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****I am sorry if this shows up a bunch of times, for some reason it keeps disappearing****

I wanted to also show the rest of the results of the two MRIs I had to see if you had any opinions on them. If you don’t mind of course. I really appreciate you being so helpful to so many people!

Lumbar:

Noncontrast MRI of the lumbar spine, 3/31/2021 9:56 PM

History: Chronic right lower back pain with ipsilateral sciatica

Technique: Sagittal STIR, T2, T1, and axial T2 and T1 sequences

Comparison: None currently available

FINDINGS:

There are 5 lumbar type vertebrae. The conus medullaris terminates at the level of the upper margin of L2. A minute filum terminale fibrolipoma is incidentally noted.

There is no discernible MRI evidence of fracture, compression deformity, or dislocation. The spinal alignment, bone marrow signal, and paraspinal soft tissues are unremarkable.

T12-L1 (above the level of the axial images): The disc height and signal are maintained. The spinal canal and neural foramina are widely patent.

L1-L2, L2-L3, and L3-L4: The disc heights and signals are maintained. The spinal canal and neural foramina are widely patent at each level.

L4-L5: There is a prominent posterior annular tear. Disc height and signal are otherwise maintained. The facet joints are slightly hypertrophied. There are trace facet joint effusions. There is mild spurring marginating the disc space. The spinal canal is widely patent. There is mild to moderate right-sided and mild left-sided bony narrowing of the neural foramina anteroinferiorly without evidence of foraminal impingement.

L5-S1: There is moderate to advanced narrowing along the canalicular margin of the disc space. The disc space is otherwise only minimally narrowed. Disc signal is diminished. There is a posterior annular tear. A broad mild spur-disc complex does not significantly compromise the spinal canal. The facet joints are slightly hypertrophied. There is a trace right-sided facet joint effusion. There is moderate spurring along the left side of the disc space and mild spurring along the right side of the disc space. There is moderate left-sided and mild right-sided bony narrowing between (a) the L5 pedicle to transverse process transitions superiorly and (b) subjacent L5 vertebral body disc space marginal osteophytes; the exiting left-sided nerve is deflected/elevated.

The included portion of the sacrum is unremarkable.

IMPRESSION:

Mild lower lumbar spondylotic/discogenic changes (level-by-level basis)

Cervical:

Noncontrast MRI of the cervical spine, 3/31/2021 9:55 PM

History: Cervical canal stenosis

Technique: Sagittal STIR, T2, T1, coronal T2, and axial T2 (turbo spin echo and medic) and T1 sequences

Comparison: None currently available

FINDINGS:

There is no discernible MRI evidence of fracture, compression deformity, or dislocation. The paraspinal soft tissues, spinal alignment, cervicomedullary junction, and cord signal are unremarkable. The moderate generalized marrow hypointensity on the T1-weighted sequences likely pertains to hematopoietic elements (red marrow), an expected finding in this age group.

C2-C3: (Attention is directed to this level) There is moderate to advanced narrowing along the anterior margin and posterior 1/4 of the disc space. There is mild narrowing of the remainder of the disc space. There is a prominent broad spur-disc complex. This abuts and impresses upon the cord. There is moderate left-sided and mild right-sided canalicular stenosis with commensurate degrees of cord flattening. Although there is at least as yet no overt/robust cord signal abnormality, such could potentially ensue — particularly on the left (consequent to compression-induced ischemia and subsequent myelomalacia). There is moderate to advanced left-sided and moderate right-sided narrowing of the neural foramina due to uncovertebral and facet joint hypertrophy.

C3-C4: There is focal advanced narrowing along the anterior margin of the disc space and mild to moderate narrowing along the posterior margin of the disc space. There is a broad spur-disc complex. The ventral aspect of the CSF space is partially effaced, but there is no overt canalicular stenosis. There is moderate narrowing of the neural foramina due to uncovertebral and facet joint hypertrophy.

C4-C5: There is focally advanced narrowing along the anterior margin of the disc space and moderate to advanced narrowing along the posterior margin of the disc space. There is a broad spur-disc complex, larger toward the right. The ventral aspect of the CSF space is partially effaced, but there is no overt canalicular stenosis. There is moderate to advanced narrowing of the right neural foramen due to uncovertebral and to a lesser extent facet joint hypertrophy. The left neural foramen is widely patent.

C5-C6: The right ventral aspect of the CSF space is partially effaced due to ipsilateral uncovertebral hypertrophy, but there is no overt canalicular stenosis. There is mild to moderate narrowing of the right neural foramen due to the aforementioned uncovertebral joint hypertrophy. The left neural foramen is widely patent.

C6-C7: There is moderate to advanced narrowing along the posterior margin of the disc space. There is mild narrowing of the remainder of the disc space. There is a broad spur-disc complex, largest in the left paramidline region. The ventral aspect of the CSF space is largely effaced, but there is no overt canalicular stenosis. There is mild to moderate narrowing of the neural foramina due to uncovertebral joint hypertrophy.

C7-T1: There is focal mild narrowing along the posterior margin of the disc space. There is a mild to moderate left paramidline spur-disc complex. This contacts the ventral surface of the cord. The canal is not overtly stenotic. Foraminal patency is adequate on each side.

IMPRESSION:

Spondylotic/discogenic changes (level-by-level basis) — attention is directed to the C2-C3 level

Again, Thank you for all that you do! You are a blessing to those in need!

Hello Dr. Corenman,

1) you mentioned “A new CT is going to be valuable to determine fusion status”. In 2019 a CT scan was performed at a different hospital setting from 2020 Scan, that stated “degenerative osseous fusion” and from your last message “reading indicates that there is a solid facet fusion at those levels”. So it probably safe to say C3-T2 is fused, with T2-T3 pending?

2) My pain management physician states the following:

“Patient presented in office today for evaluation of neck pain and bilateral upper extremity pain. His pain is most likely due to a combination of post laminectomy pain syndrome, cervical radicular pain, facet arthropathy, and myofacial pain.It was discussed in detail regarding patient’s pain management options, including medications, interventional pain procedures, physical therapy, and surgery. Patient is interested in spinal cord stimulation therapy. I explained to patient that he had undergone ten C-spine surgeries. He has extensive scar tissue and altered anatomy in his cervical spine epidural space. The risk of complication outweighs the potential benefit of the SCS. I do not rec this procedure for him”

I’ve had EMG’s that shown abnormal results from chronic radiculopathy at C5, C6, C7 and C8 nerve roots. My Neurosurgeon is reluctant to perform any posterior foraminotomy procedures at these levels due to significant scar tissue encountered during my last hardware removal that required emergency consultation with a plastic surgeon to remove scar tissue, perform an excision and debridement of upper back and neck wound and reconstruction of flaps. My last CT scan shows

C3-4: No significant disc disease. Bilateral uncovertebral spurring and bilateral facet arthropathy, mildly progressive since 5/19/2018. There is associated mild right and moderate to severe left foraminal narrowing.

C4-5, C5-6, C6-7, C7-T1: Postsurgical changes. No significant disc disease. Spondylitic ridging and uncovertebral spurring at C4-5, C5-6 and C6-7, mildly progressive since 5/19/2018. There is associated foraminal narrowing, mild on the right at C4-5 and C5-6, mild on the left at C6-7. No significant foraminal narrowing at C7-T1. No significant central canal stenosis at any of these levels.

3)If I remember correctly from past questions, if one is fused 360 then facets should not cause pain because one there’s no motion and two those nerves were obliterated during fusion?

4) My last block’s that was performed in 2020 at C3, C5 and C7 bilaterally resulted in a greater improvement at C3 with smaller amount’s at C5 and nothing at C7 (probably not a pain generator). Previous year injections at C4 and C6 resulted in a positive pain reduction. My question is would an RFA be the next course of treatment for these?

5)You state that CT Scan “is stating a solid facet fusion”, if one is fused 360 anterior (ACDF) and posterior(Facets) shouldn’t radiologist comment on fusion status of disc space? How does one know if front is not moving without any reporting on status?

6)Can these “Dorsal epidural soft tissues at all levels from C3-C4 through C7-T1” cause radiculopathy, muscle spasms or pain?

Thanks for your continued support!

Good evening Dr. Corenman,

Spoke to my surgeon earlier today in reference to a number of questions I had, however his responses were not what I expected. We spoke in reference to the following:

1)”Spondylitic ridging and uncovertebral spurring at C4-5, C5-6 and C6-7, mildly progressive since 5/19/2018”, and was told “previous surgeon removed some of spurs, however there were some that remained”.
Bone spurs take time to dissolve. I kindly mentioned, that my ACDF’s were performed in 2012 and 2013, how can they not dissolve after 8 to 9 years? Was told in my case give it a little longer, it takes a very long time. This does not sound right to me.

2)Reviewed my Ct Scan again, not overly concerned with nerve root compressions, being mild to moderate they don’t operate on those compressions. I asked about moderate to severe noted on my CT scan at C3-C4 and was told that the radiologist over stated the degree of compression. This was a bit of a surprise.

3)We spoke about Nuclei ligament that was removed during laminectomy and that one surgeon stated to me that some individuals can have issues with removal because its a cable that stabilizes neck and without it one can run into trouble with pain due to instability and muscle fatigue. He didn’t feel that was the case for me because my kyphosis is not severe. I’m lost on this one also, my thought is, if you have an instrumented fusion, how would one develop severe kyphosis after laminectomy?

4)I asked if he can order an over-read of my CT films for a second opinion to ascertain fusion status on C4-5, C5-6 and C6-7, said a CT Scan will be ordered in approximately 5 months, and they will look at cervical and upper thoracic fusion status.

5)He didn’t address nerve channels during last surgery, because in his opinion the level below my previous fusion T2-T3 should be pain generator. I’m scratching my head on this one also, by no means I’m a spine surgeon, however this is strange for a pre surgical plan to be drafted only to be scraped during surgery.

6)Still thinks after 4 months it’s too early to state surgery was not successful.

6)His plan is to order for my next office visit flexion and extension x rays – next week

7)refer me to pain management for workup

Is there any recommendations on my situation? I’m extremely tired, frustrated and confused. Thanks

Hi Dr Corenman , I have been excercisinh on my treadmill mill since January, I had done increments light jogging and some running intermediates, off and one lasting time for 12 minutes longest time in a workout of the running , not extremely fast just enough to get my heart rate up and done some rowing excercing on my machine that wasn’t very intense …My question is it possible it effected me doing this to cause major change in my neck where the bone spurs is . I learned my lesson I will only be walking not light jogging or running spirts anymore ..Sadly because I recently had that MRI in Dec 29 last year 4 months ago they won’t order me another MRI and because of covid I won’t be able to see a neurologist, and I am stressing out of this pain I been dealing with the past month …i can’t sleep from stressing over this …My pain is severe in my mouth throat, shooting throbbing nerve pain off and on in my head front of my head…my shoulder are throbbing tight burning as well as every other part of my body ..I don’t experience any weakness or any other physical symptoms other then severe pain …Can you tell me in your experience if the excercising changed anything in my neck this fast ….in the past 3 months …again I wasn’t running like a trainer but enough to bring up my heart rate to lose weight..Sorry for bothering you again hun…But greatly appreciated your expertise and time …again Happy Easter ????