Post surgical MRI finding

Tagged: post surgery MRI after ACDF and continued arm pain

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mnjody
Participant

January 11, 2020 at 6:27 am

Post count: 19

#31886

12/26 I had ACDF surgery, intended to address C5-T1. Follow up CT shows it was a C6-T2 procedure. on 12/30 I had the remaining C5-6 space addressed as well. My question is this – I still have radiating pain from my shoulder blades to my elbow in my left arm. I was told the Post surgical MRI looked good, but when I read it I am not understanding if good means everything is as it should be, or if it is “good enough”. Can you please help me understand?

IMPRESSION:
Postsurgical changes. There is been improvement of the areas of stenosis or cord
impingement since the previous study.
EXAM: MR CERVICAL SPINE WITHOUT IV CONTRAST
COMPARISON: November 21, 2019, CT scan of December 29, 2019
FINDINGS:
There has been interval surgical change with metallic plate and screws
transfixing C6, C7, T1 and T2. Interbody fusion devices at C5-6, C6-7, and T1-T2
are in place.
Skull base-C2: No MR abnormality is demonstrated.
C2-3: No MR abnormalities are demonstrated.
C3-4: No MR abnormalities are demonstrated.
C4-5: No MR abnormalities are demonstrated.
C5-6: There is redemonstration of a focal central disc herniation and/or
osteophyte. This impinges upon and deforms the cord. This is unchanged. Mild
left neural foraminal narrowing is present.
C6-7: Mild diffuse disc bulging persists. The focal disc protrusion or
herniation seen previously has improved. Flattening of the cord persists but has
improved. Neural foramina are patent on the right and mildly narrowed on the
left.
C7-T1: Postsurgical fusion changes are again noted. Epidural foraminal
narrowing is seen. The focal disc protrusion or herniation seen previously the
has diminished in size only minimal contact upon the dural sac. Left neural
foraminal narrowing mild degree is evident.
The T1-T2: Postsurgical fusion changes are seen. No central canal stenosis is
evident. Neural foramina are patent.
Alignment: Normal
Bone Marrow: Normal
Extra-spinal Findings: No significant incidental findings

Donald Corenman, MD, DC
Moderator

January 11, 2020 at 6:58 am

Post count: 8660

#31888

I am surprised that you had an anterior procedure with the bottom segment at T1-2 as this is a very low segment for an anterior approach. I assume this level was intentional and that the C5-6 segment “added on” 3 days later went well.

Your continued complaint “I still have radiating pain from my shoulder blades to my elbow in my left arm” has some differential diagnoses to consider. You still have “mild” foraminal compression at C5-T1 on the left (“C5-6: There is redemonstration of a focal central disc herniation and/or
osteophyte. This impinges upon and deforms the cord. This is unchanged. Mild
left neural foraminal narrowing is present…C6-7, Neural foramina are patent on the right and mildly narrowed on the left.,,C7-T1, Left neural foraminal narrowing mild degree is evident”.

However, residual “mild compression”, especially after an ACDF which hopefully stops motion of the disc space, enlarges the height of the disc space and subsequently enlarges the foramen should have resolved the compression and mechanical deformity of the nerve root.

Shoulder to elbow pain can be generated by a nerve root that is still compressed or inflamed, a shoulder disorder like rotator cuff syndrome or even cubital tunnel syndrome. See
https://neckandback.com/conditions/cubital-tunnel-syndrome/
https://neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/ and
https://neckandback.com/conditions/rotator-cuff-syndrome-shoulder-impingement-syndrome/.

The best way to determine the diagnosis is first with a thorough physical examination and if that is indeterminate, then with diagnostic blocks (shoulder and SNRB- see https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/). If cubital tunnel syndrome is suspected, a neurological consult and EMG should be considered.

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.

mnjody
Participant

January 11, 2020 at 7:06 am

Post count: 19

#31890

I was as surprised as you with the T1-T2. It was a human error, which is why the second surgery was needed to address the c5-6 disc space. Will having the T1-2 done when it wasn’t needed affect me in anyway? I am still hoping swelling may be the issue in my pain, but now I know where to continue on looking if it doesn’t. Thank you very much.

Donald Corenman, MD, DC
Moderator

January 11, 2020 at 7:13 am

Post count: 8660

#31892

The additional T1-2 fusion should not cause any long-term effects.

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.

mnjody
Participant

January 11, 2020 at 7:18 am

Post count: 19

#31893

Thank you!
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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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