[massimo]

#9297

It is a privilege to be in one of your Forums Doctor Corenman. I thank you and your staff for your commitment in helping people in need. I hope that you may shed some light as to what is happening to my spine. I used to be a workaholic and now I can’t even sleep because of pain. These are the findings of my spine…

CERVICAL SPINE MRI
　
MULTI DEHYDRATION AND DESICCATION IS SEEN. EVALUATION OF INDIVIDUAL LEVELS PRESENTS THE FOLLOWING.

C2-3, MINIMAL BULGING INDENTS THE VENTRAL THECAL SAC. CANAL AND FORAMIN ARE PATENT.

C3-4, CENTRAL SHALLOW HERNIATED DISC MEASURES 5MM IN TRANSVERSE AND 2MM IN AP DIMENSION, INDENTS THE VENTRAL THECAL SAC. THERE IS SUPERIMPOSED BULGE. CANAL AND FORAMIN REMAIN PATENT. BILATERAL UNCOVERTEBRAL JOINT HYPERTROPHY IS NOTED.

C4-5, CENTRAL HERNIATED DISC IS NOTED, MEASURES 7MM IN TRANVERSE AND 2.5 MM IN AP DIMENSIONS, INDENTS THE VENTRAL THECAL SAC. THERE IS SUPERIMPOSED BULGE. CANAL AND FORAMIN REMAIN PATENT. BILATERAL UNCOVERTEBRAL JOINT HYPERTROPHY IS NOTED.

C5-6, LARGE HERNIATED DISC IS NOTED, MEASURES 12MM IN TRANSVERSE AND 3MM IN AP DIMENSION, IN CONTACT WITH THE CORD. CANAL IS BORDERLINE STENOTIC. THERE IS SOME LATERALIZATION TOWARDS THE LEFT. THERE IS MILD LEFT FORAMINAL NARROWING. BILATERAL UNCOVERTEBRAL JOINT HYPERTROPHY IS PRESENT.

C6-7, DISC BULGE IS SEEN, INDENTS THE VENTRAL THECAL SAC. CANAL AND FORAMIN ARE PATENT.

　
THORACIC SPINE MRI
　
NOTE IS MADE OF MILD CHRONIC COMPRESSION FRACTURE DEFORMITIES INVOLVING T7 AND T8 VERTEBRAL BODIES. NO ACUTE FRACTURE IS NOTED. THE MARROW SIGNALS ARE WITHIN NORMAL LIMITS. THE VISUALIZED POSTERIOR ELEMENTS ARE NORMAL AND THE THORACIC CURVATURE IS WELL MAINTAINED. THE THORACIC CORD IS UNIFORM SIGNAL INTENSITY WITHOUT EVIDENCE OF FOCAL EXPANSION. MULTI-LEVEL DEHYDRATION AND DESICCATION IS SEEN. NOTE IS MADE OF SCHMORL’S NODES AT MULTIPLE THORACIC LEVELS INCLUDING T6-T7, T7-T8, T9-T10, T10-T11, AND T11-T12 REPRESENTING ENDPLATE MICROFRACTURES.

EVALUATION OF INDIVIDUAL DISC SPACE LEVELS REVEALS THE FOLLOWING
　
AT T5-T6, MINIMAL DISC BULGE INDENTS THE VENTRAL THECAL SAC. CANAL AND FORAMINA ARE PATENT.

AT T6-T7, MINIMAL DISC BULGE INDENTS THE VENTRAL THECAL SAC. CANAL AND FORAMINA ARE OPEN.

AT T7-T8, CENTRAL HERNIATED DISC IS NOTED, MEASURES 6MM IN TRANSVERSE AND 2.5MM IN AP DIMENSION PRODUCING MASS EFFECT ON THE SPINAL CORD AND DEMONSTRATES SPINAL CORD FLATTENING AND BORDERLINE CANAL STENOSIS. FORAMINA ARE PATENT.

