standard mri vs stand up nd chronic back pain helpp

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mohsinaliasdf
Member

August 3, 2012 at 5:06 am

Post count: 11

#6653

hello doctor i just had my mris done for the cervical thoracic and lumbar spine.

here are the reports

LUMBAR SPINE
History: Lymes disease. Rheumatoid arthritis. Pain.

Multiplanar multisequence noncontrast MRI of the lumbar spine. Multiple images degraded by motion artifact. No priors.

Findings:

There is no marrow replacement process, compression fracture or spondylolisthesis. No evidence of intrathecal, paraspinal or retroperitoneal mass.

L4-L5 and L5-S1 disc bulges are present. No herniated nucleus pulposus, central canal or neural foramen stenosis.

Impression:

L4-L5 and L5-S1 disc bulges. No herniated nucleus pulposus or stenosis.

cervical spine;

History: Lymes disease. Rheumatoid arthritis. Pain.

Multiplanar multisequence noncontrast MR the cervical spine. CSF pulsation phenomenon is present. No priors.

Findings:

Visualized intracranial contents. Unremarkable. There is no definitive evidence of altered intramedullary signal, intrathecal or paraspinal mass. There is no marrow replacement process, compression fracture or spondylolisthesis.

Straightening of the cervical lordosis is present. There is a shallow C6-C7 disc bulge. No herniated nucleus pulposus, central canal or neural foramen stenosis.

Impression:

1. Straightening of cervical lordosis may reflect muscle spasm.

2. Shallow C6-C7 disc bulge. No herniated nucleus pulposus or stenosis.

Thank you for the courtesy of this referral.

thoracic spine:

Clinical History: Back pain.

Multiple MRI tomographic scans of the thoracic spine were performed in the coronal, sagittal and transaxial planes utilizing multiple pulse sequences. The study reveals all thoracic vertebral bodies are maintained in height. There is no evidence of fracture, marrow replacement process, spinal stenosis or intrathecal mass.

The dorsal cord is seen segmentally and is unremarkable. There are no protrusional disc bulges or herniations demonstrated.

Impression:
Normal MRI of the thoracic spine.

Thank you for the courtesy of this referral.

please take a look at them

im very very confused because my middle back is the one that hurts the most and as i told you earlier that the symptoms i have are worst in the thoracic spine. As i was getting the mris done i was wondering that the side of my back hust not the middle so how can the spine cause pain onto the sides. i also have an infectious disease with arthritis , suppose i had an infection in the back would the mri show it or not. do you suggest i also get a ct scan .
this pain is unbearbale for me now i dont know whether i would need any type of surgery or procedure to get rid of this.
ill wait for you reply

kindly thanks.

mohsinaliasdf
Member

August 7, 2012 at 12:11 am

Post count: 11

#6673

Hello Dr corenman I’m waiting for your replyi realise that ur busy but please help . I posted my MRI results . The thing is that the pain is unbearable and I don’t know if I should get surgery. the MRI of the cervical should cervical lodosis .is there a way to fix it ? the symptoms that I have can they all be just from the bulging discs or is there something really more. Also I was wondering if you can view the MRI CDs online

MRI4U
Member

November 20, 2012 at 8:42 am

Post count: 2

#7462

First off what do you know about MRI information? What is the basis for your statement? Do you know about the ACR and what they do? Do you know that there are many Neuro and Ortho surgeons that own Stand Up MRI Scanners? Do you know that approx 50% of lower back surgeries are unsuccessful? Last, do you know that sometimes patient positional MRI trumps field strength.

Many people have had surgury based on the information from a 0.6 tesla MRI and the in plane resolution has been proven to be adequate for diagnosing a plethora of diseases and disorders. Please elaborate on your answer.

Donald Corenman, MD, DC
Moderator

November 20, 2012 at 9:09 pm

Post count: 8660

#7463

The quality of the MRI is based upon the strength of the magnet and the talent of the technician. Think of images produced from the MRI as pixels. In a low strength magnet, there are fewer pixels and the computer has to “smooth over” the information yielded by fewer pixels. The will “volume average” these points of information and “wipe out” any findings that are subtle.

Time after time, i find that these lower field strength magnets will miss a lateral recess stenosis or a foraminal disc herniation. Also, some large disc herniations are underestimated and small disc herniations can be overestimated.

I would hope a spine surgeon with a 50% success rate would be out of business in a short period of time.

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.

Donald Corenman, MD, DC
Moderator

November 20, 2012 at 9:17 pm

Post count: 8660

#7464

Your MRI findings are relatively normal. Realize that this reading is in the eyes of the radiologist and interpretation can be erroneous occasionally as the radiologist does not have the benefit of the patient contact and the physical examination. The spine surgeon will “know what to look for” while the radiologist might miss a subtle finding.

Nonetheless, If we are to accept these findings, your pain, at least in your thoracic spine does not originate from degenerative changes of the discs. Facet mediated pain will generally not show up as a finding on the MRI so those structures have not been ruled out. However, I would suspect that the Lyme disease is contributing to your pain burden.

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.

MRI4U
Member

November 20, 2012 at 9:48 pm

Post count: 2

#7465

MRI is based on a voxel which is filled with 3 dimensional information. The American College of Radiology (ACR) dictates the minimum in plane resolution, slice thickness and Signal to Noise Ratio (SNR) needed to accurately diagnose specific disease processes specific to the area of interest.

All Stand Up MRI Scanners meet these criteria and are set in place by the manufacturer. If an independent owner/operator chooses to manipulate the protocol and sacrifices image quality you can’t say that the scanner is capable of producing good images.

I would love to speak with you regarding your thoughts on this. I am we’ll trained in MRI physics and cross sectional anatomy. Please feel free to contact me.

Regards,

Rob
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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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