Wasn't sure if my MRI results were that serious...

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Hollykins2
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March 29, 2015 at 7:46 am

Post count: 3

#13458

First of all, thank you so much for this forum. I’ve been pouring over the posts and the educational material for weeks now.

I’ve had some symptoms where my primary doctor wasn’t sure what was going on. I also have Meniere’s Disease and had a vestibular neurectomy in 2010 which complicates things.

I have some pretty severe balance issues. Always blamed that on the Meniere’s and the fact that I never seemed to really regain my balance after the surgery. It had started getting better and then got steadily worse. Has been bad in the last year, with it being very bad since about August.

I fall quite often. Then I started noticing that my hands, mostly the left was feeling numb quite often. I drop things constantly. Fine motor skills are not good. I also trip over my own feet. Couldn’t figure out why except I started realizing my left foot was doing something funny. (might be foot drop)

I have some neck pain, and pain in the shoulders. Shooting pains in arm and leg, again mostly the left. Occasional muscle spasms in the left rib area. Tingling in the left foot, sometimes in the right one too. I also have bladder bowel issues to some degree. I have gone from using a cane, to using a rolling walker.

My primary sent me to a neurologist. He ordered a brain and C-spine MRI. Insurance company turned down the C-spine. Brain one came out fine, but as I was still having difficulties he pushed again for the C-Spine MRI. He said my gait was abnormal and called it Ataxia. I walk with my feet kind of far apart and wide. Finally after several months, I was able to get the C-spine one, and a follow-up of the brain MRI. The brain scan came out clear again.

BUT, he said the C-spine MRI was not good and in fact that I needed to get to a neurosurgeon asap. He said he was going to mark my referral as urgent. Now I am not sure if he was saying that because my MRI really is as bad as he said, or he was hoping to move my insurance company along to get me this referral.

I’m going to post the text from the MRI. Some doesn’t sound good, but I am not sure its THAT bad. I have the DVD of the MRI, but I can’t tell anything from it.

I do now have an appointment with a neurosurgeon that specializes in the spine at the end of April.

TECHNIQUE: Multiplanar sequential imaging of the cervical spine performed without intravenous contrast

Findings:

There is AP alignment of the cervical spine on sagittal images. There is loss of signal of the cervical intervertebral discs compatible with desiccation. Ventral effacement of the thecal sac is seen at C3-4, C5-6, C6-7. Vertebral marrow changes at the C5-6 level are compatible with discogenic degenerative changes. The spinal cord is normal in characteristics and configuration.

The visualized posterial fossa is unremarkable.

C2-3: No disc bulge or focal herniation evident. There is no narrowing of the central canal. The right neural foramen is patent. There is minimal/moderate narrowing of the left neural foramen secondary to osteophytic ridging.

C3-4: There is a left asymmetric disc bulge/osteophytic ridge complex which causes minimal narrowing of the anterior left central canal. There does not appear to be abnormal flattening of the spinal cord.

There is minimal narrowing of the right neural foramen. There is moderate/severe narrowing of the left neural foramen.

C4-5: There is a left asymmetric disc bulge/osteophytic ridge complex which causes minimal of the anterior left central canal. There does not appear to be abnormal flattening of the spinal cord. The right neural foramen is patent. There is severe narrowing of the left neural foramen.

C5-6: There is a diffuse disc bulge/osteophytic ridge complex at this level which causes moderate narrowing of the central canal. There appears to be mass effect on the anterior spinal cord. The right neural formen is patent. There is moderate narrowing of the left neural forman. There may be a small central focal herniation of the disc at this level as well.

C6-7: Minimal disc bulge/osteophytic ridge complex which does not cause significant narrowing of the central canal. There does not appear to be mass effect on the spinal cord at this level. The neural foramina are patent.

C7-T1: No disc bulge or focal herniation evident. This is no narrowing of the central canal. There is no neural forminial attenuation.

IMPRESSION:

Multilevel degenerative disc disease as described above. The worst level appears to be at the C5-6 disc space where there is moderate narrowing of the central canal. There appears to be mass effect on

The spinal cord at this level with moderate narrowing of the neural foramen. There may be a small central focal herniation of the disc at this level as well.

I know you can’t diagnose. I’m just wondering what I might be looking at. Possible surgery?

Thank you so much!

Donald Corenman, MD, DC
Moderator

March 29, 2015 at 9:57 am

Post count: 8660

#13486

Your situation certainly could be myelopathy from spinal cord compression. The physical examination is important here. If you do have cord compression causing your imbalance, you will have long tract signs (hyperreflexia and Hoffman’s sign) which would not be present with a vestibular problem.

You MRI findings (“C5-6: There is a diffuse disc bulge/osteophytic ridge complex at this level which causes moderate narrowing of the central canal. There appears to be mass effect on the anterior spinal cord”) would support this diagnosis.

I agree that you need a surgical consult from a spine surgeon or a neurosurgeon.

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.

Hollykins2
Participant

March 30, 2015 at 6:58 am

Post count: 3

#16807

Thank you! I am very appreciative of your time. :)

Hollykins2
Participant

April 10, 2015 at 2:29 pm

Post count: 3

#18821

I just went to a neurosurgeon. This wasn’t the one that the neurologist referred me to, but the one that did my vestibular neurectomy.

Did not examine me at all, nor question me, and spent maybe a minute tops in the room.

Said, “your neck doesn’t look that bad, nothing surgical”.

I asked him why I was falling, having balance issues, etc., and he didn’t want to hear it. Just said, “I don’t know, maybe you are a klutz” and walked out of the room.

Wow. Not that I want anything to be wrong with me, but now I’m even more confused. I’m wondering if I should keep the appointment with the neurosurgeon I was referred to in the first place.

Again, I know you can’t diagnose, but I guess I expected the doctor today to at least ask a question or two…. Am I wasting the second doctor’s time?
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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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Wasn't sure if my MRI results were that serious…