Myelopathy from Thoracic Disc Herniation

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RC456
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June 24, 2013 at 11:25 am

Post count: 2

#8937

Dr. Corenman,

Thank you for creating this site. I am a young male in my late 20’s who was very active (fishing, golfing, weightlifting, basketball) until I hurt my lumbar spine back in August of 2012. MRI of Lumbar spine demonstrated L2-L5 bulging discs with no neuroforaminal or spinal canal stenosis. I went to a chiropractor for 4 weeks for that injury because I started developing right sided paresthesias in addition to the lumbar pain. I underwent adjustments and decompressive therapy with the DRX-9000. Well, after a few weeks at the chiro. I started having parasthesias in my mid back where I was being adjusted 3 times a week for 4 weeks, and no improvement in symptoms. MRI of my thoracic spine was done and revealed T7-T9 small disc protrusions with mild flattening of thecal sac and cord indentation but no cord compression or cord signal abnormality.

My multiple thoracic HNP was diagnosed in October of 2012. Since then I have just been swimming and doing stretching with light weight exercises for core and back. The parathesias in my mid back have disappeared but for the past few months I have had muscle fasciculations that occur all over my body. They occur throughout the entire day in all muscle groups, prob. once every hour but it doesn’t disturb my sleep or anything. In addition, for the past few months I have had urine seeping out of my urethral opening for about 5 minutes after I urinate. I don’t know if this has been happening forever, or because I have been more vigilant for bowel or bladder dysfunction but it worries me. So I went to have another MRI back in January on 2013 when these symptoms started to appear. It stated no changes from last MRI- No acute cord compression. I have no muscle weakness and minimal back pain. Overall, just abnormal sensations down both LE at times- not constant with minimal pain, and the muscle fasciculations with the urine problem.

Therefore, would you consider these symptoms to be a sign of cord compression? Even though my MRI states that I do not have compression. I am young male and am in the field of anesthesia and have loans to pay off and need to support my family. Will this condition progress overtime and cause permanent nerve damage? Overall, nothing has gotten worse in a few months, but I just wanted to get another opinion. Thank you so much for your time.

Donald Corenman, MD, DC
Moderator

June 24, 2013 at 8:17 pm

Post count: 8660

#8938

Symptoms of thoracic cord compression include imbalance, loss of fine motor control in the lower extremities and bowel/bladder dysfunction. By your description, I do not think you have most of these symptoms.

In addition, cord compression leads to long tract signs. These are signs found upon physical examination that include hyperreflexia, clonus, dysesthesias and problems with gait seen with stress maneuvers. A spine expert should be quite familiar with these signs and should be able to identify them. If these signs are absent, there is more evidence that you do not have myelopathy (dysfunction of the cord due to compression).

Muscle fasciculations that occur “all over” your body are not related to the spinal cord. There are many different conditions that can cause these fasciculations and a metabolic work-up might be helpful.

Good luck.

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.

RC456
Member

June 24, 2013 at 9:05 pm

Post count: 2

#8942

Doctor Corenman,

Thank you for the reply. I truly appreciate the information. Upon physical examination, I did not have any long tract signs a few months ago when I visited my neurosurgeon. But I believe I have dysesthesias in my lower extremities. I get abnormal sensations that are difficult to describe. At times they are pins and needles and others it is almost a burning and numb feeling. However, sometimes these symptoms disappear. Is this a concern with compression or could this be from indentation of the cord. I am just confused about my clinical presentation because I really have no pain but have neurological symptoms.

Currently, I am taking MSM, Chondroitin, and Glucosamine. In addition, I am taking Wobenzym N which is a natural homeopathic supplement with papain, Bromelain and other enzymes. Through research from some of my medical articles I have access to from school I read about enzymatic degradation of the disc. Would you recommend these supplements? Thank you again. Have a good week.

Donald Corenman, MD, DC
Moderator

June 30, 2013 at 3:49 am

Post count: 8660

#8963

There are many different conditions that can cause strange symptoms in your legs other than cord compression. Metabolic, infectious, degenerative and autoimmune disorders can all cause these symptoms. WIthout long tract signs on examination, the source of “weird” leg symptoms should be looked into by a neurologist.

The substances you are taking will not affect the disc, spine or cord. Wobenzym is an offshoot of chymopapain, a substance that was used to inject into the disk to dissolve the nucleus and extract it. Needless to say, this technique fell out of favor due to the occasional paralysis that occurred with use.

These enzymes are proteins that are broken down in the gut and absorbed as simple amino acids. This breakdown makes these enzymes useless when they are absorbed.

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.

barca
Member

August 7, 2013 at 12:32 am

Post count: 5

#9142

RC456,
I have the exact same issues as you…WORD FOR WORD.

I have extruded discs at T7-8 and protrusions at T6-7 and T11-12.

I have fasciculations primarily from abdomen down but also get them from time to time in shoulders and arms. I also have bizarre tremors and dysesthesias. I feel like sometimes an incorrect assumption is being made that cord compression cannot affect the entire nervous system.

I have had multiple blood tests and seen just about every speciality of doctor (including 2 neurologists) and have zero answers as to the cause of continuing degenerative discs and muscle issues.

Dr. Corenman is there specific metabolic, infectious, degenerative and autoimmune disorders we should be asking about…what or where would someone start to look in relation to a disease process progressively degenerating discs?

thanks,

Donald Corenman, MD, DC
Moderator

August 7, 2013 at 10:52 am

Post count: 8660

#9149

Fasciculations can be related to cord compression but if there is thoracic cord compression and fasciculations occur in the upper extremities, this is not related to thoracic cord compression. Faciculations occur “down river” from the compression and will not occur “up river”.

I wrote two chapters about the most common non-spinal disorders that can occur to cause these symptoms. It would be difficult to cover all of these conditions here but any good neurologist or rheumatologist should be able to help deduce what the potential disorders are.

Now, degenerative disc disease is caused by genetics, trauma, occupation and advocation.

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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