MRI Results and increased pain/weakness

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kala9333
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December 7, 2012 at 6:57 am

Post count: 2

#7546

I am in a world of pain and trying to find someone to help me understand exactly what is happening to me now. I have had back pain for many years and recently found out I am HLA B-27 positive which seems to be some of the reason for some of the lower back problems. In addition I have several autoimmune problems. I had an injury a year ago to my neck causing C3-4 central disc bulging & ventral flattening of the thecal sac. C4-5 broad based disc bulging, causing ventral flattening of the thecal sac and CSF sround the spinal cord and in the nerve root sleeves. C5-6 there is a central disc bulging, causing ventral flattening of the thecal sac. No central or forminal stenosis. C6-7 There is a focal right paracantral disc herniation, causing ventral flattenig of the thecal sac, compromising the right foramen, and flattening te right side of the spinal cord. There is still a small amount of CFS around the cord dorsally and in the left nerved root sleeve, but the right nerve root sleeve is shortened.
I have very little information as to what this all means, but I am in alot of pain with grinding and popping when I move my neck. I have pain and weakness in my right shoulder, arm and hand, numbness etc. in fingers. The injury also caused atipical trigeminal neuralgia for which I was prescribed tegretol, but my primary physician screams because he says tegretol destroys bone marrow and it doesn’t seem too effective because the pain gets terrible. I am also having daily migrane type headaches. Ears are ringing and some visual disturbances The doctors wanted to do surgery for the C6-7 disc but are unable to operate due to an elevated white count possibly caused by one or all of the autoimmune problems I have had for years. Epidural steroids have been ruled out because I am not a good candidate due to reactions to steroidal injections in the past. I would appreciate any information You could give me to help me. I can’t get ant one to take the time to sit down and break down what it all means and there doesn’t seem to be any option for me at this time.

Donald Corenman, MD, DC
Moderator

December 7, 2012 at 8:06 pm

Post count: 8660

#7547

You have a number of problems going on at once. Let’s break them down to simpler elements to allow some basic understanding.

The HLA B-27 is a genetic marker that makes you more susceptible to autoimmune phenomenon that can affect the musculoskeletal system. That is, you might have your own immune system attack your spine causing pain, stiffness and aching. Have you been diagnosed with a disorder called Ankylosing Spondylitis?

The pain in your neck and right shoulder/arm/hand more likely than not is not related to an autoimmune phenomenon. You have a disc herniation at C6-7 that is compressing the right C7 nerve root. This can cause neck pain that radiates into the shoulder, arm and hand, especially into the middle fingers. Sound familiar?

You have what I like to refer to as CNS or “crappy neck syndrome”. You have four consecutive discs in your neck that are degenerative. The upper three discs bulge and efface the thecal sac, the sack of water (CSF) that surrounds the spinal cord. By your description, other than at C6-7, these bulges do not compress the spinal cord. These upper discs can cause local neck pain but should not cause arm pain if they do not press on the nerve roots.

What is the percentage of neck pain vs. shoulder and arm pain? This makes a big difference in prognosis. If you have mainly neck pain (let’s say 70%) and only 30% shoulder and arm pain, surgery for the C6-7 level will probably only give you 40-50% total relief as the neck pain is most likely caused by all the problem discs. Fixing one disc will only relieve about 20% of your neck pain (about 1/4th of 70%) and should eliminate most of your arm pain (the remaining 30% due to arm pain for a total sum of about 50%)

If we turn the numbers around and assume you have 30% neck pain and 70% arm pain, then you can speculate that you should have a total of 80% relief of pain (1/4 of 30% is about 10% and then add elimination of the 70% of arm pain for a total of 80%).

There are some bold assumptions made with that prognosis but that is the general thought process for relief of pain by surgery.

Grinding and popping in the neck is normally related to the facets. Normally, noises made by the neck are not painful but if you do have pain, degenerative facets could cause this. Do you have a degenerative spondylolisthesis on your flexion/extension X-rays (see website for explanation)? If the facets do generate pain, these can be diagnosed by facet blocks and possibly pain reduction could come from rhizotomies (see website).

Visual disturbances, ringing in the ears and trigeminal neuralgia are all mediated by intracranial processes and are not my specialty. You would have to consult a neurologist for information on those processes.

An elevated white count could originate from many different processes. If you have an elevation from your autoimmune process, this elevation should be able to be ruled out as an infection by the appropriate specialist (rheumatologist or hematologist). This should hopefully clear the way for surgery (most likely an ACDF) at C6-7.

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.

kala9333
Member

February 15, 2013 at 5:33 am

Post count: 2

#8008

Dr. Corenman,
Thank you so much for your reply. I was having so much pain and had developed several other problems. There was swelling and a buldge on the right side at the base of the skull that was very painful and the twitch in the upper lid was more frequent. the left eye was starting to develop the same deep twitch/spasm (not just a little eyelid thing going on) and there is pain in the left shoulder and side of my neck so my doctor ordered another MRI. the findings were: Vertebral bodies are stable in their height and marrow signal. No development of a foramen magnum or cervical cord lesion.
The patient shows development of about 3mm of C3-4, C4-5 and C5-6 spondylolisthesis.
C2-3 Within normal limits without change.
C3-4 There is facet arthropathy and disc bulging, progressive disc bulging, not causing central canal stenosis or foramen stenosis.
C4-5 There is a broad disc osteophyte protrusion, more bony, bilateral foramen stenosis with attenuated CSF in the root sleeves. The central canal is patent. No change.
C5-6 Broad disc osteophyte bulging and facet arthropathy. no central canal stenosis. No foramen are patent. No detrimental change.
C6-7 There is a broad osteophyte with a tight right foramen stenosis by uncovertebral joint hypertrophy. left foramen also shows some narrowing, but less so. No change.
C7-T1 No disc protrusion, central canal or foramen stenosis.

Impression:
1. DEVELOPMENT OF SUBLUXATION AT C3-4 TO C5-6.

2. FORAMEN IMPINGEMENT AT MULTIPLE LEVELS BY OSTEOPHYTE.

Needless to say I do not understand what any of this means and again would greatly appreciate your help. My pain and other problems seemed to be only affecting the right side with rarely minor pain and eye twitching on the left side. In the last three months the pain in the left side of my neck and shoulder area have increased with deep twitching in the left eye so bad that at times I am uncomfortable being in public and afraid to drive myself not knowing when and how bad it will be. With both eyes twitching at the same time now I am quite a sight and very uncomfortable with the resulting vision problems and unable to wear my contacts anymore. The pain in the left side of my neck and left shoulder area have become more debilitating than those I experience on the right. My doctor wanted to do a rhizotomy on the right side due to swelling and tenderness that had developed at the base of my skull on the right side but it has slowly gotten better over the last three weeks. I am reluctant now to pursue this plan for treatment in light of the new MRI and the increasing pain and eye problems on the left.
Again I would appreciate any insight you have into my ongoing situation. I am curious as to why and how the initial injury seemed to affect the right side only, and as time has gone by I have developed problems on the left side also. I don’t understand my doctors explanation of subluxation and that several discs had shifted forward by 3mm now. I won’t go on anymore I am sure you will understand what the problem is from the MRI results than from any explanation I could relay that I was given.
Thank you again so much for taking the time to help me.

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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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