MRI Results from Radiologist

Tagged: Differentiating neck and shoulder disorders

Viewing 6 posts - 1 through 6 (of 6 total)

Author

Posts
DarcyBee
Participant

December 28, 2016 at 12:01 pm

Post count: 4

#24033

I am not sure if I will be a candidate for surgery or not. I have had pain for about 20 years. It’s been progressively getting worse. I have tried PT, chiropractic and acupuncture with no relief. I have numbness and aching in my right arm and my handwriting/typing is getting worse and worse. I have definite weakness in my right (dominant) arm when trying to lift things (and equal size weights – the heavier the weight, the more I have problems).

My MRI results (that show abnormality):

c5-c6: There is mild narrowing of disc height. 4mm disc osteophyte complex is present causing mild central stenonis. There is a moderate right neural formaminal due to disc osteophyte encroachment and uncovertebral hypertrophy. Mild left neural formainal stenosis is present.

c6-c7: 4.5 mm disc osteophyte complex eccentric to the right is present causing moderate central stenosis with AP canal dimension measuring 7.5mm. There is moderate to severe left and moderate right neural foraminal stenosis due to disc osteophyte encroachments.

c7-T1: Small disc bulge slightly indents the ventral thecal sac without causing significant central stenosis. There is marked moderate right neural foraminal stenosis due to disc encroachment without significant left neural foraminal stenosis.

What do you think? Will I be a candidate for surgery? Is this treatable some other way?

DarcyBee
Participant

December 29, 2016 at 1:25 pm

Post count: 4

#24036

I should mention I have constant grinding pain that gets worse when I move my my arm on top of my right shoulder, and into the right side of my neck. I have dull aching pain in my bicep area and on top of my shoulder that gets worse when I write. Arm/hand strength on my right side is very much weakened, even though it is my dominant arm. I have had on and off “chest pains” which have been checked thoroughly (once) by the emergency room with no known cause – not heart related. I have muscle spasms in my legs and feet at night. Regular muscle spasms in my abdominal area muscles that will stop me from exercising.

I have been sitting at a desk for many years, just recently got a sit/stand convertible desk.

My right hand is loosing coordination. Picking up coins, opening small packages, typing and handwriting continue to decline.

My pain sometimes wakes me up at night. It gets worse after a day at the office, or trying to do things with my right hand (cooking, folding)

The pain in my shoulder/neck is greatly relieved with my arm on top of my head. I spend a lot of time resting like this, and have wondered if I could make some sort of hat to balance it there. :-) I found that wearing a hard “aspen” collar relieves pain in my neck and somewhat my arm, and I wear one occasionally at night. I am very worried about sleeping wrong. I have special cervical pillows with indentations, etc. If I sleep “wrong” it’s not a good thing – my next day is wrecked with pain.

Sometimes I get pain low in my neck where it attaches to my back. This can be almost a stabbing type pain. I have this very often when take just a muscle relaxer and no norco.

I have pain in my throat on the right like there is something stuck there. It almost feels like someone is poking a stick from the inside of the right side toward my throat. Sometimes my voice goes hoarse and it hurts to talk.

I have intense muscle spasms in my neck and collarbone, trapezoid area that never go away (for the last 15 years). Massage makes them feel a little better, but it’s pretty superficial and doesn’t last. I can feel the muscles deep in there are very tight. (This is the same area where I have the grinding pain).

My feet have felt clumsy for the last year or two. I no longer want to wear any high heel. Flats only. I feel very uneasy on ladders lately.

I feel dizzy sometime when standing and this comes and goes.

I have had headaches – migraines that I have never had before. Really bad headaches around my right eye, with vomiting (very little warning – and “projectile” :-/ Sorry.

I am 49 years old. I manage pain with cucumurin (concentrated turmeric), ibuprofen, muscle relaxers and norco (in that order. I drink more alcohol than I should, and take antidepressants and anti anxiety medication.

I’ve been told in the past after an MRI in 2006 – I have bulging discs and some arthritis and sent to PT, which took a lot of time, and didn’t do anything except feel slightly better after the massage part.

After that, I’ve been given muscle relaxers and pain pills (I don’t take every day – mostly at night). I was told to call my GP when I loose control of my bladder and/or bowels… he said then they could do surgery. Also that it was probably a torn rotator cuff and I would need surgery for that soon.

