Severe Neck Pain-Myelogram and MRI. HELP!

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mharbison
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June 7, 2021 at 9:02 pm

Post count: 5

#34136

Hi Dr Corenman,

I am having chronic, severe pain in my neck, radiating down my right arm and thumb and index finger. I am also having weakness and numbness and tingling in those areas as well. I seem to be finding that the drs that I see are not really wanting to go any further than steroid injections or radio frequency ablation therapy, which I have already done MANY times to no avail.
Here is my current Myelogram and MRI that was just recently done. I have not seen the Dr since the scans, but was wondering your thoughts on this. I have had both a lumbar and cervial fusion as well as a foraminotomy.

MYELOGRAM WITH CT CERVICAL, LUMBOSACRAL SPINE: 6/4/2021
CT CERVICAL SPINE WITH CONTRAST WITH MYELOGRAPHY: 6/4/2021 10:00 AM
CT LUMBAR SPINE WITH CONTRAST WITH MYELOGRAPHY: 6/4/2021 10:00 AM
MYELOGRAM SEDATION: 6/4/2021 10:00 AM
HISTORY: Previous neck and low back surgeries. Persistent neck and back pain.
COMPARISON: ARA MRI of the cervical spine 05/24/2021. ARA MRI of the lumbar spine 05/13/2021.
TECHNIQUE: The risks, benefits, and alternatives to myelography were explained to the patient who understood
and agreed to proceed. Signed consent was obtained.
Using sterile technique and local anesthesia, the tip of a 27-gauge spinal needle was placed within the spinal canal at
the L2-L3 level under fluoroscopic control. Contrast was instilled and maneuvered into the regions of interest. Total
contrast administered on date of service: 13 ml Omnipaque 300 – Intrathecal.
Multiple spot and overhead films were obtained. The patient tolerated the procedure well and was sent to CT where
multiple axial sections were obtained through the areas of interest. Images were viewed both in bone and soft tissue
windows. Multiple coronal and sagittal reformations were viewed as well. Utilization of dose lowering technique that
included adjusting the mA and/or kV to protocol and/or patient size.
Fluoroscopic Dose Area Product (uGy*m2): 1066.7
OBSERVATIONS: The cervical myelogram images show tiny anterior extradural defects between C2 and C6. The
right C6 nerve root sleeve is asymmetrically effaced. Both C5 nerve root sleeves are partially effaced.
The lumbar myelogram images show a small anterior extradural defect at the L1-L2 level.
The lumbar nerve root sleeves are normally and symmetrically filled.
Mild C5-C6 posterior listhesis is probably related to facet degeneration with subluxation. When allowing for
physiologic motion at the C3-C4 and C4-C5 levels, there is no indication of cervical instability when comparing
flexion and extension standing lateral radiographs.
Lumbar alignment is normal. There is no indication of lumbar instability when comparing flexion and extension
standing lateral radiographs.
There is no indication of bone destruction or acute fracture.
The anterior hardware stabilizing the C6 and C7 bodies is well-positioned without evidence of loosening or failure.
Solid interbody fusion has been achieved. The posterior elements of C6 and C7 are partially fused on both sides.
The anterior and posterior hardware stabilizing the L5 and S1 levels is well-positioned without evidence of loosening
or failure. Bilateral L5 pars defects are noted. The posterior elements of L5 and S1 are not fused at this time.
The L5-S1 disc prosthesis is associated with solid interbody fusion.
There is no indication of discitis, osteomyelitis, arachnoiditis, or epidural abscess.
C2-C3 disc: Normal. Uncinate spurring produces moderate bilateral foraminal encroachment.
C3-C4 disc: Normal. Uncinate spurring produces moderate right and mild left foraminal encroachment.
C4-C5 disc: Slightly narrowed. Minimal posterior protrusion of disc material approaches but does not deform the
anterior surface of the spinal cord. There is ample CSF posterior to the cord at this level. Mild to moderate bilateral
foraminal encroachment is noted.
C5-C6 disc: Mildly narrowed. Posterior protrusion of disc material approaches but does not deform the anterior
cord surface. A small, right posterolateral disc herniation is best seen on images 63 and 64 of series 4. The right C6
nerve root is probably compressed as it enters its neural foramen.
C6-C7 level: No canal encroachment. Facet overgrowth produces minimal right and mild left foraminal
encroachment.
C7-T1 disc: Normal.
T11-T12 disc: Posterior annular bulging slightly flattens the anterior thecal sac but does not deform the anterior
surface of the distal spinal cord.
T12-L1 disc: Normal.
L1-L2 disc: Moderately narrowed. Left posterolateral protrusion of disc material is associated with early marginal
spurring. The left anterior thecal sac is indented. There is no foraminal encroachment.
L2-L3 disc: Normal.
L3-L4 disc: Normal.
L4-L5 disc: Normal. Early facet degeneration is noted without significant foraminal or canal encroachment.
L5-S1 level: No foraminal or canal encroachment. Mild listhesis produces early bilateral foraminal encroachment.
IMPRESSIONS:
1. Routine postsurgical appearance at the L5-S1 level with solid anterior fusion.
2. No new disc herniation or significant canal narrowing at any lumbar level since 05/13/2021.
3. Routine postsurgical appearance at the C6-C7 level with anterior and posterior fusion.
4. A small, right posterolateral C5-C6 disc herniation probably compresses the exiting right C6 nerve root.

