MRI Results and Symptoms

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tkeon168
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October 30, 2013 at 5:23 am

Post count: 3

#9728

SYMPTOMS:
Started 2.5 months ago with a sharp stabbing pain between the scapula and progressed over about 6 weeks to neck pain with bilateral arm pain (triceps and forearms) that is worse in the right arm with mild weakening of the right arm. Additional pain in mid back that radiates into the rib cage and bilateral pain in the legs that seems to be due to tension of the muscles (which feel flexed and tight when they hurt). At times, spasms, tingling and burning is present in all extremities, but it comes and goes. One episode of electrical pulses down the left side (arm and leg) while sleeping and weakness in all extremities that resulted in a trip to the Emergency Department for evaluation (all within the last few weeks), with no action taken but to follow-up with the Neurologist as scheduled in a few days. The episode of weakness dissipated after about 8 hours.

MEDICAL EVALUATIONS:
Initial visit to Neurologist after 4 weeks of growing pain resulted in X-rays and a Thoracic MRI to rule out sub-acute fractures, PT, NSAID and Flexeril. PT resulted in increased pain and the Thoracic MRI included a scout image of the Cervical and Lumbar spines that had a note on the report about a central bulge at C5-C6. After the electrical pulses and weakness episode, the Neurologist ordered a full Cervical MRI. Based on the symptoms and findings a consultation with a Neurosurgeon has been scheduled for early next week and PT was stopped.

CERVICAL X-RAY REPORT:
STUDY: AP, lateral, extension and flexion views of the cervical spine.

FINDINGD: There is slight reversal of normal cervical lordosis. There is mild loss of disc height at C5-C6 with early anterior and posterior osteophytic change. There is mild 2mm retrolisthesis of C5 on C6 on neutral and extension that corrects on flexion. At C4 on C5, there is 1mm of anterolisthesis flexion and 2mm retrolisthesis on extension with reduction on neutral view. Unremarkable prevertebral soft tissues of the neck.

IMPRESSION:
1. Degenerative changes seen at C5-C6.
2. Slight motion of C4 on C5 and C5 on C6 as described above.

CERVICAL MRI REPORT:
FINDINGS: The cervical cord appears to be of normal volume and signal. Vertebral body alignment shows mild straightening of lordosis at C5, but is otherwise grossly intact. The marrow signal shows no stress reaction or focal bone lesion. The craniocervical junction is normal. Intervertebral disc narrowing at C5-6 with loss of T2 signal.

C1-2: Normal

C2-3: Normal

C3-4: Normal

C4-5: Normal

C5-6: Disc degeneration with broad-based posterior herniation effaces the ventral thecal sac and results in mild posterior displacement of the cord and moderate central spinal stenosis. Superimposed facet and unconvertebral degenerative changes results in left-sided foraminal narrowing.

C6-7: Small focal posterior central disc herniation effaces the ventral thecal sac causing mild central spinal stenosis. Mild bilateral foraminal narrowing due to facet and unconvertebral degenerative changes

C7-T1: Small focal central disc herniation with minimal ventral impact on the thecal sac. No central spinal stenosis. No foraminal narrowing.

IMPRESSION: Disc degenerative and facet arthrosis with herniation at C5-6 resulting in moderate central spinal stenosis and left foraminal narrowing. Smaller disc herniations at C6-7 and C7-T1, with compromise of central nerve elements as outlined.

QUESTIONS:
Do the symptoms match the radiologists report? It seems to me that the Neurologist (who doesn’t do surgery but does all conservative treatments) was more concerned about the symptoms in the referral to the surgeon then the MRI report. What kind of questions should I prepare for the surgeon to make the most of the visit?

tkeon168
Member

November 5, 2013 at 1:21 am

Post count: 3

#9748

Dr. Corenman,

Met with the Neurosurgeon today who reviewed my symptoms and imaging. He noted that a combination of the disk at c5-c6 along with a bone spur at c6 are causing compression of the spinal cord with an AP diameter of less then 7mm near the bone spur and complete absence of CSF anterior or posterior at that level with other areas around the disk at about 8mm with very little CSF showing.

It is of note, that my neurological symptoms (pulses, tingling, burning) have diminished since I stopped PT and the exercises, which had included extension exercises for both the back and the neck to loosen the muscles since PT was started before the Cervical MRI. It seems by doing the extensions of the neck, I was putting even more pressure on the already compressed spinal cord.

He recommended a c5-6-7 ACDF and it has been scheduled in about 4 weeks, but could be done sooner if symptoms progress during that time (as they did with the PT exercises). Does this sound like a reasonable approach based on the data given in the MRI and by the surgeon? He did review all of the images with me and showed me the areas of concern and explained why the surgery was needed to correct the issues versus other non-surgical options.

Donald Corenman, MD, DC
Moderator

November 5, 2013 at 7:34 pm

Post count: 8660

#9753

It sounds like your neurosurgeon is correct. You have a very narrowed canal at the C5-6 level. The canal should be at least 13mm in diameter to protect the spinal cord and your canal is 7mm wide.

This is compounded by the fact that you have some instability of the C5-6 level based upon flexion/extension X-rays (“There is mild 2mm retrolisthesis of C5 on C6 on neutral and extension that corrects on flexion”). Since extension (bending the head backwards) decreases the space available for the cord by 20-30%, the physical therapists were doing you no favors.

There is a problem however for a fusion at C5-7. There is also instability present of the C4-5 level of 3mm (“At C4 on C5, there is 1mm of anterolisthesis flexion and 2mm retrolisthesis on extension with reduction on neutral view”). Make sure that this instability is not a problem by discussing this with your surgeon.

I do not think you have any non-surgical options. Your cord is in jeopardy and this needs to be addressed.

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.

tkeon168
Member

November 5, 2013 at 8:31 pm

Post count: 3

#9760

Dr. Corenman,

We did discuss both C4-5 and C7-T1 during the appointment. He did not feel that fusion of either level was warranted at this time. The canal width at c4-5 was over 15mm with at least 2mm of CSF completely surrounding the cord at that level. He did mention the possibility that a problem could develop in the future at either level that would require another surgical intervention.

Do you feel I need to revisit this topic with him prior to the surgery? Would my age (mid-30s) play at all into the decision making process?

Donald Corenman, MD, DC
Moderator

November 13, 2013 at 9:15 pm

Post count: 8660

#9783

I think your surgeon is exhibiting good judgement. The smaller the procedure, the better the outcome generally. Let us know how you do with surgery.

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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