One in a Million? T9-T10 Symptomatic Disc Herniation

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rdg426
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October 24, 2012 at 1:50 am

Post count: 2

#7241

I am sorry to say that I also suffer from T9-T10 disc herniation. I am a healthy 44 year old woman with significant back problems. My problems started 8 years ago, at night, much like yours. Because I am asthmatic I thought I was having an asthma attack given the location of the pain and the fact that I had never experienced any back issues. My general practitioner told me it was indeed back pain and suggested ibuprofen. Usually I need 800mg to touch the pain.

After a long rough weekend in 2006 I called a friend of mine that was an orthopedic surgeon. He figured I pulled some muscles, gave me prednisone, pain meds and prescribed PT. After 2 weeks of PT the therapist sent me back to the doctor because the pain was worse. An MRI was performed and the disc herniation was found. Like you, I have no great story, the pain just started. I was referred to one of the best spine surgeons in Ohio who immediately said “absolutely no surgery” which was also the recommendation of my friend (the first physician). I was sent to a spine center and underwent a series of injections, physical therapy and was prescribed a portable TENS unit, something I strongly suggest.

I have to say, the injections work! They are not a cure but pretty close. I managed 3 years (most of it pain free with NO treatment) before I had to go back to the doctor.

In the course of that 3 years I moved to California and had to beg a doctor to take me on. They thought I was crazy, they said there was no way my diagnosis was correct. After my third phone call begging them to take my case they agreed and quickly sent me for an MRI to confirm that I was wrong… To their surprise I was right, I do have a disc herniation. This doctor said the same thing, no surgery. They actually told me that if a doctor suggests surgery to run the other way, the risks are too great. This doctor performed another round of injections and I have been good for the past 2 years until now.

Unfortunately I found this site because I was awakened at 3am this morning with that horrific pain once again. I keep hoping for a miracle cure but there is none. I will probably need the injections again but I am thinking that I may need to go to San Francisco for better treatment. Because this condition is so rare the doctor I was using (the best in the town I live in) struggled to get it right and actually missed with one on the injections, hit a nerve and caused additional pain.

Nonetheless, I recommend the injections. They do work and combined with PT and a TENS unit I can stay pain and med free with the exception of ibuprofen at the onset of what I call an “episode”.

Good luck with your treatment.

Donald Corenman, MD, DC
Moderator

October 25, 2012 at 8:43 pm

Post count: 8660

#7253

There are surgical options for thoracic disc hernations but the surgery is long, extensive and sometimes the surgery can cause new pain by itself. This is why most surgeons do not recommend thoracic surgery for disc herniations.

Now if the cord is compressed and causing myelopathy (chronic cord injury), surgery is generally recommended as the bad effects from cord injury are greater than the problems generated from the surgery to remove the disc herniation.

Your history for treatment is spot on. Epidural injections by a skilled injectionist, therapy and medications are important treatment guidelines.

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.

rdg426
Member

October 26, 2012 at 1:40 am

Post count: 2

#7255

I know that at some point surgery will probably be in my future but I will do my best to avoid it as long as possible. The last MRI did show that the herniation is already beginning to press on the spinal cord which is why the pain was worse 2 years ago then in the past. When an episode happens I lose all strength in my arms and legs and constantly drop things.

My biggest frustration that I face here in California is a shortage of doctors. When you call a specialist that have to agree to take your case on. Unfortunately for me I have not been able to get a physician in a big city to agree to do that which leaves me with an inexperienced injectionist. As I stated earlier, the last series of injections had some hiccups, they did not go smoothly and I was beginning to believe that this physician had never done thoracic injections before. Even the after care instructions they gave me were on lumbar injections. Because I had such an incredible injectionist in Ohio I have learned what they should be like. My husband and I are actually considering the options of traveling out of state just to get the quality care that I need for my back. And again, unfortunately the current physician has stated that because this is a chronic problem he is not sure that PT is a good idea any more and is hesitant to prescribe it for me. Luckily my daughter is a PTA and forwards the exercises to me that I need to be working on.

It’s a frustrating injury, I just wish there were easy answers.

Donald Corenman, MD, DC
Moderator

October 26, 2012 at 7:27 am

Post count: 8660

#7259

Be careful with what you assume are symptoms from a thoracic disc hernation. You note that “with an episode” you lose all “strength in arms and legs”. Compression of the cord will not cause arm strength to diminish or even cause radiation of symptoms to the arms. You should not “drop things” from a thoracic disc herniation.

There may not be any easy answers.