AT T8-T9, MINIMAL DISC BULGE INDENTS THE VENTRAL THECAL SAC. CANAL AND FORAMINA ARE PATENT.

AT T9-T10, MINIMAL DISC BULGE INDENTS THE VENTRAL THECAL SAC. CANAL AND FORAMINA ARE PATENT.

AT T11-T12, SHALLOW HERNIATED DISC IS SEEN, INDENTS THE VENTRAL THECAL SAC. CANAL AND FORAMINA ARE PATENT.
　
　
LUMBAR SPINE MRI
　
MULTILEVEL DEHYDRATION AND DESICCATION IS SEEN. SHALLOW SCHMORL’S NODES ARE NOTED AT L2-L3 THROUGH L5-S1. NOTE IS MADE OF PARTIAL SACRALIZATION INVOLVING TRANSVERSE PROCESS OF L5 BODIES. MILD LOSS OF DISC HEIGHT AND ENDPLATE SCLEROSIS IS NOTED AT L5-S1.
　
EVALUATION OF INDIVIDUAL LEVEL PRESENTS THE FOLLOWING.
　
AT L2-L3 ANNULAR DISC BULGE IS SEEN. THERE IS SUPERIMPOSED FAR RIGHT PARACENTRAL HERNIATED DISC WITH ASSOCIATED ANNULAR TEAR. THERE IS MILD TO MODERATE RIGHT AND MINIMAL LEFT FORAMINAL NARROWING. CANAL IS PATENT.
　
AT L3-L4, BILOBED ANNULAR DISC BULGE IS SEEN WITH BILATERAL INTRAFORAMINAL EXTENSION.THERE ARE SHALLOW LEFT AND RIGHT PARACENTRAL DISC HERNIATION IS PRESENT. THERE IS MILD TO MODERATE BILATERAL FORAMINAL STENOSIS. CANAL IS PATENT.

AT L4-L5, ANNULAR TEAR IS VISABLE. CENTRAL HERNIATED DISC MEASURES 10MM IN TRANSVERSE AND 2.5 MM IN AP DIMENSION INDENTS THE VENTRAL THECAL SAC. THERE IS A SUPERIMPOSED BULGE WITH BILATERAL FORAMINAL NARROWING. CANAL REMAINS PATENT. HYPERTROPHIC FACET DISEASE AND LIGAMENTUM FLAVUM HYPERTROPHY CONTRIBUTES.

AT L5-S1, DIFFUSE DISC BULGE IS NOTED. THERE IS A SUPERIMPOSED LEFT PARACENTRAL DISC HERNIATION IS NOTED. THERE IS MILD TO MODERATE LEFT AND MILD RIGHT FORAMINAL STENOSIS. CANAL IS PATENT. HYPERTROPHIC FACET DISEASE CONTRIBUTES. HYPERTROPHIC FACET DISEASE AND LIGAMENTUM FLAVUM HYPERTROPHY CONTRIBUTES.

Thank You,
Massimo

[massimo]

#9298

Sorry, I forgot to mention some other findings…

-Mild Scoliosis of the Lumbar Spine

-Bertolotti’s Syndrome
Sacralization of the L5 segment, a consequent pseudoarthrosis of the transverse process bilaterally to the ala of the sacrum.

-Osteochondrosis / Baastrup Disease of L2-S1

-Moderately severe degenerative changes throughout mid to lower thotacic spine

-Sheuermann’s Disease of the thoracic spine

-DISH (Diffuse Idiopathic Skeletal Hyperostosis)

I am wondering if something can be performed surgically to relieve some of this pain?

Thank You
Massimo

[Donald Corenman, MD, DC]

#9301

You have multilevel degenerative changes of the discs throughout the cervical, thoracic and lumbar spines. Some areas are compressing on the spinal cord somewhat and the nerve roots.

These MRI findings do not exist in a bubble. The MRI findings have to be compared to your symptoms. Many individuals have degeneration of the spine but have no symptoms. You need to be able to convey your symptoms so that a comparison can be made to the findings on the MRIs.

