Please help me understand my MRI

Tagged: Cervical myelopathy ?, Mri Results, please help, Understand MRI

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Candycakes
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June 28, 2019 at 11:58 pm

Post count: 4

#30647

Hi I really need your help I do not understand my MRI or if it’s serious. The nurse practitioner that read my results really didn’t know much.

Alignment: cervical kyphosis without focal subluxation
Marrow/vertebrae: background marrow signal appropriate negative for fracture or destructive lesion. Disc space desiccation with disc height loss and spondylosis c4-5 through c6-7 no significant bone edema noted.

Spinal cord: Spinal cord maintains appropriate signal without mass , syrinx or demyelination. No cord edema or myelomalacia
Minimal ectopia right cerebellar tonsils by 1-2 mm.
Partial inclusion of posterior fossa demonstrates small retro cerebellar arachnoid cyst 1.3 cm likely incidental.
Level by level analysis of disc space :mild short pedicle stenosis c3 through c6
C1-2 no subluxation or stenosis
C2-3 negative for disc herniation or stenosis
C3-4 Disc bulge and bony ridge with acquired mild central stenosis. Disc osteophyte contacts cord without significant cord flattening

C4-5 Disc bulge bony ridge annular fissure with uncinate spurring with mild to moderate acquired central and foraminal stenosis with mild cord flattening and likely compromise of c6 nerve roots AP canal dimension 7.4 mm

C5-6 disc bulge left subarticular recess and foraminal 3-4 mm protrusion with bony ridge annular fissure with mild to moderate central, moderate to severe left subarticular recess and formidable stenosis with cord flattening and compromise of the left greater than right C6 nerve roots . AP canal dimension is 6.6 mm
C6-7 disc bulge with left central and subsrticular recess stenosis and left sided foraminal stenosis. AP canal dimensions 5.9 mm
C7-T1 negative for disc herniation or stenosis

Impression :cervical disc degeneration , spondylosis , cervical kyphosis , with underlying mild developmental short pedicle spinal stenosis
Acquired stenosis most prominent c4-5 through C6-7 with cord flattening and prominent left sided nerve root compromise at both c5-6 and c6-7
No fracture or cord lesion identified.
Please help me to understand thank you so much in advance for all your help. 39 female prior car accident. Pain , burning numbness left arm weakness left side . Left calf and foot go numb sometimes. Balance issues , neck pain headaches loss of range of motion and bladder control issues . Thank you again

Donald Corenman, MD, DC
Moderator

June 29, 2019 at 12:46 am

Post count: 8660

#30648

I need more information regarding your symptoms. Please see the thread https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-neck-shoulder-and-arm-pain/ to understand how to describe 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.

Candycakes
Participant

June 29, 2019 at 1:46 am

Post count: 4

#30649

Sorry will describe pain better.
The pain is in my neck center and left side. I get pain down spine and in shoulder into my bicep (severe) my four fingers get numb. Sometimes I can’t pick anything up with my left hand because fingers are so numb. I get burning down arm to my fingers sometimes. Sometimes it’s I get electric shock like pain down arm. Pins and needles too. My left calf and foot go numb out of the blue I can’t feel it causes me to lose my balance . No pain or issues with right arm or leg except I can’t really turn my head much to that side. I have also lost my bladder I had no idea that it was coming and I couldn’t stop it. This happened 3 separate occasions. My pain was as high as a 9/10 in neck and bicep and had to hold onto a pillow under my face and neck had help going to doctor she gave me a shot or toradol I think it was called an anti inflammatory in buttocks area and gave me prednisone and Baclofen . This helped me be able to deal with the pain and be able to move a little more with out crying .
Pain in hand ranges from 4/5 to 7 but intermittently however with medication is much better still have numbness in two of my fingers and stabbing pain here and there but improved . The pain down neck/spine is like stabbing pain when it does lots of stabbing it’s an 8 but it stops eventually and goes away. The shoulder blade area 6/7 but again much better with meds manageable.
When pain is high I can’t move at all. Weakness left arm and hand and fingers left calf and left foot. Can’t lift left arm up much get shooting pains. The meds have helped a bit with this still weakness but pain manageable.
I do lose my balance when walking sometimes not sure if it’s from calf and foot on left side going numb or something else. I’m right handed so I write the same I don’t really use my left side especially because of the numbness and pain .
I can’t move head to look up my face always wants to look down to avoid the pain .
Car accident 2009 only had herniated c4-5 c5-6 with radiculapthy I did 9 months physical therapy chiropractor care massage and acupuncture as well as was on Celebrex , soma, OxyContin and lidocaine shots after nine months of PT and treatments I was better had pain once in a while but a month ago that changed and I’m still in pain so doctor sent me for an mri and things are a lot worse since the last one in 2009 . I picked up my two and half year old and that’s how this pain started this time and the pain worse than 2009 . Been going on severely now for a month.
The only thing I can do to reduce pain is hug a pillow sit forward chest to knees head hanging over pillow I hope that makes sense it helps relive the pain .
When the pain is a high number there is not an activity that causes it I can be sitting or laying down of standing and out of nowhere I get the shocks , the stabbing the shooting and burning . I pin point what I do because it happens even when I’m doing nothing . It does get worse if for instance I’m feeling ok so I try to pick up some toys off the floor and clean apartment then it will get real bad.
I can sit for longer than 15 mins when pain under control with meds if no meds I can’t I get up pace holding my head up with my hands . Head feels very heavy, and the pain doesn’t stop when moving either. But that is without meds now with meds I can sit , stand pain bearable. That’s just with the prednisone, Baclofen , and 800 milligram moltrin but doctor just gave me Gabapentin too. I hope this helps and thank you very much for you help

Donald Corenman, MD, DC
Moderator

June 29, 2019 at 9:53 am

Post count: 8660

#30650

Your bladder complaints; “I have also lost my bladder I had no idea that it was coming and I couldn’t stop it. This happened 3 separate occasions” This could be overflow incontinence due to spinal cord compression (myelopathy). Your leg complaints “My left calf and foot go numb out of the blue I can’t feel it causes me to lose my balance” certainly could be myelopathy.

Your arm complaints “The pain is in my neck center and left side. I get pain down spine and in shoulder into my bicep (severe) my four fingers get numb. Sometimes I can’t pick anything up with my left hand because fingers are so numb. I get burning down arm to my fingers sometimes. Sometimes it’s I get electric shock like pain down arm” sound to be radiculopathy due to nerve root compression. All these symptoms fit with the findings “Acquired stenosis most prominent c4-5 through C6-7 with cord flattening and prominent left sided nerve root compromise at both c5-6 and c6-7″.

I would say you need to find a spine surgeon very soon who can assess you and develop a surgical plan to decompress your cord and nerve roots.

See:
https://neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/ and
https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/ and
https://neckandback.com/treatments/anterior-cervical-decompression-and-fusion-acdf/”

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.

Candycakes
Participant

June 29, 2019 at 10:30 am

Post count: 4

#30652

Thank you very much for your help. I will look for a spine specialist. I do have two more questions if you could be so kind . Is there anyway I could get better without surgery? And should I be worried about the ectopia tonsil ? Thank you very much for all your help and taking the time.

Donald Corenman, MD, DC
Moderator

June 29, 2019 at 12:18 pm

Post count: 8660

#30653

With your symptoms and the potential for spinal cord injury and dysfunction, I would say that surgery should be in your near future. The ectopic tonsil should not be a problem as long as it is not associated with Chiari syndrome (https://neckandback.com/conditions/chiari-malformation-type-arnold-chiari-syndrome/).

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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