MRI Needs helps please

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elesh
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May 16, 2013 at 2:35 am

Post count: 13

#8677

I have been suffering from neck pain for 2 years or more now. I had an MRI and Dr suggested I need surgery. I would like some advice and help if surgery is only option or i can have any other treatment. I am very scared of the surgery please help to clarify this result as it seems too complicated for me. Many thanks

MRI CERVICAL SPINE

TECHNIQUE
Multi-planar,multi-sequence MRI of cervical spine was performed on 1.5 tesla phillips acheva scanner using 8 cahnnel nv coil

OBSERVATION

Curvature and Alignment
Straightening and reversal of the normal cervical lordosis.
Vertebral Bodies

With anterior and posterior osteophytic formations especially at c5/6. Focal fatty deposits/hemangioma within the c5 vertebral body.

Posterior elements

Facetal arthropathy especially at c7/01 on theleft

Discs

Small right foraminal disc herniation at C3/4 right paramedian and foraminal disc herniation at c5/6 identing the discs and impinging upon the nerve roots at the recess and neuroforament left paramedian disc. Osteophyte complex at c6/7 also obliterating the theca and imping upon the nerve roots at recess and neuroforamen.

Canal and Foramins
Canal stenosis of about 8mm at c5/6, c6/7
sorry posted in wrong sections before and dont know how to change. sorry for repost

Paravertebral sof tissues normal.

Spinal cord

Slight cord impingement by the posterior disc osteophytic complexes at c5/6, c6/7. No obvious cord signal changes seen.

Left paramedian disc osteophyte disc osteophyte complex at C6, the nerve roots at the recess and neurofaramen canal stenosis of about 8mm and slight cord impingement without myelopathy at c5/6, c6/7

Thanks please advice if any further test can be done before I can decide if surgery is necessary and if surgery is only option in my case. Thanks

Donald Corenman, MD, DC
Moderator

May 18, 2013 at 12:22 am

Post count: 8660

#8696

It is very hard to determine if you need surgery without understanding the symptoms you suffer from and your history/activity level. Are your symptoms myelopathy, radiculopathy or neck pain (see website for those descriptions)? With a narrowed canal but no significant exposure to dangerous neck activities (mountain/road cycling, surfing, skiing, horseback riding, contact sports) risks of cord injury are reduced.

You do have a very narrowed spinal canal at C5-7; “Canal stenosis of about 8mm at c5/6, c6/7” but that is followed by the statement; “Slight cord impingement by the posterior disc osteophytic complexes at c5/6, c6/7. No obvious cord signal changes seen”.

The statement; “Slight cord impingement” with a canal diameter of 8mm does not make sense to me as that should create at least moderate if not severe cord impingement. The radiologist is painting a picture that is hard to follow.

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.

elesh
Participant

May 18, 2013 at 12:41 am

Post count: 13

#8697

Thank you for prompt reply dr
Mainly neck pain.
Never suffered any kind of injury previously

Donald Corenman, MD, DC
Moderator

May 18, 2013 at 2:38 am

Post count: 8660

#8698

Neck pain may be related to narrowing of the spinal canal as the degenerative changes that occur with degenerative disc or facet disease can cause neck pain as well as produce the bone spurs that compress the spinal canal. A neck pain workup is different than a suggested surgery for cord compression but these two potential surgeries may still be one and the same if these degenerative levels cause both cord compression and neck pain.

If you are active (the noted sports I previously mentioned along with some others), you have a higher risk for cord injury (see central cord syndrome) due to head impact

Neck pain can be worked up with a careful history and physical examination as well as evaluation of the images including flexion/extension X-ray images. Further studies such as discograms, facet blocks or SNRBs may need to be considered.

Dr. Corernman

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.

elesh
Participant

May 18, 2013 at 2:49 am

Post count: 13

#8699

Many thanks Dr really appreciate your help and feedback.
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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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