nerve roots at L4/5 and L5 levels may reflect mild adhesive arachnoiditas.? time since previous surgery asymmetric osteophytic disc/ridge complex compounded by post- operative epidural and perineural enhancing granulation tissue compromises the left S1 nerve root as it crosses the disc and there is left S1 enhancement on the post contrast scans consistent with nerve root inflammation.thanks doctor for the great service you provide i wish you worked in australia thanks again

Donald Corenman, MD, DC
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July 5, 2011 at 1:40 am

Post count: 8660

#4691

Interpretation

tip of the conus lies at L1 and has normal morphology and signal intensity-

NORMAL

L5/S1 laminectomy noted. NO pseudomeningocoele or changes to suggest infectious discitis.

NOTES NO EVIDENCE OF INFECTION AT SURGICAL SITE

The lumbar nerve roots at the L4/5 level appear more clumped than on the previous scan raising the possibility of developing adhesive arachnoiditis. no generalized nerve root enhancement to support this

POSSIBLE ARACHNOIDITIS (SEE WEBSITE FOR EXPLANATION) NO ENHANCEMENT MEANS ROOTS DO NOT HAVE INCREASED VASCULARIZATION- PRESENCE WHICH COULD INDICATE INFLAMMATION- ENHANCEMENT PRESSENCE OR ABSENCE DOESN’T HELP WITH DIAGNOSIS ONE WAY OR THE OTHER.

At L5/S1 there is disc degeneration with loss of disc height and hydration. the previously documented asymmetric posterior disc/ridge complex more pronounced on the left is again noted this with the epidural and perineural enhancing granulation tissue combines to displace and slightly compress the left s1 nerve root as it crosses the disc the left s1 nerve root is swollen and shows asymmetric enhancement.

THE DISC AT L5-S1 IS DEGENERATIVE (AS WOULD BE EXPECTED AFTER 2 HERNIATIONS AND 2 SURGERIES) THERE IS A BONE SPUR PROTRUDING FROM THE DISC SPACE AT L5-S1 WHICH CONTINUES TO COMPRESS THE NERVE ROOT SOMEWHAT. THERE IS GRANULATION TISSUE (COMMON AFTER SURGERY) PRESENT. THE NERVE ROOT IS STILL SLIGHTLY COMPRESSED. THE MODIFIER “SLIGHTLY” IS HARD TO INTERPRET. COULD COMPRESSION BE SIGNIFICANT OR MILD? THE LEFT NERVE ROOT IS SWOLLEN- EXPECTED AFTER 2 HERNIATIONS AND 2 SURGERIES. NO SIGNIFICANT FORAMINAL STENOSIS AT L5 (THIS WAS ONE OF THE POSSIBLE DIAGNOSES AND IS NOT PRESENT ACCORDING TO THE RADIOLOGIST).

ACCORDING TO THE REPORT, THE NERVE IS SWOLLEN AND STILL COMPRESSED BUT BY HOW MUCH IS NOT DETERMINED. YOU COULD HAVE ROOT IRRITATION (SEE CHRONIC RADICULOPATHY ON WEBSITE) OR CONTINUED COMPRESSION WHICH MAY IMPROVE BY A THIRD DECOMPRESSION SURGERY. ANOTHER SET OF EYES (A SECOND OPINION) MAY BE HELPFUL TO UNDERSTAND WHAT IS GOING ON

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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