Please help me understand my MRI report

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Laura1963
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December 13, 2019 at 7:53 pm

Post count: 36

#31674

Hi Dr Corenman ..
I would greatly appreciate it if you are able to interpetae this report in simplified terms regarding mostly about the osteochondral bar as to where it’s situated ..my question is it pressing on the CSF is it between CSF flow and spinal cord ..Is it releasing any CSF in my body leaking ..can it cause that in the future if not now ..is it serious what I have ..my prominent central canal has never ever changed since first d/x in 2005 ..so I believe it’s not a true syrinx …but was wondering if the osteochdral bar is causing any issues pain stiffness ..leakage if CSF .As I feel and taste and gag on something that seems to be flowing throughout my entire body ..which is from osteochondral bar from if it’s pressing on my CSF ..or it’s another cause that it could be ..be greatly appreciated it if you could give me your valued opinion …my MRI report is below ..thank you again

A very tiny syrinx/ verses a prominent central canal is noted again extended from level C2 -C3 disc space caudally to approximately the C5 C6 disc space .There is no associated cord expansion or cord edema .the appearance is relatively similiar compared to previous ..

The cervical spinal cord otherwise demonstrates normal signal intensity and morphology

The cervical spinal cord is preserved

The cranial cervical junction is intact .

At C5-C6 there is a broad based posterior osteochdral bar with a more focal central component . CSF remains interposed between the osteochondral bar and the spinal cord .

Summary
Stable prominent central canal/ verses a tiny syrinx . No associate cord expansion or edema .

Posterior osteochdral bar C5-C6

Sincerely Laura

Donald Corenman, MD, DC
Moderator

January 30, 2020 at 3:35 pm

Post count: 8660

#32026

A chondroosseous bar is a development of degenerative disc disease. The wall of the disc buckles and causes the insertion of the disc fibers to slightly pull off. This causes the bone endplate to react by growing more bone (called an enthesopathy). This new bone forms as a bone spur and projects into the canal. It is quite common and many individuals go through their entire life not knowing that they have this finding.

This bar will impinge against the sack (the dura) that contains the spinal fluid (CSF) and will “push the sack inwards” This by itself is not any problem. If this spur impinges against the spinal cord or causes significant narrowing of the canal, then it can be a problem.

In your case “CSF remains interposed between the osteochondral bar and the spinal cord” meaning there is still room in the canal for the cord and CSF-a good thing.

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.

Laura1963
Participant

January 30, 2020 at 4:12 pm

Post count: 36

#32029

Thank you Dr Corenman ..I greatly appreciate your time and knowledge ..and explaining everything to me ..You are the best !!

Laura1963
Participant

March 4, 2020 at 3:55 pm

Post count: 36

#32218

I was wondering Dr Corenman if you could read this recent MRI ..my question is if this is actually compressing my spinal cord …if it could be causing the issues of nerve pain in my mouth or throat …or if this protrusion is effecting the messages going and coming from the Brain to Spinal cord ..

The MRI report

At C 2-3 and C3-4 there is central disc bulging

At C 4-5 ,there is mild central disc bulging

At C5-6 there is disc bulging with a small broad central disc protrusion MILDY indenting / flattening the anterior OF the spinal cord.

At C6-7 there is very mild disc bulging

At C7-T1 there is mild disc bulging

At T1-2 T2-3 and T3-4 there is central disc bulging and mild osteophyte mildly indenting the thecal sac

There is prominence of the central canal of the spinal cord / tiny stable syrinx at the C5-C6 levels measuring up to 2mm in caliber .The cervical spinal cord is otherwise unremarkable ..The cerebellar tonsils are normally located ..

Impression

Mildly degenerative changes as describe

At C5-6 there is a small broad central disc protrusion mildly indenting / finding the anterior spinal cord

Prominence of the central canal of the spinal cord /tiny syrinx at the C5-6 levels as described which is if uncertain significance but possibly related to the disc protrusion..Long term MRI follow up advised to ensure stability or resolution ..

This report is an actual second opinion based on last MRI report and recent image done Dec 2019 ..The tiny syrinx has been stable exact same size as it was first d/x in 2005 …no change ever as it states in other Reports verses a prominent central canal verses a tiny syrinx ..in 2005 I never had any disclosure degeneration as it is now …so last comment I feel is invalid when mentioned probability related to disc protrusion ..

But was wondering if the significance of the protrusion is causing messages going and coming from the Brain to Spinal cord ..As in previous messages that these symptoms only started after taking a medication that should of not been prescribed to me …

Thank you for your time and knowledge …

Sincerely Laura

Laura1963
Participant

October 1, 2020 at 11:56 am

Post count: 36

#33086

Hi Dr Corenman …

Here is a recent MRI report are you able to interpret this to me please and much thank you..

Brain

Clinical Indication…headaches…follow up syrinx

Compare to May 6 2019

No abnormal focus of diffusion restriction

No Blooming low signal intensity focus on the gradient echo sequence to suggest hemosiderin deposition

No hydrocephalus ..the the ventricular system , convexity sulci , and basel cisterns are intact

aside from a solitary deep periventricular high signal intensity focus right frontal lobe , series B image 20 which is stable compared with previous , no high signal intensity foci within white matter…

Major arterial end venous flow voids are intact

craniocervical junction is intact

ON T1-T2 …within the subcutaneous tissue , left parietal region , there is a subcutaneous lesion measuring 11 mm … This was present on previous ..This should be clinically apparent and could represent a sebaceous cyst and correlation required

Summary
cause for headaches not seen ..Essentially normal MRI of Brain with no significant change compared to prior

MRI Cervical Spine

compared to Dec 11 2019

Cranial cervical junction in tact

At C5-6 there is a generalized posterior osteochondral bar with a more focal central component ..CSF remains interposed between the osteochondral bar and the spinal cord ..Moderate narrowing right foramina and mild narrowing left neural foramina

The cervical spinal cord is preserved

Prominence of the central canal/thin syrinx is noted to extend from approximately level of the C3-C4 disc space crudely to approximately the level of the C6-C7 disc space ..No cord expansion of cord edema

summary
stable prominent central canal/tiny syrinx
posterior osteochondral bar C5-C6

Donald Corenman, MD, DC
Moderator

October 2, 2020 at 7:53 am

Post count: 8660

#33089

Your MRI report summary is a “stable prominent central canal/tiny syrinx…posterior osteochondral bar C5-C6”. Nothing seems to has changed since the last MRI.

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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