neck and lower back

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Abbeygirl
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November 24, 2011 at 11:51 am

Post count: 40

#5151

Hi Dr I have a lot of neck pain and lower back just had Mri done was wondering if you could please explain the report to me please
MRI CERVICAL SPINE
TECHNIQUE T1 AND T2 sagittal T2 axial and Merge axial sequences through the cervical spine were obtained
FINDINGS There is loss of the normal cervical lorotic angle which is most likely due to muscle spasm
No pathological marrow infliltration identified
At the base of the peg there is an apophysis which appears to be fused
No inherent cord signal abnormalities identified The craniocervical relationships are preserved
C2/3 C3/4 No significant disc bulging herniation or exit forminal stenosis identified
C4/5 A broad based disc bulge is identified There is some disc osteophytic encroachment on the left sided exit foramen the right sided exit forman is patent
c5/6 c6/7 c7/T1 No significant disc bulging herniation or exit foraminal stenosis identified
The vertebral arterial flow voids are preserved and symmetrical The paraspinal musculature defines normally.The lower brainstem and upperb thoracic cord demonstrate no inherent signal abnormalities
Comment Minor disc bulging with no significant exit foraminal stenosis or spinal canal compromise demonstrated.
MRI LUMBAR SPINE
Technique T1 and T2 sagittal T1 and T2 axial and post Gadolinium T1 fat sat sagittal and axil sequences were obtained
Findings There is evidence of disc dessication at L1/2 and L5/S1 in keeping with degenerative disease.
Endplate marrow changes are demonstrated at L5/S1 andL1/2 There is an anterior inferior schmorls node in the inferior endplate of L1
L1/2,L2/3 No significant disc bulging herniation or exit foraminal stenosis identified
L3/4 There is a left paracentral disc bulg and there is some encroachment on the left sided exit foramenThe right sided exit foramen is patent No central spinal canal compromise identified
L4/5 A broad based annular bulge is noted There is no exit foraminal stenosis No definite annular tear identified there is facet joint degenerative change
L5/S1 loss of volume and an annular tear with a central disc protusion is noted There is encroachment on the central spinal canal there is also bilateral encroachment on the exit foramina following the adminastration of the intravenous gadolinium there is evidence of exiting neural enhancement This appears to be quite prominent and a neuritis must be considered There is no definite cauda equina enhancement The cauda equina were noted to lie discreately within the thecal sac with no clumping or marigination to suggest an arachnoiditis
THE Conus is in satisfactory location
There is no evidence of perithecal fibrosis but some enhancement in the region of the laminectomy was demonstrated
Comment Evidence of previous surgery at L5/S1 with loss of disc volume but an annular tear and broad base disc bulge with some exit foraminal narrowing are identified There is some neural enhancement detected The possibility of a neuritis must be considered clinical correlation is advised There is enhancement in the surgical tract extending posteriorly to the skin surface
That is the report Dr i would not have a clue what that means but i am very sore in my neck and hands and my lower back as well as calf muscles in my bum as well just seem to ache all the time thanks for this service doctor

Donald Corenman, MD, DC
Moderator

November 25, 2011 at 1:56 am

Post count: 8660

#5152

You have to remember that the MRI does not always correlate with the symptoms. You could have a large disc herniation compressing a nerve root and have absolutely no arm pain. I will interpret what is on the MRI and what symptoms that could be caused by the results.

According to the radiologist, the only problem he or she noted on your MRI of the cervical spine is a broad based disc bulge with foraminal stenosis of the left exiting nerve root. This could cause central neck pain and shoulder pain with some arm pain and numbness on the left. The shoulder and arm pain would be worse with looking up and improved with putting chin on chest.

The lower back has more degenerative changes. You have very degenerative discs at L5-S1 and L1-L2. These can cause significant lower back pain at the belt line and at the highest area of the lower back. Your L5 nerves “light up” with gadolinium which outlines inflammation and you have had previous surgery here. Either the nerves were previously injured before the prior surgery or the current compression is actively injuring the roots. This would cause buttocks pain and posterior leg pain to the foot.

At L3-4, there is a left sided compression of the root. This could cause buttocks pain on that side with radiation into the anterior thigh.

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.

Abbeygirl
Member

November 27, 2011 at 2:31 pm

Post count: 40

#5162

Hi Dr thanks for your answer to my MRI report you are just about spot on where my pain is any way my next question is a bit hard for you without seeing me or my films anyway here i go my I took my MRI report to my GP and he read the report and said there is nothing to worry about anyway he did not do a physical check on anything also he did not look at the films not trying to say that he does not know what he is doing but does the report mean that there is nothing wrong because doctor i am in a lot of pain my back aches and my right thigh is numb my left calf achesmy toes go numb but maybe i have to try and harden up but i am really sore maybe i am going crazy or it is a bad dream sorry doctor but my main question is. Does that report say thati should be find thanks again doctor for this service

Donald Corenman, MD, DC
Moderator

November 27, 2011 at 3:40 pm

Post count: 8660

#5163

You need a good spine surgeon to look over the results of your MRI and perform a thorough history and physical examination to determine what your diagnosis is and what needs to be treated.

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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