massimo

Hello Doctor Corenman,

During my last communications via your forum I was pursuing different options as to surgical intervention in regards to my spine. I have had to put my investigations on hold since having a heart attack on April 13, 2014. An emergency stint procedure had to be performed for a 100% blocked Coronary Artery. Sadly, I have come to find out that I had high lipids/cholesterol for over 20 years and unfortunately I was never aware and obviously never treated for. I have an intertwined question for you…
“Can cardiovascular conditions such as mine be contributed in part of spinal diseases such as A.S, D.I.S.H and Scheuermann’s Disease” ?

I have spoken to an internist and he could not elaborate as spines and diseases within the spine are simply not his specialty. I have come across some medical literature in the research of the correlation of heart disease and spinal arthropathies and I was just wondering if you had some insight to this connection.

Secondly but most paramount, my spine. I have hit additional crossroads in my research for answers and a possible partial resolution. Living in Ontario, Canada I have spent some time lately obtaining updated diagnostic information and surgical inquiries. I have come to understand the complexity of my spine by means beyond borders. I have had the privilege to have spoken to numerous orthopaedic and neurosurgeons from various countries around the world which have evaluated my diagnostic imaging. I realize that there are no simple solutions to my spinal demise.

Unfortunately there has been no improvement in my vertebral spine pain and upper and lower limb radiculopathy / pain and loss of mobility. The frequency of urinary retentions and dribbling has increased over the last two to three years now. In fact, there has been consistent regression in my overall physical status and frankly, the widespread pain has become somewhat inhumane. Pharmaceuticals have proven to be inadequate and therapies such as chiropractic and physiotherapy only provide minimal relief at best and at times make things worse. I have become very cautious when I walk because of leg radiculopathy / pain and weakness but unfortunately my walking has been severely compromised since the fall of 2011. After experiencing leg weakness and falling for over three years I have fragmented a bone in my foot in 2012 and I fractured my ankle in May of 2013. It’s the little things in life that we take for granted but how I miss the ability to be who I was…

I have included updated diagnostic reports for your viewing. This leads me to my second question…
Being 45 years of age I have been familiarized with unfounded Canadian labels and diagnosis but what is really happening to my spine?

I have recently spoken with an American neurosurgeon that shared his recommendation of multilevel – segmented spinal surgeries. The uncommon twist of his perspective which varies from past opinion and recommendations is that he would also address my spine with stem cell therapies.

Thank you as always Doctor Corenman,

Massimo

MASSIMO
CERVICAL SPINE SECOND OPINION
CONDENSED REPORTS
MRI AND X-RAY

There is straightening of the spine with loss of normal cervical lordosis seen due to paravertebral muscle spasm. There is evidence of grade one retrololisthesis of C2 over C3 and minor retrololisthesis of C5 over C6. Multilevel dehydration and desiccation is seen. The nuchal ligament is hypertrophic at the C6 and C7 levels.

At C2-C3 level, minimal bulging indents the ventral thecal sac. Canal and foramen remain patent.

At C3-C4 level, central shallow herniated disc measuring 5mm in transverse and 2.5mm in AP dimension, indents the ventral thecal sac. There is a superimposed bulge with annular laxity with bilateral uncovertebral joint hypertrophy, this is marginally worse on the left side resulting in mild left foraminal stenosis.

At C4-C5 level, central herniated disc measuring 7mm in transverse and 2.5mm in AP dimension, indents the ventral thecal sac. There is a superimposed bulge. Canal and foramen remain patent. There is bilateral uncovertebral joint hypertrophy.

At C5-C6 level, there is a large herniated disc / osteophyte noted, measuring 12mm in transverse and 3mm in AP dimension in contact with the spinal cord. There is mild canal stenosis (AP dimension is 9.5mm). There is some lateralization to the left side and likely in contact with the left exiting C6 nerve root. There is mild to moderate narrowing of the left lateral recess consequent compression of the left descending C7 nerve root can be expected. Bilateral uncovertebral joint hypertrophy is present.

At C6-C7 level, a disc bulge is seen indenting the ventral thecal sac. Canal and foramen remain patent. The nuchal ligament at the C6 and C7 vertebral level is hypertrophic.

At C7-T1 level, there is no bulge or herniation. Canal and foramen remain patent. There is a small 3.5mm per neural cyst seen in relation to the exiting right C8 nerve.

