MRI OF CERVICAL SPINE

Tagged: Syringomyelia, syrinx

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

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Drjcastill
Participant

November 16, 2015 at 6:32 pm

Post count: 3

#20740

Hi Dr. Corenman,

I have Chiari 1 Malformation and Syringomelia and was decompressed last April. I would like your opinion on my recent MRI…the tech went a little lower to cover my thoracic where the syrinx was.

IMPRESSION
Statues post Chiari one decompression with stable extensive lower cervical and upper thoracic syrinx.
Stable multilevel spondylosis

FINDINGS
A segmental syrinx extending from C5-C6 to at least T5. There is a straightening of the cervical lordosis.

C2-C3 and C3-C4 demonstrates a tiny central disc protrusion
C4-C5 demonstrates a mild bilateral facet hypertrophy. There is no significant central or neuroforaminal stenosis.

C5-C6 demonstrates a broad disc osteophyte complex eccentric to the left with a small paracentral disc protrusion. There is bilateral Uncovertebral joint hypertrophy. Bilateral, left greater than right neuroforaminal stenosis. Mild central stenosis.

C6-C7 demonstrates bilateral uncovertebral joint hypertrophy with a broad bulge. Mild bilateral neuroforaminal stenosis.

C7-t1 through T4-t5 are within normal limits

The paracentral soft tissues are within normal limits.

I am still experiencing burning in hands, arms and sometimes chest area and back. Neck pain, shoulder and back pain also.

Donald Corenman, MD, DC
Moderator

November 17, 2015 at 6:50 am

Post count: 8660

#20742

Generally, a Chiari syrinx causes minimal symptoms unless it is expanding or has expanded. You do have foraminal stenosis at C5-6 which could explain some of your upper extremity symptoms. You could consider a SNRB (selective nerve root block) of the C6 nerve to determine if you gain temporary relief (see pain diary). This level might be contributing to your overall symptom picture.

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.

Drjcastill
Participant

November 17, 2015 at 1:32 pm

Post count: 3

#20743

Dr Corenman,
2/14 – My syrinx was 10mm in diameter before I had surgery. Since then it has reduced to 4mm but the sympthoms persists.

2-14 & 7/14 ~ C6 & C6-C7 disc buldging, mild space narrowing, osteophytes and uncovertebral joint hyperostotic osteoarthritis causing mild bilateral neural foraminal encroachment.

MRI 1 yr post op
IMPRESSION
Status post suboccipital craniectomy with post surgical changes in the posterior fossa
Multiple ares of syringohydromyelia within the lower cervical and upper thoracic, as described below.
Mild multilevel degenerative changes without significant central canal or neural foramina narrowing

COMMENTS
There is a straightening of the normal cervical lordosis with normal alignment of the vertebral bodies. There is normal vertebral body height and signal intensity. There is narrowing of disc height at C5-C6 with small osteophyte formation, and also at C6-C7 level.
Stable postsurgical changes suboccipital craniectomy with mild changes of encephalomalacia in the posterior cerebellar hemispheres and mild enlargement of the 4th ventricle.
There are multiple linear ares of syringohydromyelia within the lower cervical and upper thoracic cord, starting at the level at C5 vertebra superiorly to at least the level of T4 vertebral body inferiority. The maximum AP diameter is of approximately 4 mm at the level of C7 vetebrae. The maximum transverse diameter is approximately 6 mm. There are small areas of susceptibility artifact seen within the syringomyelia at the level of C7-T1

Drjcastill
Participant

November 17, 2015 at 1:34 pm

Post count: 3

#20744

Dr Corenman,
2/14 – My syrinx was 10mm in diameter before I had surgery. Since then it has reduced to 4mm but the sympthoms persists.

2-14 & 7/14 ~ C6 & C6-C7 disc buldging, mild space narrowing, osteophytes and uncovertebral joint hyperostotic osteoarthritis causing mild bilateral neural foraminal encroachment.

MRI 1 yr post op
IMPRESSION
Status post suboccipital craniectomy with post surgical changes in the posterior fossa
Multiple ares of syringohydromyelia within the lower cervical and upper thoracic, as described below.
Mild multilevel degenerative changes without significant central canal or neural foramina narrowing

COMMENTS
There is a straightening of the normal cervical lordosis with normal alignment of the vertebral bodies. There is normal vertebral body height and signal intensity. There is narrowing of disc height at C5-C6 with small osteophyte formation, and also at C6-C7 level.
Stable postsurgical changes suboccipital craniectomy with mild changes of encephalomalacia in the posterior cerebellar hemispheres and mild enlargement of the 4th ventricle.
There are multiple linear ares of syringohydromyelia within the lower cervical and upper thoracic cord, starting at the level at C5 vertebra superiorly to at least the level of T4 vertebral body inferiority. The maximum AP diameter is of approximately 4 mm at the level of C7 vetebrae. The maximum transverse diameter is approximately 6 mm. There are small areas of susceptibility artifact seen within the syringomyelia at the level of C7-T1

I am missing the last page but this was April and the one I posted last night was from last wee. It seem as though C5 to C7 is getting worse what ever is wrong.

Donald Corenman, MD, DC
Moderator

November 22, 2015 at 10:16 am

Post count: 8660

#20770

Your symptoms could be from the syringo but might also originate from the C5-7 levels. I would think a cervical selective nerve root block (SNRB) at the worst level or the level that seems to be related to your symptoms (figured out by a good history and physical examination) would be helpful to determine if these are pain generators.

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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