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.

hart
Member

October 27, 2012 at 12:20 pm

Post count: 34

#7264

Dear rdg426:

Thank you for sharing your story. I am sorry to hear of your spinal woes! I have had a difficult time but am doing reasonably well.

I grew up in Ohio and I am now in California. What is the chance of that? Do you have floating 10th ribs too? Dr. Corenman, I found a professor of surgery interested in cutting off that newly protruding tenth rib. Now that my disc herniation has shrank and my belly has filled back in with muscle, the rib is tucked away and almost no bother! EXACTLY like you said in this thread! T9 spinal nerve must innervate some of that musculature? And to think I could have been stuck with another neuropathy!

Rdg426, one good thing about CA is the “pain mandate”. You have a right to pain control. Acutely, this is probably going to mean narcotics and you should be able to obtain them easily in CA. If you can’t tolerate them (like me), you can get Zofran for the nausea and a benzodiazepine (trade names are rejected as spam!) for the agitation. Of course, this is not an ideal long term solution but you can get pain relief and I think knowing this is important. I tried ketorolac IV in an ER and found it very GOOD! But it is hard on the kidneys when used for more than a few days and the oral preparation didn’t seem as effective. Ketorolac is an NSAID with some unique properties and I would recommend in an ER situation, saving narcotics until you are confident you are in good hands. I was seriously afraid of ending up with a laparotomy (getting the belly cut open) and I was determined to have my wits about me.

I saw a highly regarded spine surgeon here who told me. “It herniated once, it’s herniated twice, come see me when it herniates again and I’ll fix it. In the meantime, here are a few (undated scripts) for PT next door.” NOT FUNNY!

I have a great chiropractor. I had a great PT but I am running my own show now in that regard. I have discovered Foundation Training, a technique developed and promoted by a Santa Barbara chiropractor, Eric Goodman. He advocates strengthening the posterior chain muscles, the muscles on the back of the body as opposed to focusing on the abdominal muscles. It’s not about the six pack! If Dr. Corenman is familiar with this approach, I would be interested in what he has to say about it! foundationtraining dot com (urls not permitted on this site)

This summer, I recovered enough to walk in the Alps. I had really underestimated my fitness. I complete a week long (often outlined as a 10-12 day endeavor) hike of the Vanoise region (France) in a week. I then did the GR54, a 10 day circuit around the Ecrins that is often touted as the hardest hike in Europe. At first I was scared by the littlest slip or tumble. Little by little, I realized how robust I am.

After a week home, I was sitting on a metal chair outside at my local coffee shop innocently working at my computer and one of the front legs broke. When I hit the ground, I felt an instant shock from the level of the umbilicus through the brain stem, I guess. I have had a very sore back but no radicular symptoms for the last couple months. I obtained plain films of the entire spine two weeks later. I didn’t seek further imaging. It has been psychologically very hard! I am reluctant to do many of the movements and activities that it took so long to get back.

NO SURGERY! Except under the specific circumstance mentioned by Dr. Corenman. You CAN find surgeons who will do it, chomping at the bit to do it. It’s not an operation spine surgeons get to do every day. There are a few different options and they are all difficult. NO SURGERY!

You have found an excellent resource! This site is amazing. Check out the videos. (BTW: you can find videos of a thoracotomy on youtube if there isn’t one here!) Dr. Corenman’s book is well done. Also check out this book by an LA spine surgeon… Do You Really Need Spine Surgery by Aaron G. Filler. He has a chapter devoted to the T-spine. He indicates that thoracic spine surgery is becoming a sub-specialty of sorts. If I remember correctly, he discusses the various procedures. Don’t get conned into the less invasive procedures…they have their own set of problems! NO SURGERY!

As for going out of state, I intend to visit Dr. Corenman for advice going forward. I hope you are taking new patients! Thanks you again for the insight. I am especially impressed with your advice/prediction regarding the rib!

Hart

Donald Corenman, MD, DC
Moderator

October 27, 2012 at 11:08 pm

Post count: 8660

#7267

This is a very good reply. The general guidelines are very appropriate. Try to avoid surgery unless there is a clear compression of the spinal cord with myelopathy (very rare).

The Santa Barbara chiropractor is spot on with “posterior chain muscle” strengthening. The thoracic spine has a built in forward curve (the kyphosis) which loads the discs. Herniations in the thoracic spine will actually increase this curve which obviously increases the load on the discs. Increased disc load increases the pain.

The antagonists to this kyphosis or forward curve are the posterior thoracic muscles (the extensor muscles or posterior chain muscles). Strengthening of these muscles will reduce the load on the disc. Extensor training is as simple as using a rowing machine and extension “sit-ups” while lying on an exercise ball.

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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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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