MRi with/wo IV contrast 2 years post op acdf C5-7 with same symptoms

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Rosalynn01
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December 26, 2016 at 2:45 pm

Post count: 6

#24031

Thank you for taking the time to review my recent MRI.

comparison: previous outside cervical spine MRI scan dated Oct 29, 2014
History: neck pain and stiffness. Right upper extremity numbness. Cervical soine surgery in 2014
Findings: since the prior MRI scan there has been interval anterior fusion at c5-7, with placement of anterior plate ans screws at these levels. There has been interval resolution od spinal cord compression at c5-6. Soinzl cord signal remains normal. There is no Chiari malformation. Their is no vertebral compression deformity or subluxation. Disc height has further decreased at c4-5. There is new mild reactive signal change at c4-5.
The atlantoccipital and atlantoaxial junctions are intact.
C2-3: mild disc bulging. Mild to moderate spinal stenosis with a congenital component. Mild facet degeneration remains more marked on the left. Patent neural formina. Unchanges
C3-4 disc bulging. Mild to moderate spinal stenosis with congenital component is unchanged. Mild right neural foraminal stenosis is unchanged.
C4-5: there is again demonstrated to be a disc osteophyte complex, which remains larger on the right. Facet degeneration remains more marked on the right. Mild right neural foraminal stenosis is unchanged.
C5-6: interval anterior fusion with intrumentation. Resolution of disc protusion and spinal cord compression. Metal artifact from fusion hardware. Mild bilateral neural forminal stenosis has decreased bilaterally. Mild spinal stenosis has decreased.
C5-7: interval anterior fusion with instrumentation. Resolution of disc bulging. Facet degeneration. Minimal ligamentum flavum hypertrophy is again demonstrated. mild spinal stenosis has decreased. Moderate right and mild left neural foraminal stenosis. Decreased on the left.
C7-T1: no disc protrusion or bulging. No spinal or neural foraminal stenosis.
Postcontrast images reveal no abnormal enhancement.

Dr. Corenman I’ve had 3 previous shoulder surgeries besides the acdf. I have ROM loss in neck and also reaching across my chest. Ive still got numbness into the 3 fingers down back of the arm into the elbow along with achiness that waxes and wanes. Sometimes when using weight or overhead. The pain between shoulder blade ( all right sided) that goes thru shoulder with burning sensations. Ive also noticed that when its cold out i cant be out that it causes arm pain. Please advise on what is concerning?

Donald Corenman, MD, DC
Moderator

January 6, 2017 at 2:35 am

Post count: 8660

#24053

Sorry but without attachment to a previous forum post, I have no reference to prior posts.Your report; “C3-4 disc bulging. Mild to moderate spinal stenosis, C6-7 Moderate right and mild left neural foraminal stenosis” can indicate root compression and even cord compression. The pain in the shoulder blades (all right sided) could be from either of the two root compressions (C4 or C7) or from shoulder problems (rotator cuff syndrome). You don’t have enough information to differentiate these two potential disorders. You need a good physical examination and then either a shoulder diagnostic injection or a SNRB from one of the two (or both) nerve roots depending upon the injection results. Then possibly surgery can be planned for these symptoms.

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.

Rosalynn01
Participant

January 6, 2017 at 9:09 am

Post count: 6

#24056

Thank you for your recent response!

I am, as i write back this i am having severe pain on right side of neck along with swelling on the right side on top of shoulder. It is the second day of swelling along with arm pain. Do you think this would warrant a revision surgery of my previous acdf 5-7? Could this be a possible non union or further complications from previous surgery?
This surgery was related to an accident i had in 2013. My recent surgeon explained that my MRI looked good.

Kind regards,
Rosalynn01

Donald Corenman, MD, DC
Moderator

January 6, 2017 at 11:55 am

Post count: 8660

#24059

I would need to know if you had a pseudoarthrosis of either of the two levels. Standard X-rays with flexion/extension views can be helpful to reveal this lack of fusion but a CT scan of the neck is the gold standard to understand fusion status. A good physical examination will help to delineate if this is neck, shoulder or both.

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.

Rosalynn01
Participant

January 7, 2017 at 1:04 pm

Post count: 6

#24083

Thank you! Sorry for the late reply.

I had a CT Scan of brain and neck yesterday in the ER. My neck and top of shoulder( right side) is very sore and ive been sedentary. The dr did mention to see the surgeon the did the previous surgery and also my primary dr.

My question about the CT Scan is does this show why im having the swelling?
Dr also mentioned an EMG and Nerve test that was no help last yr. why cant this test pick up nerve pain im having?
If i had an Acdf c5-7 why would i still possibly have nerve or cord compression?
Does the fact that i have congenital narrowing upper vertabrea cause me to be at risk? Explain?

Kind regards,
Rosalynn01

Rosalynn01
Participant

January 7, 2017 at 3:05 pm

Post count: 6

#24084

Also, i’m wondering if cervical Radiculopathy could be permanent or myelopathy since ive had cord compression in the past? Could this warrant pain management long term?

Thank you again for your time!
Kind regards,
Rosalynn01
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Donald Corenman, MD, DC

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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.

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