Question about finding on my Lumbar MRI with contrast

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jewelz
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October 29, 2014 at 6:03 am

Post count: 4

#11614

I have been in increased low back, hip and abdominal pain in the last 6+ months.
Then my bladder suddenly stopped working in Sept. So I have a catheter in since then. Also bowel problems progressively worsening since became unable to urinate, now unable to make bowel movements for past week or so.
My specialist ordered MRI of lumbar with contrast, and I am very concerned about a finding on there:
It says 3.8 mm enhancing nodule along the roots of cauda equina at lower L4 level. Only seen on postcontrast images. May represent small neurogenic tumor such as Schwannoma/neurofibroma – Drop metastasis is not excluded.
I got MRI the results online, and do not have appt. with my dr. to discuss them until next week. So I am unable to ask him about this currently, and I am extremely worried about cancer or other (I have been increasing ill and lost 40 pounds unintentionally in past 6 months also, along with fevers, night sweats, increased severe fatigue – Sleep 20 hours at a time some days/nights.
Can you give me advice if this sounds like cancerous or any idea what it may be? Also if that could be causing my bladder to stop working and bowel problems?
Any info/suggestions on what this nodule on caudal spine could possibly be would be very appreciative, as I am so worried. Thank you so much.
Julie

Donald Corenman, MD, DC
Moderator

October 29, 2014 at 9:44 pm

Post count: 8660

#11615

Bowel and bladder dysfunction is generally a central nervous system problem although a very large disc herniation in the lumbar spine (cauda equina syndrome-see website) can also cause this.

There is no evidence of significant nerve compression in your lumbar spine to contribute to your bowel and bladder dysfunction. The small enhancing nodule may be nothing (neurofibroma- a small generally benign tumor) but can be from something more problematic.

A “drop metastasis” is a neoplastic tumor from higher up in the cord or even brain that has shed cells. These cells then “drop” down in the CSF due to gravity and attach lower in the dural sac.

Significant unintentional weight loss is a sign that much more work-up needs to be completed to discover what the cause of this weight loss is from.

A brain MRI is warranted as well as possibly MRIs of the cervical and thoracic spine.

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.

jewelz
Member

October 30, 2014 at 8:19 am

Post count: 4

#11625

Thank you so much for your quick and informative response.

I just have a couple additional questions regarding that –

Could a central nervous system problem from my Chiari Malformation possibly cause the bladder & bowels to stop working if it worsened?
(My last cervical MRI w/out contrast showed the chiari herniation worsened a year ago – from prior year). I have not been to surgeon for that yet as my health has declined too much to make the trip.

Then I fell down very hard just before my bladder stopped working and all my chiari-type neurological problems – headaches, pressure, dizzyness, vision spots/flashing lights, blurring, autonomic dysfunction, vagus nerve dysfunction, etc all got worse – the same time my bladder stopped working. (So possibly the jar from the fall worsened it again more).

But since my low back & hip pain also has been severely increasing since I fell, I was thinking it was all due to lumbar.

So I am just wondering if the Chiari Malformation is something that could cause the bladder/bowel dysfunction?

And also if that small nodule/tumor (which I will take your advice and ask my doctor for further testing, including brain MRI) on Cauda Spine could possibly cause such increased pain through low back and hip (even though it is so small) since nothing else is showing in lumbar area to cause all that increased pain? Or do you think that is too small to cause any pain?

Thank you so much for your time and all your helpful advice,
I really appreciate it!

Donald Corenman, MD, DC
Moderator

October 30, 2014 at 8:04 pm

Post count: 8660

#11630

Chiari malformation (compression of the spinal cord at the base of the skull) can cause your bowel and bladder symptoms. A fall can aggregate this condition and cause further dysfunction of the cord.

An MRI of the brain should include the cervical spine as these Chiari malformations can be associated with a syringomyelia (a swelling of the middle of the spinal cord).

You need to get into a base of skull specialist to have a full workup. Do not hesitate on this.

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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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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