MASSIMO
THORACIC SPINE SECOND OPINION
CONDENSED REPORTS
MRI AND X-RAY

The vertebral bodies from T6 to T11 show elongation of the antero-posterior dimension. Note is made of mild compression fracture deformities of T7 and T8 vertebral bodies. Schmorl’s Nodes are seen at multiple thoracic levels including T6-T7, T7-T8, T8-T9, T9-T10, T10-T11 and T11-T12 levels representing endplate micro fractures. There is mild disc desiccation seen at the T2-T3, T3-T4, T9-T10 and T10-T11 levels. There is moderate disc desiccation from T4-T5 to T8-T9 levels. Mild reduction of disc height is seen from T6-T7 to T10-T11 levels. Type II modic endplate changes are seen at the T11-T12 level. There is evidence of mild dextroscoliosis at the apex, approximately at the T9-T10 level. There is moderate degree of anterolateral osteophytosis seen worse on the right side caudal to the T3-T4 level.

At T1-T2 level, there is annular disc laxity causing mild left foraminal stenosis. Minimal hypersclerosis is seen with minimal anterior and posterior marginal osteophytosis.

At T2-T3 level, minimal hypersclerosis is seen with minimal anterior and posterior marginal osteophytosis. No canal or foraminal stenosis.

At T3-T4 level, minimal hypersclerosis is seen with minimal anterior and posterior marginal osteophytosis.
No canal or foraminal stenosis.

At T4-T5 level, minimal hypersclerosis is seen with minimal anterior and posterior marginal osteophytosis.
No canal or foraminal stenosis.

At T5-T6 level, minimal disc bulge indents the ventral thecal sac. Canal and foramen remain patent. Mild endplate sclerosis is seen. There is mild facet arthropathy. There is mild to moderate anterior and posterior marginal osteophytosis.

At T6-T7 level, minimal disc bulge indents the ventral thecal sac. Canal and foramen remain patent. There is moderate endplate sclerosis. There is mild facet arthropathy. There is mild moderate anterior and posterior marginal osteophytosis. There is mild costo-transverse joint arthropathy seen.

AT T7-T8 level, minimal disc bulge indents the ventral thecal sac. Canal and foramen remain patent. There is moderate endplate sclerosis. There is mild facet arthropathy. There is moderate anterior and posterior marginal osteophytosis. There is mild costo-transverse joint arthropathy seen.

At T8-T9 level, central herniated disc noted measuring 6mm in transverse and 2.5mm in AP dimension producing mass effect on the spinal cord and demonstrates spinal cord flattening and borderline canal stenosis. Mild loss of joint disc space is seen. There is moderate endplate sclerosis. There is moderate anterior and posterior marginal osteophytosis. There is mild facet arthropathy. There is mild costo-transverse joint arthropathy seen.

At T9-T10 level, minimal disc bulge indents the ventral thecal sac. Canal and foramen remain patent. There is moderate endplate sclerosis. There is mild facet arthropathy. There is moderate anterior and posterior marginal osteophytosis. There is mild facet arthropathy. There is mild costo-transverse joint arthropathy seen.

At T10-T11 level, There is moderate endplate sclerosis. There is mild to moderate anterior and posterior marginal osteophytosis. There is mild facet arthropathy. There is mild costo-transverse joint arthropathy seen.

At T11-T12 level, shallow herniated disc indents the ventral thecal sac. There is moderate endplate sclerosis. There is mild to moderate facet arthropathy seen causing mild to moderate right and mild left foraminal stenosis with the disc / osteophyte seen in contact with the exiting right T11 nerve root.

OTHER DIAGNOSIS IN PARTOF THE THORACIC SPINE[/b]

1) SCHEUERMANN’S DISEASE
Diagnosed March 14, 2013 Dr. Stephen Lewis (Toronto Western Hospital)

2) DISH (DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS)
Diagnosed May 7, 2002 Dr. Angela Mailis (Toronto Western Hospital)

3) A.S (ANKYLOSING SPONDYLITIS)
Diagnosed December 17, 1990 Dr. Ian Sutherland
(The Medical Centre, Peterborough) HLA-B27 Positive

MASSIMO
LUMBAR SPINE SECOND OPINION
CONDENSED REPORTS
MRI AND X-RAY

There is disc desiccation from L2-L3 to L5-S1. Mild reduction of disc height is seen from L2-L3 to L5-S1, most marked at the L5-S1 level. Shallow schmorl’s nodes are noted from L2-L3 to L5-S1 levels. Dextroscoliosis is noted with the apex at approximately at the L4-L5 level. Note is made of minimal grade one retrololisthesis of L1 over L2. Grade one retrololisthesis of L2 over L3 is not appreciated measuring 4mm. There is grade one retrololisthesis of L4 over L5. Multi-level spondylolisthesis with evidence of ligament instability. Mild degenerative changes at both sacroiliac joints. Note is made of L5 segments sacralised to the ala of the sacrum.

At the L2-L3 level, there is an annular disc bulge seen. There is a superimposed far right paracentral herniated disc with associated annular tear. There is mild to moderate right and mild left foraminal stenosis with disc / osteophyte seen in contact with the exiting right L2 nerve. Canal is patent. Moderate endplate sclerosis is present. There is mild to moderate facet arthropathy / ligament flavum hypertrophy noted. There is moderate anterior and posterior marginal osteophytosis in conjunction with spondylolisthesis and spurring.

At L3-L4 level, bilobed annular disc bulge is seen with bilateral intraforamen extension. There is a shallow left and right parietal disc herniation present. There is mild to moderate foraminal stenosis with disc / osteophyte seen in contact with both exiting L3 nerves. There is no canal stenosis but the disc is also in contact with both descending L4 nerves. There is mild to moderate endplate sclerosis present. There is moderate anterior and posterior marginal osteophytosis. There is moderate facet arthropathy / ligament flavum hypertrophy seen.

At L4-L5 level, annular tear is visible. There is a central herniated disc measuring 10mm in transverse and 2.5 mm in AP dimension that indents the ventral thecal sac. The canal is patent. There is a superimposed bulge with bilateral foraminal stenosis and mild left lateral stenosis. Corresponding compression of the bilateral L4 exiting nerve can be expected. There is mild endplate sclerosis with minimal anterior and posterior marginal osteophytosis. There is moderate facet arthropathy / ligament flavum hypertrophy.

At L5-S1 level, diffuse disc bulge is noted. There is a superimposed left paracentral disc / osteophyte herniation noted. There is mild to moderate bilateral foraminal stenosis and left lateral recess stenosis. Corresponding compression of the bilateral exiting L5 nerve and left traversing S1 nerve can be expected. The canal is patent. Mild endplate sclerosis is noted. There is mild to moderate facet arthropathy / ligament flavum hypertrophy.

OTHER DIAGNOSIS IN PART OF THE LUMBAR SPINE

1) BILATERAL SACRALIZATION OF THE L5 TRANSVERSE PROCESS
Diagnosed August 4, 1998 Dr. w. Weiser (Radiologist)
Diagnosed August 6, 2013 Dr. Michael Yuz (Radiologist)

2) SPINA BIFIDA OCCULTA
Diagnosed May 7, 2002
Dr. Angela Mailis (Toronto Western Hospital)

3) DYSPLASTIC (FALSE ORIENTATION) OF THE RIGHT SUPERIOR ARTICULAR
PROCESS OF THE SACRUM
Visulaized in 3D CT Study L-Spine June 17, 2011

4) BILATERAL SACROILIAC DISEASE
Diagnosed September 27, 2013 Dr. William Smith (AIMIS SPINE)

5) OSTEOCHONDROSIS OF THE FACETS AND SPINOUS PROCESS
Visualized 3D CT L-Spine June 17, 2011

6) MILD SCOLIOSIS
Diagnosed March 1, 2013 Dr. Frank Marrocco (Radiologist)
Diagnosed March 10, 2013 Dr. Michael Yuz (Radiologist)

7) BAASTRUP’S DISEASE
Visualized 3D CT L-Spine June 17, 2011

Hello Doctor Corenman,

I have had a number of spinal consults and it has taken some time to put things in perspective. Spinal instability at multiple levels has been indentified through a series of Dynamic X-RAYS including flexion and extension.

After being involved in a moderate rear end collision back in October 2011 my life has been a state of regression. I can’t deal with the daily pain anymore. I have decided to follow through with the posterior spinal fusion of T3 to L1 with the posterior osteotomy. Unfortunately the lumbar spine is comprimised at 4 levels in a multifactorial way. A three level ADR has also been advised for the lumbar spine as well as a one level ADR in the cervical spine.

It has not been an easy decision however with the progressive symptoms and unbearable pain I now welcome the last resort, surgery.

Thank You for your devotion to this forum and the support and guidance you give to all your patients and forum members.

Sincerely,
Massimo

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Hello Doctor Corenman and Forum Readers

I have recently researched a surgical institute that performs “GEL FIX IMPLANTS”.
Has anyone had this procedure performed?

Thank You