Please shed some light

Tagged: mri

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mdanko
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October 10, 2015 at 9:55 am

Post count: 1

#20501

hi, i am wondering if you can shed some light on this reading from my MRI. I have a lot of pain in my neck, shoulders and arms as well as numbness and tingling, especially at night. I had surgery last March on L5-S1 for bulging disc“>bulging disc“>bulging disc“>bulging disc that was compressing a nerve causing extremely severe leg pain on the right side. That seems to have cleared up but i still have a lot of pain in lower back, mild to moderate pain in central back and moderate pain in neck, arms and shoulders. Also, I frequently suffer from general pain all over such as in my legs, hands, body…. I have been diagnosed several years ago with fibromyalgia, but that just doesnt seem to fit how i feel…

Here are the results of my 2 MRIs:

EXAMINATION: MRI CERV SPINE DATE: 10/9/2015

TECHNIQUE: Multiplanar, multisequence images of the cervical spine
were obtained without contrast.

EXAMINATION DATE: 10/9/2015 8:23 AM

COMPARISON/CORRELATION: Radiographs 01/16/2015.

CLINICAL HISTORY: neck pain“>neck pain“>neck pain, with R>L radicular symptoms

FINDINGS:

C2-C3: No significant stenosis.

C3-C4: Central disc protrusion approaching the ventral cord.

C4-C5: Spondylotic ridging without significant stenosis.

C5-C6: No significant stenosis.

C6-C7: No significant stenosis.

C7-T1: No significant stenosis.

The alignment/” class=”thirstylink” title=”alignment“>alignment of cervical spine is normal with normal bone marrow
appearance.

The craniovertebral junction is normal.

The cervical spinal cord is normal in caliber without abnormal signal
changes.

There is no central spinal canal or intervertebral foraminal stenosis.

There is no prevertebral or paravertebral mass.

IMPRESSION:
Mild spondylotic changes of the cervical spine, as detailed above,
without significant spinal canal or foraminal stenosis. Central disc
protrusion at C3-C4 approaching the ventral cord.

MRI Lumbar Spine

Date: 2/6/2015

History: Lumbar radiculopathy

Comparison: None

Technique: Sagittal T1, sagittal fast spin-echo T2, axial T2 weighted
fast spin echo and axial T1 weighted images of the lumbar spine were
obtained.

Findings:

The conus medullaris is within normal limits.
The vertebral body heights are well-maintained. alignment/” class=”thirstylink” title=”alignment”>alignment/” class=”thirstylink” title=”Alignment”>Alignment is
well-maintained.
The bone marrow signal is age-appropriate.
The paravertebral soft tissues are unremarkable.

Small left renal cyst is seen.

At L1-L2: no significant abnormality.

At L2-L3: broad-based diffuse disc bulge is seen without significant
canal or foraminal stenosis.

At L3-L4: Mild endplate changes are present otherwise no significant
canal or foraminal stenosis.

At L4-L5: Broad-based central disc protrusion with annular fissure is
seen causing mild indentation of the ventral thecal sac. Mild
bilateral facet arthropathy is also seen. There is extension of disc
into the left neural foramina causing mild to moderate left foraminal
stenosis with disc appearing to at least abut the exiting left L4
nerve root.

At L5-S1: There is a left paracentral disc protrusion extending into
the left lateral recess and compressing the traversing left S1 nerve
root. Superimposed broad-based diffuse disc bulge is also seen
extending into the bilateral neuroforamina resulting in mild right and
mild to moderate left foraminal stenosis with mild impingement of the
exiting left L5 nerve root. Endplate degenerative changes are also
seen.

IMPRESSION:

Multilevel spondylotic changes of the lumbar spine as detailed above
with a right paracentral disc protrusion extending into the right
lateral recess with compression of the traversing right S1 nerve root.

Donald Corenman, MD, DC
Moderator

October 16, 2015 at 9:55 am

Post count: 8660

#20507

Starting with your lumbar spine, you note lower back pain but do not note buttocks or leg pain. I will assume that your right leg pain went away after surgery and you no longer have leg pain.

You currently have degenerative disc disease with disc herniations at both L4-5 and L5-S1. At L4-5, you also have degenerative facet disease. It is possible you might have a lumbar degenerative spondylolisthesis at that level too but without standing and flexion/extension X-rays, this is difficult to ascertain.

At L5-S1, you have a disc herniation on the opposite side from your prior surgery (“There is a left paracentral disc protrusion extending into the left lateral recess and compressing the traversing left S1 nerve root”). You do not note left buttocks pain so probably the nerve root is not reacting in spite of the nerve compression.

You note “moderate pain in neck, arms and shoulders” but you are not specific. See the section regarding symptom description to understand how to “organize” your pain description to make it understandable to a spine professional.

The description of your neck MRI by the radiologist is most likely incomplete and there are subtle findings that are not recognized and described.

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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