What do these MRI's really indicate???

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indetyna
Participant

November 23, 2017 at 4:32 pm

Post count: 3

#26909

I am in the midst (desperate midst) of trying to get someone to help with excruciating pain and constant spasms in my lower back. I had an MRI Jan of 2016 that resulted in my doctor at that time ordered Epidural Steroid Injections in my Lumbar spine. I had 2, 1 in Jan and 1 in Feb. Those held until this summer. Ended up seeing a Pain Management Interventional Radiologist, that did an additional ESI in June that helped to alleviate the pain, radiant pain, tingling, pins/needles; etc until September. I had my 4th injection done September 27th. By October 1st I had all my symptoms back and worse than ever, so I decided it was time to seek out a doctor in my new area so we could figure out what to do about this ongoing pain and other symptoms. After completing a new MRI, and reviewing the results, this provider advised me that there are no significant issues with my lumbar spinal area and my symptoms must be caused by my SI Joint. So I am now beyond frustrated and am anxiously seeking additional impressions and direction to go. Do I go to the SI Joint route or find a new Ortho/Neuro surgeon to look at my back?
What does all of this info from my MRI’s really say????
Location Findings MRI Date
L3-4 Mild Broad-Based Disc Bulge 2016
with overlying small Right Foraminal Disc Protrusion 2016
Bi-foraminal Disc Protrusion 2017
Mild Right Neural Foraminal Stenosis 2016
Mild Bilateral Foraminal Stenosis 2017
Mild Facet Hypertrophy 2016

L4-5 Mild Broad-Based Disc Bulge 2016
Annular Tear – Posterior Aspect 2017
Mild Bi-foraminal Disc Osteophyte ridging 2017
Mild Bilateral Foraminal Stenosis 2017
Mild Facet Hypertrophy 2016

L5-S1 Nothing reported 2016
Small disc protrusion 2017

Any help and direction is greatly appreciated

TPepe

Donald Corenman, MD, DC
Moderator

November 23, 2017 at 9:58 pm

Post count: 8660

#26911

First, your symptoms are confusing. Do you have more lower back pain or more leg pain? See https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-lower-back-and-leg-pain/ to understand how to describe symptoms.

I would generally disagree with this specialist regarding the origin of your pain. You never had any sacroiliac joint injections but obtained relief with spinal injections so I would suspect the pain generators are in your lumbar spine. You have reports of foraminal stenosis and I would bet these areas are causing nerve pain.

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.

indetyna
Participant

November 27, 2017 at 9:42 pm

Post count: 3

#26948

I have significantly more lower back pain than leg/buttock pain. The pain continues to get worse throughout the week with general activities of sitting, standing, walking. ect. The pain is alleviated after laying down for day(s), such as over the holiday weekend.
I am working on trying to get a second opinion. Is there anything you would recommend for the next visit? I have gone through the section of how to explain my pain to provider and am working on addressing each point prior to my visit.

Thank you for your help

indetyna
Participant

November 28, 2017 at 6:43 am

Post count: 3

#26949

Doctor,
with the MRI results that I have combined with my symptoms and previous treatments, in theory what would your recommendation be for the next step to relieve my pain and be able to get back to normal activities:

Jan 12, 2016 – Dx: M51.16 Lumbar Disc Herniation with Radiculopathy
Jan 15, 2016 – Dx: M51.26 Displacement of Lumbar Intervertebral Disc Without Myelopathy

 Initial treatment – 62311, 76005 Jan 18, 2016 Issaquah, Wa
 62311 – Injection(s), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; lumbar or sacral (caudal)

 Jan 29th, emailed PA-C to provide update regarding symptoms returning to roughly 60% of what symptoms were prior to injection

 Secondary treatment – 62311, 76005 Feb 5, 2016 Issaquah, WA
 62311, 76005

 This treatment sustained pain relief until Mid-May 2017

 Third treatment 62323 June 23, 2017 Fresno, CA
 62323 – Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal), WITHOUT IMAGING GUIDANCE (previous code 62311), WITH IMAGING GUIDANCE (i.e., fluoroscopy or CT)

 Fourth treatment 62323 Oct 27, 2017 Fresno, CA
 62323

 No relief provided by injection, immediate return of symptoms

 Current Symptoms
Location – Right side of midline at belt line
radiates to buttocks, groin, thigh both front and back, knee, back of calf, foot
Tingling / Pins and Needles in Foot
Sharp Shooting painful Muscle spasms
Worsens with general activities, sitting, standing, walking
no skin change, some skin sensativity (probably more due to ice packs and hot packs)
Intensity currently ranges –
after periods of rest (24-48 hours of laying down and inactivity) 2-4
baseline of daily occurring pain all day 5-7
sharp shooting pains / muscle spasms 8.5 – 9.5
My right leg has the sensation of weakness/fatigue – as if too tired to lift, walk etc
Limping due to this feeling of “dragging” my leg
have had times that stepping on R leg brought on severe shots of pain

Original Injury Nov 2015
Recent onset beginning of September – ESI from June 2017 alleviation of symptoms discontinued
had additional ESI at end of September with No alleviation of pain
There has been no recent activity or action to create new pain

Activities of sitting standing walking all inflame
I have limited my activities substantially to the bare minimums and accommodated the sitting / standing
issue at work with a sit/stand desk

Previous consults
Dec 2015, MRI Jan 2016, Exhausted conservative treatments of Physical therapy, chiro, massage therapy, then 2 ESI Jan and Feb of 2016
June & Sept 2017 2 ESI
Nov 2017 specialist that stated pain due to SIJ and referred me to Pain Management Partner in Practice.

Any insight, and theoretical/hypothetical recommendations I would greatly appreciate.

TPepe

Donald Corenman, MD, DC
Moderator

November 28, 2017 at 9:33 pm

Post count: 8660

#26955

You had a disc herniation in the lower lumbar spine (no indication of level). You then had an injection (probably and epidural). You had 40% relief of symptoms after the injection. You then had another injection with a years worth of relief. You had 2 more injections in June and oct of this year without relief.

It sounds like you have a disc herniation that has failed conservative care. It might be time to consider a microdisectomy. If you have motor weakness (“My right leg has the sensation of weakness/fatigue – as if too tired to lift, walk etc, Limping due to this feeling of “dragging” my leg”), you need surgery in my opinion. Read the section on home testing of motor weakness (https://neckandback.com/conditions/home-testing-for-leg-weakness/).

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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