Central herniation T-10

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Lrae
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July 1, 2012 at 1:25 am

Post count: 4

#6454

Hi Dr. Corenman, I have a central, large herniation in T-10. I am a paramedic and originally hurt my lumbar area in Sept last year. Several bulging disks and possibly 1 tear. Severe sciatic pain, burning, and pain in the leg and calf. I had therapy and 3 ESI shots total 9 steroid shots and 2 oral steroids. I went back to work and was lifting the legs of the cot w/o a patient, they stuck and I had instant pain in the URQ of my abdomen, along with severe leg pain/back pain. I had an MRI and it showed a central herniation at T-10. I was told by the ER, to see a specialist immediately and not to bend, twist, lift, cough, sneeze, or bare down. I saw an Orthopeadic/spine doc and they said the same thing.. they wanted to do more steroids and more scans.. I saw a Neuro/ortho doc and he said steroids, therapy, and pretty much the same thing.. I have been off work since April 28, (which is driving me crazy), I refused the steroid, because the other shots did not work or worked temporarily. I started therapy with terrible results. Increased back and leg pain, but worse when I bend or lift even slight objects, my SNS kicks in and I break out in a sweat, have pain over my gallbladder, and central back pain. I know the surgery is very invasive and would cause additional problems, but IDK what to do. When I do nothing it causes problems, (like my feet/ankles turning purple)and when I live life normal, I only last a little bit and then I have to lay down. I checked into the minimally invasive alternatives, but like you said, they have mixed reviews..also a problem, I live in Arkansas.. I guess my question is, since the herniation is on my spinal cord, what would you recommend? I am familiar with spinal surgery, I have a cervical fusion C-4 to C-6. My husband has had 3 lumbar surgeries. the third was due to 2 failed, the disk pieces and hardened so much they cut his nerve in his leg. Please help. No one will tell me what I should do or options. The therapist threw her hands up in frustration, the WC have no idea, my case manager has no advice.. sigh.. thank you for this forum, I hope you can help.

Donald Corenman, MD, DC
Moderator

July 1, 2012 at 7:47 am

Post count: 8660

#6456

You have symptoms from both the lower lumbar spine and the lower thoracic spine. The T10-11 herniation will cause belly pain on the side of the herniation (the T10 nerve radiates to the umbilicus) and local pain in the lower thoracic spine. If there is cord compression, the symptoms will be imbalance in the legs and possible blower/bladder involvement.

The lower lumbar spine can cause lower back pain as well as leg pain so I assume you have herniations at that location as well.

The treatment of thoracic disc herniation is generally conservative unless there is cord compression causing cord dysfunction. That means steroid injections, therapy, medications and time. The reason for that is that surgery to correct this condition is quite involved normally requiring a fusion and not uncommonly requiring an anterior approach (through the chest cavity).

I don’t want to disappoint you but maybe the physical requirements of patient extrication and lifting might cause more problems than it is worth continuing the job of being a paramedic. You might be able to continue if you rehabilitate well. With a 2 level fusion in your neck, probable multi-level lumbar disc disease and now a thoracic herniation, your spine is not cooperating with you. Could you find a position as a supervisor or other less taxing opportunities?

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.

Lrae
Member

July 1, 2012 at 8:31 am

Post count: 4

#6458

Thank you for getting back to me. My MRI of the lumbar show no herniation’s, just some spinal stenosis, possible tear w/o protrusion, and dry facets.

I’m very familiar with the traditional surgery and do not want that. I am experiencing bowel changes, but the sphincter works fine. At the moment I’m not even on light duty. I have a home gym and pool, but when I walked on the treadmill, I had needles and pins followed by itching across my back and abdomen, going down the legs. Lifting even something small triggers pain in the abdomen and profuse sweating.

I have almost come to terms with not being on an ambulance, and I am a certified teacher, but I’m also a woman, and there are no women in a supervisor position of education. Although, I teach in the hospital. I know it doesn’t make sense.

I suppose what i really would like to know is, am I making it worse when I get the pain? or is that just a fact of life? Do you ever see any good things about the minimally invasive procedures such as endoscopy? accurascope? or should I just deal with it, until I can’t walk anymore.

thank you for your opinion.

Donald Corenman, MD, DC
Moderator

July 1, 2012 at 8:55 am

Post count: 8660

#6459

Spinal stenosis is unusual for someone as young as you but not unheard of. Do you have congenital stenosis (naturally narrowed canal) or is it the typical degenerative stenosis?

In general, you are not causing damage as long as there are no significant findings of weakness or long tract signs from the physical examination.

Endoscopic procedures for “discectomy” in the thoracic spine have a reasonable success rate for the nerve compression but are not as simple as in the lumbar spine. Local pain from the disc tear is not addressed with this procedure if that is a major complaint.

These herniations are normally not progressive so it is unlikely you are going to have increasing inability to walk.

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.

Lrae
Member

July 1, 2012 at 8:59 am

Post count: 4

#6460

I’m not really sure of what kind of stenosis. I didn’t have any major problems before Sept. Would exercising that causes burning and lightning pain down the leg be detrimental? or the symptoms of the pins and needles, do you think that is just a “side effect” of exercise and ultimately, the exercise is beneficial?

Donald Corenman, MD, DC
Moderator

July 2, 2012 at 2:33 am

Post count: 8660

#6462

I cannot comment without a complete history, physical examination and review of the images. The symptoms you describe could be related to stenosis or the many other disorders.

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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