I changed my doctor, this doctor did an xray and MRI (results above) and said I didn’t have to wait until I loose control of my bladder/bowels before they could do something besides the pills to control the pain (epidural shots or possibly surgery).

I see the neurosurgeon January 4. Any ideas, thoughts, comments, etc would be welcome. I am a nervous wreck, and hurting a lot. I’m trying to educate myself, and prepare myself for what might come next.

DarcyBee
Participant

December 29, 2016 at 1:46 pm

Post count: 4

#24037

One more thing – my fingers/hand tingle. All of them, sometimes just one or two, sometimes all of them. this usually goes with pain going down the outside of my arm. A gnawing pain. All of my symptoms have been around for about 20 years, slowly progressing except for the chest pain and the migraines/vomiting – those are new this year.

Donald Corenman, MD, DC
Moderator

January 4, 2017 at 10:15 pm

Post count: 8660

#24044

We have a lot of ground to cover. There are many symptoms that point to nerve compression from foraminal stenosis, possible myelopathy from cord compression and some smaller signs that point to rotator cuff impingement syndrome.

First-your neck symptoms that fit with radiculopathy. “I have had pain for about 20 years.I have numbness and aching in my right arm and my handwriting/typing is getting worse and worse. I have definite weakness” and “The pain in my shoulder/neck is greatly relieved with my arm on top of my head”. Also, “I have dull aching pain in my bicep area and on top of my shoulder that gets worse when I write”. All these symptoms are consistant with nerve compression, especially the relief you gain by placing your forearm on the top of your head (Bakody’s Sign).

These symptoms match with your right foraminal stenosis at multiple levels (“C5-6 a moderate right neural formaminal due to disc osteophyte, C6-7 4.5 mm disc osteophyte complex eccentric to the right is present causing moderate central stenosis with AP canal dimension measuring 7.5mm. There is moderate to severe left and moderate right neural foraminal stenosis” and “C7-T1:There is marked moderate right neural foraminal stenosis due to disc encroachment”. Any or all of these can generate the pain you experience with the respective nerves (C6,C7 and C8). The hand weakness could also originate from the C8 root compression.

You could have myelopathy (cord compression) that is causing your instability symptoms (“My feet have felt clumsy for the last year or two. I no longer want to wear any high heel. Flats only. I feel very uneasy on ladders lately”).

Finally, your complaints of “I have constant grinding pain that gets worse when I move my my arm on top of my right shoulder, and into the right side of my neck. I have dull aching pain in my bicep area and on top of my shoulder that gets worse when I write” could be from rotator cuff inflammation or even cuff tear.

You need a good work-up including a thorough physical examination to differentiate your symptoms and then probably selective nerve root blocks to identify the nerve pain generators. Depending upon your shoulder examination, you might need a shoulder MRI. Make sure the neurosurgeon can evaluate the shoulder as well as the neck.

Check the website for individual cervical nerve symptoms and shoulder disorders.

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.

DarcyBee
Participant

January 5, 2017 at 4:24 pm

Post count: 4

#24047

Thanks so much for your comments Dr. Corenman. I was able to get in to see a neurosurgeon yesterday. He would like to do a 2 disc replacement surgery (C6 and C7), and if I am not a good candidate anatomically, ACDF. He said I could wait if I wanted to and have injections. I have radicuopathy I’m feeling ready for surgery, because it’s been so long and getting worse and worse. I will ask him about the shoulder as well. I’m going to seek a second opinion before I make the decision for surgery.

I really appreciate you spending time to reply to my post! Thank you!!!

Donald Corenman, MD, DC
Moderator

January 6, 2017 at 1:27 am

Post count: 8660

#24048

The C5-6 and C6-7 levels might need to be addressed surgically. I would be worried about your C7-T1 level where it is noted “C7-T1:There is marked moderate right neural foraminal stenosis due to disc encroachment”. If you have hand weakness, this could be a C8 radiculopathy (compression of C7-T1 level) and leaving this level might be a big problem. See the section https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/ to understand what a C8 nerve injury would look like.

Also, see the section on cervical artificial disc replacement to see if you are a candidate for this procedure (vs. ACDF). The neurosurgeon might not be the specialist to see for differentiating both neck and shoulder. You might need to see a spine surgeon (who has an orthopedic background) to understand what is what.

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.
Author

Posts

Viewing 6 posts - 1 through 6 (of 6 total)

You must be logged in to reply to this topic.

Donald Corenman, MD, DC

Average rating:

81 reviews

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel