MRI report of the Lumbar & Thoracic

Tagged: burst fracture L1

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VarunGupta
Participant

June 30, 2015 at 8:03 pm

Post count: 4

#19975

Greetings Doctors

Can you please explain me in a layman term regarding my MRI report (please refer below) and what steps I need to take

MY MRI report from the radiologist is as follows:

MRI – THORACIC & LUMBAR SPINE
Indication: Spinal injury 34 year ago. Increase in weakness and
instability.
Findings: There is a crush fracture of Ll which has healed and there is
some retropulsion of the body of Ll with narrowing of the spinal canal. There is gliosis of the conus with cystic myelopathy measuring 33mm beginning at the mid T12 vertebral body level.
There is mild foraminal constriction at L1/2. There is no disc
protrusion at T12/L1 or L1/2.
L2/3 shows mild generalised disc bulge and retrolisthesis but there is only
mild central stenosis. Bilateral foraminal constriction is seen prominent
however and there could be pressure on exiting L2 nerve roots. Facet
degenerative changes are seen.
L3/4 shows mild facet degenerative change and generalised disc bulge but no significant central stenosis or foraminal constriction is seen.
L4/5 shows no disc protrusion but generalised annuls bulges. No
foramina’ constriction or significant central stenosis is seen.
L5/S1 shows mild generalised disc bulge and posterior element hypertrophic change with mild central stenosis. There is prominent left sided
foraminal constriction and there could be pressure on exiting L5 nerve roots.
The rest of the thoracic spine shows spondylosis and facet degenerative changes but there is no significant central stenosis or foraminal constriction. Mild disc protrusion is seen at T7/8 and below.
Spondylosis of the cervical spine is seen as well with disc protrusion at C3/4 and below with some effacement of anterior CSF space. There is no cervical compressive myelopathy however. Facet degenerative changes are prominent.
Coot /2
The craniocervical junction looks normal. Mild scoliosis is convex to the
right in the upper region with minimal scoliosis convex to the left in the thoracic region. No new pathology is seen. No bony destruction is
apparent.
Impression: Old healed crush fracture of Ll with some residual spinal
canal stenosis and cystic myelopathy of the conus which would explain the neurological symptoms with post traumatic syrinx.

Thank you

Kind regards

Varun Gupta

Donald Corenman, MD, DC
Moderator

July 9, 2015 at 1:44 pm

Post count: 8660

#20005

Imaging studies do not live in a vacuum. Symptoms need to be correlated to the images to understand the pain generators.

You have had a previous burst fracture of L1. The vertebra under too much load fails and “bursts” apart like a wine barrel that has been dropped from a height. The pieces spread apart and one or more fragments entered the spinal canal. At this level, there are nerve roots and the end of the spinal cord called the conus. This fracture injured the conus as noted by the post-injury appearance (“There is gliosis of the conus with cystic myelopathy measuring 33mm beginning at the mid T12 vertebral body level”). Gliosis is scar tissue formation in the spinal cord and cystic myelopathy is a fluid-filled cyst formation that can occur after spinal cord injury.

There remain stenosis (narrowing) of the spinal canal due to the healed fracture fragment remaining in the canal.

The conus is responsible for bowel and bladder function as well as sensation to the rectum and perineal areas (buttocks). I would suspect that you have issues with these areas.

You might have some compression of the L5 nerve on the left (“prominent left sided
foraminal constriction and there could be pressure on exiting L5 nerve roots”). See lumbar foraminal stenosis to understand this condition.

There is no mention of the alignment of the old L1 fracture. This area of the spine is normally “straight” but with a fracture like this, you might be developing increased kyphosis (anterior bowing of the spine). Standing X-rays with flexion/extension are necessary to determine stability and alignment.

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.

VarunGupta
Participant

July 15, 2015 at 4:38 am

Post count: 4

#20020

Thank you Dr. Corenman for your feedback.

I will try to find a way to send you the MRI images.

Can you please advice me of the short/long term issues and complication that can arise.

Presently I have been undergoing deep massage therapy & Hydrotherapy and I find my muscles on the legs (calf) are improving.

I do not have any issue with bladder / bowel movement.

Dr. Corenman, I appreciate your thoughts please when convenient

Donald Corenman, MD, DC
Moderator

July 18, 2015 at 1:14 pm

Post count: 8660

#20047

The issues depend upon deformity and symptoms. Deformity is the alignment of the spine after the fracture. Is the deformity acceptable or is the spine too “bent forward” (fracture kyphosis). Symptoms obviously are pain, numbness and weakness developed from the fracture. Are these acceptable to you?

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.

VarunGupta
Participant

January 25, 2016 at 6:10 pm

Post count: 4

#21199

Dear Dr Corenman

Greetings & Happy New Year.

I am based in Brisbane, Australia.

I need you help again. I have done my 2nd MRI after a gap of 6 months. Can you please advise me in laymans language about my short & longterm issues and the complication that can arise. What kind of treatment do you advise.

Over the last 6 months I have had three falls and most recently I have bruised by tailbone (coccyx).

Please find below details of the current MRI Report:

Findings: Abnormal segmentation of the spine with only 11 thoracic type vertebrae. The fracture has been previously called L1 vertebral body (however when counted down from the craniocervical junction this is T12 although no ribs are present). For reporting purpose, the fracture vertebrae will continue to be referred to and labelled as L1 with absent T12 vertebrae.

Old compression fracture of L1 vertebral body with posterior extension by 7mm which narrows the central canal with an associated conus syrinx which extents is 35mm in cranicaudal dimension and is 5 x 6 mm in maximal transverse by AP dimensions.
At L1/2 minor disc bulge not causing significant stenosis.
At L2/3 minor Grade 1 retrolithesis of L2 on L3 measuring 5mm with uncovering of the intervertebral disc, minor narrowing of the neutral foramina bilaterally without nerve root compression.
At L3/4 mild disc bulge not causing significant stenosis.
At L4/5 disc bulge causing mild narrowing of the neural foramina without nerve root compression.
At L5/S1 moderate disc bulge is causing severe narrowing of the left neural foramen and compression of the exiting nerve root and mild narrowing of the right neural foramen. Bilateral facet joint arthropathy at L5/S1 with enhancement present in keeping with synovitis, this is worse on the left
Conclusion:
Abnormal segmentation of the spine with only 11 thoracic type vertebrae, the fractured vertebrae has been labelled as L1 however it is the 12 thoracic vertebrae if counted from superiorly.
Long standing L1 fracture with posterior retropulsion narrowing the central canal and an associated conus syrinx, no prior imaging available to assess the change.
Degenerative change present through the lumbar spine, most marked at L5/S1with is severe narrowing of the neural foramen with nerve root compression, although on the images, this has been labelled as L5/S1 it is in fact L4/5 if counted from superiorly and this will be the left L4 nerve root.
At L5/S1 bilateral facet joint anthropathy and synovitis, worse on the left

Appreciate your help Dr Corenman

thank you

Kindest regards

Varun Gupta

Donald Corenman, MD, DC
Moderator

January 30, 2016 at 10:57 am

Post count: 8660

#21236

You do have some pathology from your fracture but I cannot determine any correlation between these disorders and symptoms until I know what your symptoms are. See the section https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-lower-back-and-leg-pain/ to understand how to describe what you are suffering from.

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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