Official MRI include...surgery?

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Hutchinson
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March 15, 2012 at 7:51 pm

Post count: 4

#5766

Dr Coleman,

Your videos are so much help, thanks so so much.

here is the hospital MRI file (sequential) of my back MRI taken in China that I had them give me

box.com/s/dc4a8fb469da4595ba96

please can you help explain the issues as I didn’t understand the chinese doctors.

Age:31 Height:6,1 weight:170lbs Health:Good

I have tried rest/healthy living and giving my body time to heal for 1 year but it has failed.

Near Constant pain down the left leg, especially upon standing

Sitting for more than 5minutes leads to a severe lack of flexibility upon standing, radiating pain around the lower back and shooting pain down the leg

Flares up around once a month leaving me basically bed ridden for a week then I can move around and walk freely but with leg pain

Hope you can give me your advice here on this one as I can only see surgery left as an option now to fix that L5-S1 problem.

Again thanks so much for your time and I really hope you can help

Regards

Sven.

P.s I took Roaccutane (accutane) as a teenager leaving me with poor healing ability hence my reluctance for surgery so I would be looking for the latest least invasive surgical method.

Donald Corenman, MD, DC
Moderator

March 17, 2012 at 3:06 am

Post count: 8660

#5774

I generally cannot open and read internet files regarding imaging. I can tell you at this point that I have yet to learn Chinese and will not be able to read the Chinese radiologist’s report.

By your description, you have a radiculopathy- most likely of the L5 or S1 nerve. The most common cause of that is a herniated disc. If you have no motor weakness, you could be a candidate for epidural injections and physical therapy.

If in China you have no resources for that, you could try non-steroidal anti-inflammatories or see if you can take an oral steroid prescribed by a physician. If you have had pain for a year, I am not sure that reliable improvement can be expected with conservative care.

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.

Hutchinson
Member

March 17, 2012 at 5:30 am

Post count: 4

#5775

Thanks for the reply Dr Coleman.

That file is the standard MRI images from the MRI machine not the report. There is no Chinese.

I just wanted you to take a look and tell me what you think of the structure of my back.

They are the ones that the radiologist use for their report and then put onto the MRI film prints.

In fact they are actually just as clear if not clearer than the actual film print.

Please could you take a look. I don’t mind paying if that would help here.

Regards

Sven.

p.s I know the L5-S1 is herniated and hasn’t recovered itself which I was hoping.

The L5-L4 and L4-L3 are degenerated and bulging from the looks of it.

I need to know any other issues there are and if there is any way of that L5-S1 recovering without surgery.

I believe it is only going to get worse and leave me unable to walk. If there is another option to fix the issue (I don’t mean pain relief here but a solution to that huge herniation) that I will do everything to achieve it. :)

Donald Corenman, MD, DC
Moderator

March 18, 2012 at 10:09 pm

Post count: 8660

#5779

Again, I generally cannot access images on the internet. Please feel free to send me your images via Fed Ex or DHS. I can comment on radiological reports but the caveat is that the report is through the eyes of the radiologist and important findings may be misinterpreted or missing.

If you have had pain for one year or longer, the pain matches the level and side of the disc herniation (right L5-S1 HNP should cause right sided leg pain that can radiate to the foot) and there are no other potential causes of this pain, a microdiscectomy of L5-S1 should be considered. Because of the length of time of compression of the nerve root, pain relief after surgery may be less reliable because of the potential for chronic neuropathy (chronic radiculopathy- see website for explanation).

The degenerative changes of L3-4 and L4-5 are part of your genetic make-up (see section on lumbar degenerative disc disease). You have no significant reported lower back pain (consider yourself lucky) despite these degenerative discs. These do not factor into your current symptoms and whether or not they give you problems in the future, do not be concerned about them now.

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.

Hutchinson
Member

March 18, 2012 at 10:29 pm

Post count: 4

#5782

Hey Dr Coleman,

Sorry to bother you on the weekend,

I am confused here, the link is the file just like you would receive via email you just download it, I can send the file to your email if that puts you more at ease.

These are not ‘internet images’ but the original MRI images.

If you take a look at the images and can honestly tell me that they are not of high enough quality (they are of the same quality as the MRI film) I will not bother you any more.

This is how documents are now passed between people.

Please please help me here just to take a look.

They are crystal clear sequential MRI images identical to the MRI film

Sending the images via fedex would be a nightmare for me to get them back here into China as I doubt they would arrive. And are no different from what I am trying to give you now.

Thank you for taking the time with these replies… One look at the MRI images and I am sure you will know exactly my problems, in fact I guarantee it as even I can see most of the problems but need some help with clarification.

Regards

Sven.

Here is a screenshot of one of the images (obviously this has lost image quality as it just a screenshot)

screencast.com/t/S3xov0nrf

Donald Corenman, MD, DC
Moderator

March 18, 2012 at 10:43 pm

Post count: 8660

#5784

Although my policy is not to access internet files as viruses are not uncommon, I did try to access that file and cannot gain access. If you could type the report from the radiologist on the forum, I could give you my opinion.

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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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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Official MRI include…surgery?