widening of the central canal?

Tagged: Subacute Combined Degeneration of the Cord

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patmar
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September 1, 2016 at 2:54 pm

Post count: 6

#22895

hello,
I had a microdiscectomy in Oct 2012.I felt a lot better straight after surgery,my leg pain was gone.I continued to heal for about 5 months.After that I was never able to sleep on my back again without waking in severe pain.I wasn’t even able to lie on my back long enough for a facial before the pain was killing me.
I’ve been having all kinds of health problems since that and finally was diagnosed with B12 deficient Pernicious Anemia in february 2015.I’m now on monthly injections ,which are making a big difference,so I explain away all my aches and pains now as being related to the b12,or lack of.
my MRI before the surgery reads:

“Mild prolapse seen in the cervical region at c4-c5, Indenting the thecal sac,but neither reaching or compressing the cord.
The thoracic region is normal.
high signal seen in the center of the cord is due to widening of the central canal ,and is not a syrinx.(WHAT DOES THAT MEAN?)
In the lumbar region there are degenerate discs at both L5-S1 and L4-L5.The disc at L5S1 is significant,and indents the right side of the spinal canal and thecal sac causing significant compression to the right nerve root (THIS WAS WHERE THE MICRODISCECTOMY WAS PERFORMED)
The disc at L4-L5 is degenerate focally in the center(WHAT DOES THAT MEAN?) neither compresses the thecal sac to any significant degree nor adjacent nerve roots.”

I have a couple of questions …
Is it OK/normal to have widening of the central canal?
“the disc is degenerate focally in the center”Is that OK/normal?
I am worried that my back problems on the MRI above are related to my b12 issues and that I might have or have had Spinal Myelopathy (which is treated with b12 shots). Is there anyone out there that knows if the findings on the MRI above suggest so.
I really appreciate any feedback and insight

Donald Corenman, MD, DC
Moderator

September 6, 2016 at 3:55 am

Post count: 8660

#22906

Can I assume that the B12 injections have relieved your back pain?

Any time you have had a disc herniation, you will have degenerative disc disease (DDD) as this is really the definition of DDD.

Myelopathy due to B12 deficiency is generally reversed by B12 supplementation. It would be deep third world countries that could even possibly display B12 myelopathy in todays world.

The cryptic statement “high signal seen in the center of the cord is due to widening of the central canal ,and is not a syrinx” makes no sense except if there is artifact (lines or shades on the MRI which are really not there). Widening of the canal has nothing to do with cord signal.

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.

patmar
Participant

September 6, 2016 at 5:51 am

Post count: 6

#22907

Thank you so much Dr.Corenman for getting back to me.

I was diagnosed with Autoimmune Pernicious Anemia B12 deficiency in 2015, where my body attacks the B12 and won’t let me absorb it.

My b12 level was checked from 2011,it was low normal at 274(normal level 180-900) as I am in Ireland..My back problems had already started in 2011.In 2013 a full blood count was done,and b12 was 235,still low normal….no one picked up on the fact that it was dropping.

In Oct 2012 I had the micro discectomy,which relieved my foot drop and leg and back pain….problem solved I thought.
Afterwards I never could lie on my back again,a new or leftover back problem.(?)

Finally in feb 2015 I was diagnosed with Pernicious Anemia when my B12 levels dropped to 174.Now below the cutoff point I was told I would need B12 injections for life.

I had never made a connection between B12 deficiency and back problems until after loading doses of B12 shots and now weekly injections my 4 years of pretty severe back problems,every night ,and no sleep,along with a myriad of other physical issues gradually improved to where I am practically pain free today.

On looking into things and doing some research online and in my eyes the overwhelming 4-5 years of evidence being in this body of mine. Yes’ without doubt The B12 ,or lack of is the ONLY factor (for me).I am not taking any meds at all.I take vitamins daily to balance my B12 supplementation.

Am I unreasonable to attribute my back pain and recovery on my B12 situation? (Myleopathy).

Unfortunately there are still doctors around who dismiss completely B12 problems”in this day and age”.I personally just cannot absorb B12 through food,as it is essentially a malabsorbtion issue with me. I am not a vegetarian etc..

I guess my question now is what changes/improvements would you expect to see on an upcoming MRI (my last one was August 2012) to prove or disprove what I am thinking?

I still would love to know what widening of the central canal IS…( :

I really do appreciate you taking the time to read and reply to my questions.I have recently moved to Ireland and I am struggling to be heard here.

Thank you so much

P F

Donald Corenman, MD, DC
Moderator

September 12, 2016 at 5:56 am

Post count: 8660

#22959

I am fascinated that there is a correlation between your back pain and a B12 deficiency as I have never seen these two correlated. Patients with B12 deficiency generally have symptoms such as fatigue, shortness of breath, palpitations, sore mouth or tongue and weight loss. Did you have any of these other symptoms when you had your lower back pain?

I will start to consider this disorder when seeing my patients.

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.

patmar
Participant

September 12, 2016 at 8:45 am

Post count: 6

#22961

hello Dr.Corenman ,

Thank you so much for listening to me.
below I have copied and pasted an email I sent to myself to sum up my ongoing symptoms .This was just before my blood tests which showed my Serum B12 at a level of 174.Keeping in mind that active B12 was probably much lower.
—————————————————————————————————

On Sunday, 15 February 2015, 16:32, p———————@yahoo.com> wrote:

SLEEPLESSNESS

Anxiety

back pain(in the mornings)

numb 3 fingers (usually when I wake up,i put this down to disc compression)

heart palpitations

eye pain,feels like bulging,kaleidoscope looking out,feels like curtains closing

dizziness

itchy rash on my back for 8 months

constipation

brain fog,forgetting everyday words and people I knew well, names.
—————————————————————————————

I hadn’t had a full nights sleep for 4 years at this stage. The back pain was waking me,the exhaustion was awful.The palpitations were VERY scary.I actually thought I was dying.

By the way I belong to a Pernicious Anemia/B12 deficiency support group which has 12,400 members and speaking to them spine problems are quite common among B12 deficient people.
Quite a few are mistakingly diagnosed via MRI as having MS before the B12 deficiency is found or considered.
If found in time this can be stopped or even reversed.
If this can help even one person I will be very happy.

Thanks again for taking the time to listen.

PF

patmar
Participant

September 12, 2016 at 10:13 am

Post count: 6

#22962

Dr Corenman ,I am thinking SACD,do you think this is possible?

these are my full MRI findings……

M R I (AUGUST 2012)SPINE:
“All the symptoms appear entirely lower limb. Mild prolapse seen in the cervical region at c-4 c-5,indenting the thecal sac,but neither reaching or compressing the chord.

The thoratic region is normal.

High signal seen in the center of the chord is due to widening of the central canal and is not a syrinx.

In the lumbar region there are degenerate discs at both L5-S1,and at L4-L5.

The disc at L5 =S1 is significant,and indents the right side of the spinal canal and thecal sac,causing significant compression to the right nerve root.

Of note is the fact that the uterus is significantly retroverted.”

(NOVEMBER 2013)SHOULDER:…..i also have had rotator cuff problems,which are MUCH better,I now have no pain,just limited movement in my right shoulder.
..The doctor told me after the shoulder MRI that the M R I results showed ..torn muscle and calcifications,and inflamed bursa in the rotator cuff…

…or what else could possibly have been be causing these problems?
Thank you SO much

PF

I hope you don’t mind me asking all these questions
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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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