Can Scheuermann's kyphosis compress internal organs

Tagged: hyperkyphosis thoracic spine, Thoracic Scheuermann's disorder

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Amacad
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November 14, 2016 at 9:55 pm

Post count: 2

#23438

Hi Dr Corenman,

I was diagnosed with scheuermann’s kyphosis when I was 13, I am now 38, have been told a few years ago the thoracic curve is 78 degrees, also have an excessive lumbar lordosis, but that has not been measured, my neck is kind of straight. I have also been diagnosed with hyper mobile ehlers danlos this year. The wedging is predominantly from T9 to T11 with 23-28% loss of vertebral body height, and minimal wedging of T7 and T8 with 15-20% loss of vertebral body height, there is osteophyte bony lipping at T7/8 to T11/12 levels, and fatty marrow changes at the anteroinferior corner of the T9 and T10 vertebral bodies.

I have constant pain in my lower back, mostly at the SI joint and where the lordosis is most prominent, I also found out from an x-ray this year there is widening of the pubic symphysis, most likely from the EDS, as I have never been pregnant, but thought this could possibly cause some of the low back pain. The thoracic area is not overly painful, provided I don’t do much, walking and standing get very painful quite quickly, in thoracic and lumbar area’s, and any jumping is a definite no no.

I am worried that my kyphosis could be affecting my internal organs, my dad and grandmother had a kyphosis too, though not scheuermanns, my dads is up higher on his back, and both his lungs collapsed a few years ago, which they think was from the kyphosis. A couple of years ago I had patella stabilisation surgery on my right knee, but the tourniquet damaged a vein, and I had a pulmonary embolism, we incidentally found focal nodular hyperplasia lesions on my liver, and interestingly, the warfarin helped a lot with my chronic constipation, so I am wondering if lack of blood supply is playing a part. I work as a bus driver, and have noticed when I am on holidays, I have a lot less pain, I don’t sit up straight to much, as it is more comfortable reclining, but at work I have to, and at the end of the day, there is pain in my abdomen, under my ribs, my back hurts more and my hips, I am wondering if wearing a brace while at work could keep me more upright, and put less pressure on my organs. I am doing Physio, at first we tried sitting up straight while doing excersises, but I think this caused a dislocated vertebra, severe pain for 2 weeks, and tingling down my legs, until my massage therapist pushed it back in, so now we do all core excercises laying on the floor, which works better. So trying to just sit up straighter while at work, is really difficult, the pain in my thoracic area when trying to do that is much greater than the abdominal pain from not sitting straight.

The only concern I have with a brace is the possibility of tethered cord, my dad found he had occult Spina bifida in his late 30’s, and a tight filum terminale is common in EDS, the only indications I have is hind brain hurniation of only 3-4mm, and a scabby sore when I was 12 for 6 months that was sterile, in the buttocks area, where they usually find the tethered cord dimple, right before the kyphosis developed. I don’t know if trying to force my spine straight would cause more issues. I would like to avoid surgery, as I am worried it would make the pain worse, and have complications like my knee surgery did.

Would it be worth seeing a spine specialist again, I have not seen one since I was 13, I asked my GP 5 years ago, and he just sent me for a MRI, I have a new GP now that I am sure would give me a referral.

Sorry for such a long post.

Regards
Amanda
Australia

Donald Corenman, MD, DC
Moderator

November 15, 2016 at 6:47 am

Post count: 8660

#23441

78 degree scheuermann’s kyphosis is a very large curve that probably needs to be fixed surgically. Any curve over 70 degrees will advance 1 degree (or more) per year and the larger the curve, the harder to fix. The lumbar lordosis is accentuated due to compensation for the large thoracic curve to balance your spine while standing. This hyperlordosis can wear out the lumbar spine, especially the facets.

The larger kyphosis can eventually put strain on the heart and lungs due to the restrained volume of the chest wall. Your job as a bus driver can be more comfortable if you use a lumbar support cushion and recline your seat (if possible). Wearing a brace can give you some relief but has the price to pay of weakening the extensor muscles.

It sounds like you have Arnold Chiari syndrome (“hind brain herniation of only 3-4mm”) so that might need to be addressed. You have to make sure you don’t have tethered cord syndrome but there are signs found on the MRI that can be diagnostic. The kyphosis is most likely from Scheuermann’s disorder as tethered cord does not have vertebral deformity of wedged vertebra, endplate changes and does have scoliosis which it sounds like you do not have.

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.

Amacad
Participant

November 15, 2016 at 11:24 pm

Post count: 2

#23448

Thanks so much for the reply, the radiologist said the curve was stable compared to x-rays from a couple years prior to MRI, but I will ask to see a spine specialist anyway, so I can at least monitor it, and get his opinion.

Donald Corenman, MD, DC
Moderator

November 17, 2016 at 6:10 am

Post count: 8660

#23455

Please keep us informed.

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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