potts spine

Viewing 6 posts - 13 through 18 (of 19 total)

Previous 1 2 3 4 Next

Author

Posts
vkas.stha
Member

October 17, 2013 at 8:18 pm

Post count: 12

#9599

hello Dr. Corenaman,
Here I have presented my previous MRI results and latest MRI report. I want to know is there is progress in the condition or not? and regarding to this condition, how much is complicated is this case? Is there is chances of Paralysis?
Here goes my the MRI report:

The report of MRI test on the date june 17,2013 was:

FINDINGS:

a. There is a destruction of inferior surfaceof L2 vertebral body and superiror surface of L3 vertrebal body is noted. reduced disc height of L2 vertebral body and L2-L3 disc space. Marrow signal changes noted L2-L3 vertrebal bodies which shows heterogenous low signal intensity in T1 weighted images and heterogenous high signal intensity in T2 and fat suppressed images.Similar marrow signal changes also seen in the pedicle of L2 vertrebal body. Fluid sign is seen in inter vertrebal disc. Slight posterior angulation noted L2-L3 level. Minimal pre and paravertrebal collection is noted. Approax 11.0*4.5*5.0 cm size collection seen in the right psoas muscle which display low signal intensity in T1 weighted images and high signal intensity in T2 weighted images. loss of lumbar lordosis is noted Disc buldge noted at L4-L5 and L5 S1 levels.

b. All lumbar intervertebral foramina are well visualized with exiting nerves roots within superior aspects and do not show any abnormality.

c. Lower part of the cord is normal. CSF space around the cord is sormal. No space occupying lesions seen.

d. no para-spinal abnormilty.

e. No abnormal signal changes noted in dorsal disc, vertrebal bodies and dorsal spinal cord.

f. No abnormal signal changes noted in bilateral hip SI joints.

IMPRESSION.

a. Findings consistent with infective spondylitus and discitis. Minimal paravertrebal abscess. Large right psos abscess. Most likely tubercular pathology.

Another MRI was done on the August 30,2013and the findings were:

a. Destruction of lower end of L2 and upper end of L3 vertrebal bodies. Reduced disc space with slight posterior angulation noted. marrow signal changes noted at L2, L3 and L4 vertebral bodies and L2-L3 disc which shows heterogenous high signal intensity in T2 and fat suppressed images and heterogenous iso signal intensity in T1weighted images. Similar signal with compromised central spinal canal is seen. Approax. 4.0*3.5*2.5 cm size collection seen in right psos abscess.

b. All lumber intervertebal foramina are well visualized with exiting nerve roots within superior aspect and do not show any abnormality.

c. Lower part of the cord is normal. CSF space around the cord is normal. No space occupying lesions seen.

d. No para-spinal abnormality

IMPRESSION:
a.Findings suggestive of tubercular spondylitis with discitis involving L2, L3 and L4 level vertebral bodies and L2-L3 disc. Compromised central spinal canal at L2-L3 level.

b. Minimal, pre, para and epidural collection with right psos abscess.

Your reply is highlyy apreciated. Thank you. Sincerely Bikash Shrestha

vkas.stha
Member

October 17, 2013 at 9:45 pm

Post count: 12

#9600

hello doctor I came to hear that the diseases in the Vertebrae L1-L2-L3 are maainly permanent and they are the most difficult to heal if it get injury. Is this true? Can’t I be the 100% fit as before? Please doctor do help this had made me insane. Sincerely Bikash Shrestha

Donald Corenman, MD, DC
Moderator

October 20, 2013 at 2:04 am

Post count: 8660

#9623

You have destruction of the vertebral bodies of L2 and L3 with an infectious mass in the spinal canal due to the bacterial TB. This indicates progression of the infection based upon your two serial MRIs. If you are currently under oral antibiotic treatment (and you are fastidious regarding your medication intake), then the current treatment regime is failing and you need different medications.

In addition, with your prior reported neurological deficit and now compelling evidence of nerve compression, surgery may be indicated. With TB, proper treatment and progressive destructive erosion of the spine, in general surgery is indicated.

Now, if you are not taking your medications on schedule (which is unfortunately a common occurrence and explains why TB is developing multiple drug resistance), then a change of your medications and a careful schedule of taking the antibiotics on time is needed.

