Please give me some much needed insight to my T9/T10 spinal compression

Tagged: Thoracic cord compression, thoracic myelopathy

Viewing 4 posts - 1 through 4 (of 4 total)

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Laura93
Participant

October 18, 2015 at 8:09 am

Post count: 2

#20525

Dear Dr.Corenman,
I would first like to thank you for having such an informative forum. I am new to the forum “thing”. In saying that, I have been searching frantically for some similar case to mine. I am a 41 year old female who had an MRI done on my cervical and thoracic spine in late September. PI am not new to back problems as I have had 20 plus years of lumbar degeneration and pain.
The most recent findings however have me very scared . My T9/T10 disc “area” has my spinal cord compressed to only 4mm of space with possible bleed of the cord. Everything I have read on this is not good. I am currently waiting to see a neurosurgeon and the first available appointment is November 23. In the mean time the not knowing is worse. I have been told I will have to have surgery. However I’m not sure which surgery will be best for me. I am very concerned of the possible out come of any surgery because it is my understanding this area is very rare to have an injury.
Any advice or discussion on my case would be greatly appreciated.

Donald Corenman, MD, DC
Moderator

October 18, 2015 at 6:57 pm

Post count: 8660

#20526

If your cord is compressed and the canal diameter is 4mm, you will need surgery. The type of surgery will depend upon where the narrowing occurs. If this a disc herniation or a large spur protruding from the front of the disc space, there are two different surgeries that can be contemplated.

One is a posterior approach where part of the pedicle as well as all the lamina is removed (a laminectomy). The offending compression is approached from the side, removed and a fusion is then performed. The other is an anterior approach where the approach is through the chest cavity, part of the anterior vertebra is removed to decompress the canal and a fusion from the front is performed.

If the narrowing is “global” (no one specific region protrudes into the canal) and the level is stable (will not become unstable with bone removal), then a laminectomy/decompression can be performed.

This does need to be addressed sooner than later. Avoid impact activity or heavy lifting until your doctor’s meeting.

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.

Laura93
Participant

October 19, 2015 at 7:35 am

Post count: 2

#20529

Dr.Corenman thank you for your response. I apologize for not being more descriptive on my injuries. I do have my MRI report and I should have included it before asking such an important question. I have read many of the responses that you have given to others and I value your opinion. I hope this is more helpful in answering my question.

FINDINGS:
The alignment is normal. The bone marrow signal is within normal limits.
T1/2:A small osteophyte and disc complex is seen only partially effacing the anterior CSF space. The neural foramen are not significantly narrowed.
T2/3: Normal
T3/4: Normal
T4/5: Normal
T5/6: Normal
T6/7: Normal
T7/8: A small central right-sided osteophyte and disc complex indents the anterior right aspect of the cord.
T8/9: Normal
T9/10: A large central right-sided focal disc excursion is seen which indents the anterior right aspect of the cord and narrows the anterior posterior dimension of the neural canal in the midline to only approximately 4mm. This occupies a majority of the right lateral recess. The thoracic cord signal in this region demonstrates some diffuse increased T2 signal suggesting cord compression and cord edema. The differential diagnosis includes myelomalacia.
T10/11: Normal
T11/12: A small right-sided osteophyte complex narrows the right neural foramen and mildly narrows the right lateral recess.
T12/L1: Normal
CONCLUSION :
Large central right-sided focal disc extrusion occupies a large portion of the right lateral recess and indents the anterior right aspect of the cord displacing the cord posteriorly and to the left. The cord in this region demonstrates some diffuse increased T2 signal suggesting cord compression and cord edema if not frank myelomalacia.

Smaller degenerative changes are seen in the thoracic spine as described in detail above.

Dr. Corenman taking all of this into consideration could you please tell my what approach you would want to be taken on you if you were the patient? I apologize for being so vague before and in light of this information does it even make a difference in the approach you would recommend? Thank you again for your time it really does make a world of difference.

Donald Corenman, MD, DC
Moderator

October 20, 2015 at 6:28 am

Post count: 8660

#20533

Without seeing the MRI findings on film, my preliminary opinion would be a lateral, transpedicular approach to this herniation from the back of the spine with a laminectomy and fusion of this level.

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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