Look at the section on the website regarding how to describe symptoms to better convey what your impairment is.

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.

[massimo]

#9314

Hello Doctor Corenman,

As a patient, living in Ontario Canada is rather discouraging when spinal issues are of a concern. After waiting a year and a half to see a Neurosurgeon, posterior spinal fusion from T3 to L1 was recommended with a possible posterior osteotomy. Unfortunately when I had seen the surgeon I did not have the results of my cervical and all of the lumbar spine imaging. I asked if there was another approach to the thoracic surgery and the Surgeon told me “unfortunately in Canada we still operate spines in a very archaic way”. I have been put on another year waiting list for surgery. I am currently looking into surgery in India.

Current Cervical Spine Symptoms

-Neck pain 60% shoulder arm pain 40%
-Headaches with dull pain at base of skull
-Midline pain in lower portion of the neck increased pain with flexion
-Midline tingling, pins and needles radiating into trapezius and shoulders bilaterally and
at times radiating dull surge like pain travelling laterally into shoulders to mid portion of upper arm increased with head rotation
-Dull surge pain travelling down lateral portion of forearm to tight band like stinging around wrists accompanied by cramping in hands
-Lying on back during sleep dull aching forearms with numbness in pinkies and ring fingers
-Some relief during peak pain by supporting neck alleviating weight of head
-Occasional weakness in hands.

Current Thoracic Spine Symptoms

-Thoracic spine pain 65% ribs, upper back (scapula) upper abdomen pain 35%
-Mid-upper thoracic crushing spine pain with stinging, tingling and pins and needles warm surge like pain in the spinal erector muscles
-Lateral pectoral muscle tenderness/ache
-Stinging, tingling into scapulas with tightness into triceps
-Stinging, tingling, and tight wrap around rib pain more intensified in the lower quadrant of rib cage and upper abdomen below the rib cage
-Range of thoracic spine motion affected in all directions during peak pain intensified with movement
-Peak thoracic spine pain = shallow breathing.
-Peak thoracic spine pain increased with rib expansion, sneezing, coughing is like shrapnel throughout the torso and ribs with intense stinging and tingling
-Some relief during peak pain by lying on the floor with knees bent up

Current Lumbar Spine Symptoms

-Lumbar spine pain 50% hips, lower abdomen-groin, and leg pain 50%
-Mid line lumbar – lumbosacral wreathing pain radiating into upper buttocks and travelling across into hips with burning, stinging amplified with extension of lumbar.
-Tight stinging hamstrings and calves.
-Stinging, tingling into upper leg folds to groin (pubic bone area), lower abdomen
increased sensitivity to the touch.
-Surge like stinging, tingling down inner, front and side of thighs to inner knees
-Stinging, tingling down inner shins to ankles, surge like at times.
-Stinging, tingling down outer shins and across the inner top of the feet.
-Intense stinging and tingling around ankles (band like).
-Relief sitting, however intensifies lumbosacral pain. Lying on the floor is often best form of relief (knees up).
-Prolonged sitting then standing I feel a sensation like cold water running down my shins and into my feet.
-Occasional weakness in legs more so l.s and ankles.
-Occasional urinary retention and rectal pressure.

Thank You,
Massimo

[Donald Corenman, MD, DC]

#9327

I am unclear as to why a deformity type surgery (fusion of T3-L1) is contemplated to relieve symptoms. Do you have scoliogram images (full spine front and side views) that delineate a problem curve (Scheuermann’s disorder or degenerative kyphosis-see website)? Your MRI findings contribute to the possible diagnosis of Scheuermann’s disorder but the lateral scoliogram is the test to confirm that this problem exists.

You do have a large herniated disc in your neck that could be contributing to your symptoms of neck and arm pain. A good physical examination would go a long ways to determine if there is weakness that can be attributed to your disc herniation. A workup could include selective nerve root blocks (keeping a pain diary-see website) to determine the contribution of this HNP to your overall neck and arm pain.

