Pressure from neck? No pain.

Tagged: Stand-up MRI and image quality.

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andrea2289
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March 13, 2017 at 2:55 pm

Post count: 2

#24526

Hi there. I’m hoping you have some insight as to what might be going on. In the beginning of January, I had a sudden onset of tingling in my leg, which spread to both legs and both arms. The tingling is still there but has subsided and eye/sinus pressure is my biggest symptom. I also have facial numbness off and on, brain fog (not dizziness), but the biggest symptom is the pressure. The pressure is significantly worse when I’m sitting and mainly behind the eye and sinus area. Driving for more than 20 minutes is almost unbearable, as is sitting at my desk, which preventing me from even being able to work.

I’ve gone to my eye doctor, and my eye pressure tested fine even while I was feeling the pressure. I’ve also had a CT angiography of the head and neck, as well as a brain MRI. I DO have three meningiomas, but both Mayo and my team at Vanderbilt are confident they are not causing any of these symptoms and were incidental findings.

My neurologist said he see no signs of intracranial pressure, but I am scheduled for a lumbar puncture next week. My last cervical MRI was January 26th, but that was before I felt this pressure. I also just had a lumbar and thoracic. Insurance wouldn’t approve another cervical, even though there is a worsening of symptoms. I’ll post the results below.

The pressure can also be exacerbated by literally anything touching the back of my upper neck. I can’t even lay back on the couch. Literally, anything pressing on the back of my upper neck makes the pressure behind my eye worse.

I went to a chiropractor, and she said something about occipital nerves and muscles. She worked on that area, and I did feel better, although it only lasted about two days. I also had two bupivacaine injections into the muscle of my neck, and that helped for about two days as well. Could this all be a muscle issue?

And even though I do have benign brain tumors, I’ve been telling them for two months that I think something is going on in my neck. My doctor seems to be stumped. I have no pain, none. It’s all pressure. Here are my MRI reports. Thank-you in advance!

——————————————————————

26-Jan-2017 22:15 *** Final ***
Exam: MR Cervical Spine WO+W/CST

Technique: In addition to routine cervical spine protocol, sagittal STIR T2 sequence was obtained for evaluation of spinal cord signal abnormality. This was followed by postcontrast study.

Contrast: 7.5 mL IV Gadavist

Impression: Stable exam with C3-C6 disc degeneration with C4-C5 disc height loss and right uncovertebral spur.

Findings: Again identified is mild kyphotic deformity of the upper cervical spine with minimal retrolisthesis of C4 upon C5. The remaining vertebrae demonstrate normal alignment. The vertebral bodies have normal height and there is no marrow signal abnormality.

There is mild height loss and bulging of the C4-C5 disc with small right uncovertebral joint spurs. There are C3-C6 enhancing disc annulus fissures. No other significant disc abnormality is identified. The spinal canal and neural foramina are widely patent. The craniovertebral junction, facet joints and visualized soft tissues of the neck appear unremarkable.

The cervical and visualized upper thoracic spinal cord appears normal. In particular there is evidence for intrinsic cord signal abnormality. No evidence for abnormal intramedullary or leptomeningeal enhancement.

The incidental left paramedian posterior pontine telangectasia noted on the brain MRI is again identified.

——————————————————————

Exam performed on 2017/03/03 09:56
MRI OF THE THORACIC AND LUMBAR SPINE
HISTORY: Q85.9 Phakomatosis, unspecified

TECHNIQUE: Multiplanar multisequence MR imaging of the thoracic and lumbar spine was performed before and after
administration of 6.5 mL Gadavist intravenously.

FINDINGS:

Thoracic spine: Thoracic vertebra are normal in height and alignment. There is no abnormal marrow signal. Intervertebral
disc spaces are preserved. The spinal cord is normal in size and signal intensity.

Lumbar spine: Lumbar vertebra normal in height and alignment. A subcentimeter sclerotic focus in the L1 vertebral body is
most likely a bone island. There is mild degenerative edema of the inferior L4 endplate. Degenerative disc disease is
greatest at L4-L5 where there is a mild disc bulge and also mild facet arthropathy. There is resultant mild bilateral L4-L5
neural foraminal narrowing. There is a minimal L3-L4 disc bulge. There is no canal stenosis.

There is no abnormal contrast enhancement in the thoracic or lumbar spine.

IMPRESSION:
1. Mild L4-L5 degenerative disc disease and facet hypertrophy with mild neural foraminal narrowing.
2. Normal MRI of the thoracic spine.

Donald Corenman, MD, DC
Moderator

March 15, 2017 at 10:46 am

Post count: 8660

#24533

Some of the dictated report is not congruent. The sentence “The cervical and visualized upper thoracic spinal cord appears normal. In particular there is evidence for intrinsic cord signal abnormality. No evidence for abnormal intramedullary or leptomeningeal enhancement”. makes no sense as there cannot be a normal appearance but “evidence for intrinsic cord signal abnormality”. Probably a missed “no” in there.

He does say “craniovertebral junction, facet joints and visualized soft tissues of the neck appear unremarkable” so there is no significant degenerative change to the facets. You still might have inflammatory facet disease that does not show up on the MRI scan. You can test this possibility with facet blocks (see https://neckandback.com/treatments/facet-blocks-and-rhizotomies-neck/ and https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/.

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.

andrea2289
Participant

March 15, 2017 at 11:07 am

Post count: 2

#24534

I have my first appointment at a pain clinic next week, and I will mention this. Thank-you for your help :)

What are your thoughts on upright MRIs? I had a friend say it sounded like some sort of instability, and that’s nearly impossible to diagnose without an upright MRI.

Donald Corenman, MD, DC
Moderator

March 19, 2017 at 8:04 am

Post count: 8660

#24556

Upright MRIs are worthless in my opinion. Two factors that make it worthless. First is the the machine is a 0.7 Tesla strength magnet, a very low power machine. Imagine that the machine Tesla strength is the power of a flash bulb at night. The more powerful the flashbulb, the greater the illumination of the picture. Our machine at the clinic is 3.0 Tesla. You can understand then the problem with this “stand-up MRI” to resolve good pictures.

The second problem is the the MRI captures a picture like the old time wild-west photographs. That is, it takes some time under the camera to get the exposure and if there is motion during the exposure, ghost images would occur (the picture would become blurry). I don’t know about you but I can’t stand (or sit) perfectly still for 20-40 minutes but I certainly can lie still for that period of time. 40 minutes is about the acquisition time from the MRI images to be obtained.

Also, with a normal (supine) MRI of great quality and standing X-rays including flexion and extension, almost all problems of instability can be diagnosed.

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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