Thoracic spine issues

Tagged: thoracic spine pain

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robin555
Participant

April 6, 2018 at 5:05 pm

Post count: 12

#28031

Hello Doctor
My doctor scheduled a thoracic spine mri with contrast for my thoracic spine. Now I just found out that the radiologist has ordered one with no contrast. My question is can a radiologist do that? If so, does contrast really make a difference? Should I push my doctor for a contrast one? I have no knowledge regarding contrast so that’s why I am asking. I am experiencing thoracic spine pain along with spasms, burning sensations, and a lot of cracking and popping of ribs. I had a previous mri done without contrast which failed to show anything significant except some disc space narrowing which might be causing a few of my symptoms (would like your opinion on this as well). I definitely also do think that I have rib and joint issues in my thoracic back which the mri is just not picking up. My ribs crack a lot and feel misaligned. So, I was wondering if I should push for a mri with contrast. Please advice. Also, doctor I am experiencing abdominal pain and other stomach issues which I think is referring from my thoracic spine. Is this possible? I have never had these issues in my life, only after the thoracic injury have these symptoms showed up. Please, let me know your opinion on this as well. Thank You.

Casper
Participant

April 7, 2018 at 10:38 am

Post count: 10

#28034

Hi, I am a medical doctor from Europe. I also have symptoms that you have. I had stress fractures in my costovertebral joints and a rib subluxation. Whenever did your symptoms started, any injury before that? Mine was a ballet injury. On witch segment do you have pain? My is thoracolumbar junction. Sometimes radiologist only look for herniated disc, they don’t even look the joints. This small joints are responsible for 40% of chronic back pain – in T spine there are costovertebral, costotransversal and facet joints, and they have this nerve endings that can really Hurt, due to arthritic changes or injury. You should do MRI with axial slices not only sagittal, best sequnces are T2 and STIR to see i there are any arthritic changes or inflamation. I am a resident of sports medicine and rheumatology.

Casper
Participant

April 7, 2018 at 10:44 am

Post count: 10

#28035

As far as I now contrast in spine is used to make a distinction between inflamattion and a tumor. I did MRI without contrast, but I told radiologist to look at my small joints and to do more of that axial slices

robin555
Participant

April 8, 2018 at 12:36 am

Post count: 12

#28037

Hey
Thanks for all the info. I really appreciate it. Will tell the radiologist to look at my small joints in axial views. Not completely certain as to how this happened but I might have a clue. I used to bench press a lot so I think this caused a lot of pressure on my ribs and messed up my joints. I have been suffering from this for a year and a half now. I can’t really pin point my pain generators but I think one is around t2-t3 and the other is somewhere between t5-t8. The lower end of the t-spine might be a problem too. Just not sure on these as the pain is wide spread and mainly on the left side. Are you having abdominal issues as well? Also, have you been able to find some relief? Thanks for the advice. Let me know if you want to discuss more or you can e-mail me. I really do think that I have joint dysfunction but its so hard to explain it to the doctors since they believe that ribs are sturdy. It also doesn’t help that the previous mri didn’t pick up anything or like you said they didn’t focus on my small joints. Another thing I have noticed is that my spinous process is sore. Do you have that? Thanks.

Casper
Participant

April 8, 2018 at 2:54 am

Post count: 10

#28038

How old are you? I am 29,and have this problem for a year. I have pain on the right side only. My spinous process is not sore, but near it on the right is really sore. First 6 months I had abdominal pain, feeling like I have ruptured my muscle, but then went to osteopat and it helpped. Now I only have t spine and rib pain. Do you take pain medication. For me naproxen works a bit. Nobody believed me that I have small joints issue and rib subluxation, because ribs can’t subluxate. But my CT scan showed it. Everyone told me not to do it because of radition but I knew it will show rib problem. If your MRI would show nothing than consider CT scan because it is better for the bones and joints, MRI is better for neural structures. I have found a good neurosurgeon, private clinic who has experience With t spine. He gave me prp injections in my joints, regenerative method and it helpped but now after 3 months the pain is back. I will do second MRI and then He will give me intercostal nerve blocks and maybe another prp. Your abdominal pain is from lower t spine. But is it like musce pain or you have like intestinal problems or something like that?

Casper
Participant

April 8, 2018 at 3:05 am

Post count: 10

#28039

One more thing. Did you go to reumathologist olso? Do you have morning stiffnes? Did you do rheuma test and gene tests to see If you have HLA B 27 a gene that goes With spondyloarthritis. Because SpA is associsted With abdominal issue. Every back pain that lasts longer than 3 months in young people and With morning stiffnes spondyloarthritis should be ruled out.
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Donald Corenman, MD, DC

Average rating:

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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