MRI CERVICAL SPINE WITH AND WITHOUT CONTRAST: 5/24/2021
HISTORY: Cervicalgia with radiculopathy, right upper extremity, for two years. Spinal stenosis, history of two
surgeries, arthrodesis status.
COMPARISON: MRI-08/18/2018.
TECHNIQUE: Appropriate pulse sequences were employed in multiple planes. Total contrast administered on date
of service: 9 ml Gadavist – IV.
FINDINGS:
General Comments: Again seen is artifact related to hardware used for anterior fusion at C6-7. Cervical vertebral
body heights are within normal limits.
Alignment: There is mild reversal of normal cervical lordosis centered at C4-5 which has progressed. There is no
significant listhesis.
Cord: No evidence of a mass or intrinsic T2 signal abnormality. After contrast, there is no abnormal enhancement.
Craniocervical Junction: The cerebellar tonsils are normally positioned. The regional osseous anatomy is within
normal limits.
C2-C3: Uncovertebral hypertrophy bilaterally is causing moderate foraminal stenosis, similar to the prior. Patent
canal.
C3-C4: Uncovertebral hypertrophy bilaterally is causing mild to moderate right and mild left foraminal stenosis,
similar to the prior. Patent canal.
C4-C5: Uncovertebral hypertrophy bilaterally is causing mild to moderate bilateral foraminal stenosis, similar to the
prior. Patent canal.
C5-C6: Shallow dorsal disc/osteophyte complex with posterior annular fissure is present along with mild bilateral
uncovertebral hypertrophy. Mild right and minimal left foraminal stenosis is similar to the prior. The canal dimensions
remain adequate.
C6-C7: At this postsurgical level, the canal and right foramen are patent. There may be mild left foraminal stenosis,
not significantly changed.
C7-T1: Patent canal and foramina.
Other: The paraspinous soft tissues are within normal limits.
IMPRESSION:
1. Anterior fusion changes at C6-7 are redemonstrated. Mild left foraminal stenosis is suspected, similar to
08/18/2018.
2. Multilevel bilateral foraminal stenosis from C2-3 through C5-6 as detailed above, similar to 08/18/2018.
3.Reversal of normal cervical lordosis has mildly progressed compared to the prior. No significant listhesis.

Thank you in advance for all your help and advice. You have helped me get through the last 6-7 years in the midst of all of this.

Donald Corenman, MD, DC
Moderator

June 9, 2021 at 1:47 pm

Post count: 8660

#34140

“I am having chronic, severe pain in my neck, radiating down my right arm and thumb and index finger”. This could be from a C6 or C& nerve problem. I won’t spend time on the lumbar spine today.

Your CT myelo notes:
“C4-C5: Uncovertebral hypertrophy bilaterally is causing mild to moderate bilateral foraminal stenosis, similar to the prior. Patent canal.
C5-C6: Shallow dorsal disc/osteophyte complex with posterior annular fissure is present along with mild bilateral uncovertebral hypertrophy. Mild right and minimal left foraminal stenosis is similar to the prior”.
C6-C7: At this postsurgical level, the canal and right foramen are patent. There may be mild left foraminal stenosis, not significantly changed”.

Well, unless you have a chronic injury to your C7 nerve root, the C6-7 surgical level (I assume an ACDF here) should not be causing your current symptoms. C5-6 is a likely culprit as the C6 nerve will radiate down to the thumb and index finger. C4-5, while it wont radiate into the hand, will radiate into the shoulder and cause deltoid weakness (lifting the arm up to shoulder level).

A selective nerve root block test to determine the affected level is in order. See:
https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/ and
https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/ and https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/

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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