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.

vkas.stha
Member

October 28, 2013 at 9:55 am

Post count: 12

#9704

Thanks doctor for your valuable suggestion and information. After that information, I imeediately went to the hopital for the check up and I did my MRI test and Blood test too. And the report of MRI on the date Oct 23,2013 was:
Findings:

a) Destruction in thelower end plate of L2 vertrebal body and upper end plate of L3 vertrebal body are noted. L2-L3u disc space is markedly reduced. Marrow signal changes noted in L1,L2 and L3 vertrebal bodies which shows high signal intensity in T2and fat suppressed images. Corresponding area shows heterogenous iso to low signal intensity at T1 weighted images. Epidural collection is noted which is extended from L2-L4. Approax. 3.0*2.0*5.0 cm size collection is noted in right psoas anterior aspect. Disc buldge noted at L3-L4 and L4-L5 levels.

b) All lumbar intervertebral foramina are well visualized with exiting nerves roots within superior aspects and do not show any abnormality.

c. Lower part of the cord is normal. CSF space around the cord is sormal. No space occupying lesions seen.

d. no para-spinal abnormilty.

e. No abnormal signal changes noted in dorsal disc, vertrebal bodies and dorsal spinal cord.

IMPRESSION:

a) findings suggestive of tubercular spondylitis with discitis. Minimal epidural collection. Right psoas absscess.

Blood Result
Haematolgy:
WBC count: 8600
ESR: 6

Diffrential count

Nuetrophills: 78
Lymphocytes : 22
Eosinophils, Monocytes, Basophils and others all : 0

Biochemistry
Blood Urea: 3.3
Serum Creatinine: 110
Na/k: 145/4.5

Liver function test:

Serum Billirun(T): 16 umol/l
Serum Billirun(D): 4 umol/l
Serum GPT : 75 U/l
GOT: 42 U/l
Serum Alkaline Phosphatase: 223
Through this report my surgeon said that the medication is working… they had said that the epidural collection and absscess has been decreased and ESR is normal.
Before accident I wasn’t having Rifampicin due to the liver infection and now i’m taking 600 mg of it and this process is continuing since 15 days. and now i’m in Ethambutol 1200mg, isoniazid 300mg and Rifampicin 600mg

Now through this latest report I want to know how much progress is there comparing to the 2nd MRI. is my medication is working doctor? and i have also incresed in weight too. My back pain has been reduced too and also after physiotherapy I’m getting little strength on my both legs.

Your information is highly acceptable. Thanks. Sincerely Bikash Shrestha

Donald Corenman, MD, DC
Moderator

November 18, 2013 at 12:38 am

Post count: 8660

#9812

It appears your medication is effective. The psoas access is receding and the epidural access is small according to the radiologist; “Minimal epidural collection”.

Continue to use physical therapy to strengthen your legs and work hard.

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.

vkas.stha
Member

January 29, 2014 at 7:37 pm

Post count: 12

#10262

Hello Dr. Corenman,

I am so much happy to say that now my present condition is far more better than the previous one. Now I can walk by myself without any support. I am so happy that now i am gaing my leg strength more and more day by day. Thank you for your precious information about my diseases.

Moreover, I just got my latest MRI on Jan 20, 2014. So, I am desperatly waiting for your views through observing this report.

FINDINGS:

a) Destruction in thelower end plate of L2 vertrebal body and upper end plate of L3 vertrebal body are noted. L2-L3 disc space is markedly reduced. Marrow signal changes noted in L1,L2 and L3 vertrebal bodies which shows high signal intensity in T2 and fat suppressed images. Corresponding area shows heterogenous iso to low signal intensity in T1 weighted images. Epidural collection is almost not seen at this scan. No obvious collection seen in right psoas region. Disc buldge noted at L3-L4 and L4-L5 levels.

b) All lumbar intervertebral foramina are well visualized with exiting nerves roots within superior aspects and do not show any abnormality.

c. Lower part of the cord is normal. CSF space around the cord is sormal. No space occupying lesions seen.

d. no para-spinal abnormilty.

I am just curious on my disk spaces that when the disc space of L2 and L3 will be normal? Can i get the same life styles as before after this treatment. Can i Ride vechiles like motorcycles and so on?

Sincerely, Bikash Shrestha
Author

Posts

Viewing 6 posts - 13 through 18 (of 19 total)

Previous 1 2 3 4 Next

You must be logged in to reply to this topic.

Donald Corenman, MD, DC

Average rating:

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel