Post T6-T9 fusion pain-unbearable, please advise

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stace
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July 16, 2014 at 8:58 am

Post count: 3

#11186

I wrote to you two years ago about my thoracic stenosis. I waited with surgery until the pain was so bad I could not function. Unfortunately, due to the travel distance from Nebraska and other health related expenses in the last two years I was unable to have you do my surgery. If ever you have read a post and responded. Please do so now! I am scared and do not know what to do.
I am in the worst pain of my life. I am no stranger to pain and have dealt with it for years so I know all the typical pain relieving options. I have met with the pain clinic here in town and am on a 10mg. butrans patch and hydrocodone.
In Feb. I had a T6-T9 fusion and laminectomy. The surgeon approached from the back where I had a prior surgery for my rupture about 18 years ago. Everything went perfectly for the first two months. I was in low levels of pain and pulling myself off meds. I could not feel the hardware and my back muscles were calm. All of that changed in one day. Nothing happened that I am aware of I just knew something was wrong. I waited a few days thinking I just strained something even though I was not doing anything that was out of Dr. orders. When I went a week later to see the surgeon he said all hardware looked good. Did a CT scan and found nothing unusual. I continued to have pain and had to go back to work at this time. What I felt and told them was that I thought something had changed position. I felt that a rib right where he approached had slipped up over the fusion and was putting pressure above and below the fusion. I also felt pain in the fusion which was not there previously. I also requested a brace to wear since I was in so much pain.
Since the pain continued I went to a neurologist I knew well. He who had injected me before and I had him inject under the fusion. This dr. felt originally that I had pulled a ligament below and injected that with steroids. That calmed the bottom down. The pain on all other sides and top of the fusion has continued. These areas have also been injected with no pain relief.
It is now 5 months post op. The pain has worsened to the point where I am nauseated at times. A couple weeks ago I had the sorest spot I have ever felt right where I have thought the rib was stuck up. I rolled a tennis ball over it and felt the rib tip slide back under. The pain in this area calmed down but weirdly seemed to move to the other side. The pain inside the fusion is better but the pain above was and is excrutiating. I went back to my surgeon last week and he did an xray. He said it was fused but I have degeneration in the two disks above my fusion and they were not ruptured. Can you tell that from just xrays? He suggested that I go to the pain clinic connected with his office. He seemed to think they could do an injection in deeper. They said no when I met with them.
I am in so much pain that I cannot make it through a store like Walmart and then drive home without feeling like going to the ER. I go from putting on ice/heat. I cannot sit, stand, or move around comfortably. I have seen a physical therapist and chiropractor. The muscles have calmed down. My pain is so bad and amps up in the evening so bad that I don’t feel things are at all right. Something has to be wrong. Could the dr. be missing something. I know he did not believe in any bones being out of place from the beginning. I feel like the fusion has possibly sunk. I have severe pain above it and wrapping around my ribs often. I don’t even know where to turn. I truly did not feel like my surgery was done incorrectly but now I don’t feel I am going to be able to tolerate this much pain.Do you have any suggestions at all? What should I request or do? I am so scared. Thank you so much!

Donald Corenman, MD, DC
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July 21, 2014 at 9:05 pm

Post count: 8660

#11200

Having no symptoms for two months after a thoracic fusion and then having severe symptom onset makes me think of a pseudoarthrosis developing, hardware displacing or pain-induced changes above or below the fusion levels.

A CT scan was ordered at two months and the hardware was intact eliminating the hardware displacement concern. You apparently were not given a brace right out of surgery and you might have put more stress on the surgery causing some loosening or changes not apparent on the CT scan.

Using an X-ray to determine fusion status is very difficult to do, especially in the thoracic spine. If your surgeon used BMP (bone morphogenic protein) during the surgery, I could understand that you could have a solid fusion at five months. If BMP was not used, I would doubt that you have a solid fusion at five months.

You certainly could have developed pain in the degenerative levels above the fusion levels. A good surgeon could tell on a well exposed lateral thoracic X-ray that there is degenerative changes present in the levels above your fusion but that discovery does not prove these levels are pain generators.

With severe pain five months after the initial fusion, a work-up in my office would include a new CT scan to determine fusion status and a new MRI to look at the discs, cord and nerve roots. Subsequent diagnostic injections would then be used to determine the pain generators.

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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