Second Opinion Different from the First?

Tagged: Cervical Results, Lumbar Results, Second Opinion, Veteran

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Thoracic07
Participant

April 17, 2018 at 1:17 pm

Post count: 3

#28083

By the way…veteran. My neck is killing me. Thank you to anyone who can help me understand what is going on. First doctors minimized pain for years. Long story.

FIRST REPORT 2016:
At C2-C3, subarachnoid spaces are intact without significant central canal or neuroforaminal stenosis. There is right greater than left facet degeneration.

At C3-C4, there is a shallow disc bulge with intact subarachnoid spaces. The effective AP canal diameter is approximately 17 mm. Mild left uncovertebral spurring contributes to mild left-sided neuroforaminal stenosis.

At C4-C5, there is a central/right central annular fissure and tiny disc protrusion with intact subarachnoid spaces. No significant neuroforaminal stenosis.

At C5-C6, there is a right central disc protrusion with annular fissure contributing to minimal narrowing of ventral subarachnoid space with an effective AP canal diameter of approximately 10.2 no meters. Mild left uncovertebral spurring contributes to mild left neuroforaminal stenosis.

C5-C6 levels with minimal narrowing of ventral subarachnoid space at C5-C6 without cord flattening or cord signal abnormality. No significant neuroforaminal stenosis.

At C6-C7, no significant central canal or neuroforaminal stenosis.

At C7-T1, there is no significant central canal or neuroforaminal stenosis.

Impression: There is a mild cervical kyphosis centered at C3-C4. Alignment is anatomic. The atlantoaxial and the atlantooccipital joints are within normal limits. The anterior atlantoaxial interval is normal. No focal marrow signal abnormalities are identified. There is intervertebral disc degeneration at C3-C4, C4-C5, and C5-C6 with mild loss of normal intrinsic T2 hyperintense signal without significant height loss. The carotid and vertebral artery flow voids are intact. Visualized structures of the posterior fossa are within normal limits. Soft tissue structures of the neck are unremarkable. Mild cervical kyphosis centered at C3-C4.2. Intervertebral disc degeneration at C3-C4, C4-C5, and C5-C6 levels with minimal narrowing of ventral subarachnoid space at C5-C6 without cord flattening or cord signal abnormality. No significant neuroforaminal stenosis.

LUMBAR MRI: (X-ray was normal study) There is a normal lumbar lordosis. Alignment is maintained. There is preservation of vertebral body and disc space height. >. Cord signal is normal. The conus medullaris is normal in signal characteristics and morphology and terminates at the superior endplate of L2 level. At T12-L1 to L3-L4, there is no significant central canal or neural foraminal stenosis.

At L4-L5, there is radial posterior annulus fissure with an associated shallow broad-based protrusion with mild compression of the thecal sac, causing an effective central canal AP diameter of 10.7 mm. There is mild bilateral neural foraminal stenosis.

At L5-S1, there is no significant central canal or neural foraminal stenosis.
Impression: Shallow broad-based protrusion at L4-L5 with resulting mild bilateral neuroforaminal stenosis. No significant central canal stenosis…

Dx of Chronic back pain (SCT 134407002)
Dx of Neck pain (SCT 81680005)

SECOND DOCTOR REPORT ON SAME CERVICAL AND LUMBAR MRI + NEW THORACIC (2017)

Cervical MRI: C3-4 C5-6 HNP with mild stenosis. CXR: Mild spondylosis. Reviewed findings with patient. Has disc herniation at C3-4 and C5-6 – but believe C5-6 has greater stenosis an may explain symptoms. In lumbar spine has small HNP and mild stenosis at L4-5.Recommend continue with scheduled Lumbar ESI. If effective – may then also try cervical ESL May also consider further cervical w/u with bilateral UE EMG. Also believe maybe candidate for C5-6 ACDA to provide chance of improving cervical symptoms.

Lumbar MRI: small HNP at L4-5, L5-S1. Mild bilateral recess/foraminal stenosis at L4-5.
Thoracic MRI: Mild Scoliosis

1) Dx of Cervical disc herniation with radiculopathy (ICD-722.0)
2) Dx of Cervicalgia (LCD-723.1)
3) Dx of Lumbago (CD-724.2)
4) Dx of Lumbar disc herniation with radiculopathy (ICD-722.10)
5) Dx of Cervical spondylosis without myelopathy (ICD-721.0)

Thoracic07
Participant

April 21, 2018 at 12:46 am

Post count: 3

#28095

I also posted a video of the Thoracic MRI on YouTube:
The diagnosis was Mild Scoliosis.

Donald Corenman, MD, DC
Moderator

April 21, 2018 at 9:54 am

Post count: 8660

#28098

Sorry but no hyperlinks allowed from this site except for intersite links.

The comment “my neck is killing me” is not a good description of your symptoms. See https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-neck-shoulder-and-arm-pain/.

What is your question regarding the 2 different MRI reports?

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.

Thoracic07
Participant

April 21, 2018 at 2:13 pm

Post count: 3

#28105

Symptoms are extreme fatigue, burning, neck pain, inability to do just about anything at this point. One weird symptom is about every three days or so, if I try to put my chin to my chest, my neck pops and it’s like electricity shoots up into by brain.

AP canal diameter 10.2 for C-6 and 10.7 for Lumbar, with disk herniation. They say this is mild? I don’t want to get out of bed in the morning or do anything…how is any of this mild? First MRI says Kyphosis but doesn’t mention spondylosis. Is spondylosis insignificant or something?

Where can I post an intersite link?

Thanks for the response.

Donald Corenman, MD, DC
Moderator

April 22, 2018 at 8:13 am

Post count: 8660

#28107

Your symptoms are compatible with either cervical degenerative facet disease or degenerative disc disease. See “https://neckandback.com/conditions/cervical-degenerative-disc-disease/ and “https://neckandback.com/conditions/cervical-degenerative-facet-disease/

It really depends upon how significant your degeneration really is to determine what levels are causing pain. I cannot tell based upon the radiological report what structures are more or less degenerative. You probably would have to use diagnostic injections to determine what is causing pain. See https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/ and https://neckandback.com/treatments/facet-blocks-and-rhizotomies-neck/ as well as https://neckandback.com/treatments/cervical-discograms/

Your report of canal narrowing is not too impressive. Canal narrowing by itself will not cause pain. Even spinal cord compression will generally not cause pain as that compressive condition-myelopathy is generally not a painful condition.
See https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/

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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