You also have degenerative changes in your lumbar spine that can contribute to your back pain including degenerative facets and discs. There is foraminal stenosis also present. See the section on the website concerning lumbar foraminal stenosis to see if your symptoms match this disorder.

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.

[massimo]

#9330

Hello Doctor Corenman,

I have had a number of diagnostic studies performed on my spine including Dynamic X-Rays. AP, Lateral, Flexion and Extension of the Cervical, Thoracic and Lumbar Spine were included in this study. Scheuermann’s Kyphosis was concluded at a 51% curve. I realize that the Kyphosis is minimal, however, the degree of the curve is rather amplified from the T6 to T9 levels perhaps from the chronic compression fractures wedging the vertebral bodies. Originally the proposed surgery did not encompass the extensive fusion of eleven vertebras. There is a varying degree of issues throughout my Thoracic Spine including multi level spondylosis, osteophytosis, end plate sclerosis and multi level disc changes…I often suspect if there might be spinal instability as the Dynamic X-Rays were improperly performed. The Flexion and Extension views were performed with me lying on a X-Ray bed therefore instability would be inconclusive in this study without the spine being weight bearing.

Being on a surgical waiting list I have to wait for the pre-op visit with my Surgeon to inquire as to why his surgical proposal has changed. Unfortunately that will take an upwards of six months. Endoscopic Spinal Surgery (Minimally Invasive) is at it’s infancy here in Ontario. I am wondering if that perhaps this extensive surgery proposed would encompass the multi-level issues in my Thoracic Spine in one step in means of the surgical procedure indicated. I have a great concern if I were to proceed with the Thoracic Spine surgery and the ramification that it would have on my cervical and lumbar spine. There are multi-level degenerative changes in my neck including one large herniation in contact with the spinal cord. As far as the lumbar I have Bertelotti’s Syndrome, encompassing partial sacralization of the L5 Vertebral Body to the Sacrum. A unilateral Superior Articular Process (Sacral Horn) is missing and subsequently the entire facet joint on that side. The L5 Transverse Process are bilaterally sacralised to the Ala of the Sacrum. To further complicate the matter I have Baastrup’s Syndrome encompassing L2 to L5. Viewing my lumbar 3D Cat Scan Imaging seems like that the anomaly caused some pelvic tilt. Subsequently the enlarged S1 Sacral Crest and the L5 Spinous Process actually overlap each other significantly. To conclude the matter there are clearly degenerative changes at multi-levels of my Lumbar Spine with mild to moderate foramina stenosis exacerbated by osteophytes, hypertrophic facet disease and ligamentum flavum hypertrophy.

I have compared my symptoms of foramina stenosis to the information on your website. They do correspond. Having four lumbar levels affected with osteophyte complex definitely contributes to the overall symptoms in my legs.

Often I have thought of my Lumbar Spine as the foundation to a house. I realize that the issues on hand are multi factorial in the Lumbosacral region of my spine. This makes me ponder the consequence of attempting to correct one spinal segment only to burden another. Dr. Gorenman, I have watched you X-STOP Video Presentation and wonder if that would be a starting point or perhaps resection of the transitional articulation before attempting the Thoracic Spine surgery. How would you approach this matter?

I appreciate your view point in regards to my Cervical Spine and I will take your advise in documenting my daily symptoms and possible aggravating factors. I use to document my symptoms and daily activities on a pain chart. I gave up my daily journal a few months ago, it just seemed fruitless having no advocacy or gatekeeper to my health. I am not a Doctor… just a factory worker. Imagining that I would be learning about the human spine two years ago would have been the last thing on my mind. Since 2010 my G.P told me that I had a perfectly normal healthy spine, hence, the label Fibromyalgia and Chronic Pain. He has since retired. So I shall continue this quest, I am not looking for a perfect spine, only one that I can work and live with.

Thank You Doctor Gorenman,
Massimo

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