What is an arachnoid diverticulum?

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Heidi
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February 26, 2013 at 12:51 am

Post count: 6

#8085

I have just received a report of MRI on my cervical spine, first one ever.

Had C-Spine xray year and a half ago, showed some degeneration. So for me this has been an ongoing thing.
Just want some relief so I can have my life back.

Wondering what this report has revealed. I have parasthesia in left arm, neck and arm pain when sitting or driving, can’t drive a car without excruciating pain, can’t sleep. Have been off work for 4 months, a healthcare professional, have done a lot of heavy lifting.
Went to er recently with chest pains, and facial numbness, can this be related to MRI findings?
Have my first appointment with Neurologist in two weeks for a nerve conduction test and consultation. My NP is not too concerned about the MRI’s results, but I cannot tolerate much more pain. It has taken over my life, I am very sad, and tired. Just wiped out.

MRI Findings-
Normal caliber cord is unremarkable. There is mild degenerative change at c6-c7 with reduced disc height and spurs. Right assymetric disc osteophyte complex at this level indents the thecal sac without deform from the spinal cord.
There is lesser disc dessication at c4-c5 and c5-c6 where bulging discs indent the thecal sac without deforming the spinal cord.
Remaining cervical and upper thoracic discs are relatively preserved. There is no disc extrusion, canal stenosis, or significant foraminal narrowing but there is an 8mm right arachnoid diverticulum c5-c6 intervertabral foramen.

Ok, so I’ve done a little digging on the arachnoid diverticula, is this something to be concerned about?

Would this MRI explain why I am in pain?
My NP seems to think that PT will be the only solution, but have done 2 months @ twice a week without any relief.
I have been taking NSAIDS, and heat therapy, and a topical NSAID, no relief.

I would be so happy to hear any kind of response, been feeling like I’m hauling a heavy load here.

Donald Corenman, MD, DC
Moderator

February 28, 2013 at 2:38 pm

Post count: 8660

#8110

Arachnoid diverticula might be another term for a Tarlov cyst or a cystic root sleeve dilation as these diverticula would be rare to be located at the nerve root sleeve. Also, this cyst is on your right side whereas your symptoms are located on your left side.

Radiological reports you must know are interpretations from the radiologist. I would assume that there is no foraminal stenosis on your left side based upon the reading but
I am always suspicious when I cannot personally read the MRI myself.

Arm and shoulder pain does not have to originate from a nerve root compression. Thoracic outlet syndrome and rotator cuff injuries can also cause similar symptoms.

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.

Heidi
Member

March 1, 2013 at 1:13 am

Post count: 6

#8111

Thank you for your quick reply. :-) I am scheduled for a nerve conduction test and consult with a neurologist next week. Hopefully everything will be explained to me at that time. Thank you so very much again, your advice is definitely appreciated!

Donald Corenman, MD, DC
Moderator

March 2, 2013 at 11:59 am

Post count: 8660

#8116

Nerve conduction tests (EMGs) will only be positive (show something is present) if there is nerve damage that leads to motor weakness. This test will not diagnose thoracic outlet syndrome, cervical nerve compression causing pain but not weakness or rotator cuff injury. Hopefully, this neurologist will also give you a thorough physical examination and that will lead him or her to the correct diagnosis.

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.

Heidi
Member

March 3, 2013 at 2:35 am

Post count: 6

#8118

Thank you for your input. Very interesting!
Should I ask him about this? I don’t want to come off as questioning his opinion, but I also want to make sure he explores all aspects of my concerns. :-)
I have looked into the Thoracic Outlet Syndrome and it seems quite similar to what I am experiencing; the hospital visits for chest pain, facial numbness, etc. It’s quite striking actually, the similarities are almost right on.
Is genetics a factor? I believe my mother had an operation to relieve this (forgive the spelling-) a simple thoracectomy. She has had cervical discs replaced as well. We are both fairly tall women, I am 5’11”.
I don’t know much about anything to do with this, that is why it is so nice to find someone with a knowledge of these things. Looking for answers online can scare a girl to death!
If you like I can keep you posted about his findings.
Thanks so much again :-)

Donald Corenman, MD, DC
Moderator

March 3, 2013 at 1:13 pm

Post count: 8660

#8119

You need to tell him everything you know or can think of when you meet him. After all, he is there to serve you-not the other way around. This is what the history is for in the “history and physical examination. Do not be shy as he needs to hear you and know that you have performed your research.

Yes, genetics is associated with thoracic outlet syndrome.

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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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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