[B767-323]

#6904

Dear Dr. Corenman,

I have the titled herniations, I believe we caused by chest dips. I did this about 10 months ago. Not terrible painful in the spine at all. However, i developed a sharp stabbing pain located on my right flank, it is dull, with frequent lightning bolts. I can find the exact nerve with my fingers just underneath the last rib.

I have had three epidural treatments, the first two lasted almost exactly 5 weeks. The last did nothing. Now my Dr. thinks I have a bruised rib, or bruised intercostal nerve,
and his next plan is to inject the nerve beneath the last rib.

My question is whether the pain is a function of the herniations, or if it is a bruise, could it still be bruised after 10 months?

I am an Airline Pilot, and I need to get back to work, and from our Corporate medical director your advice is extremely reliable, as well as your treatment.

Thanks !!

[Donald Corenman, MD, DC]

#6905

Disc herniations in the thoracic spine are difficult to treat if epidurals are ineffective. The pain can originate from four potential generators: the nerve root compression, the degenerative disc itself, compression of the spinal cord or from a condition called Scheuermann’s.

Nerve compression should cause pain that radiates around the chest wall associated with numbness of that dermatome (the sensory area the nerve serves). This condition is unlikely to be the painful disorder as it is very uncommon.

The most common pain generator is disc degeneration itself. Discs act as shock absorbers. When discs become degenerative, they tear which can cause pain as the disc wall is full of pain nerves in some patients. Patients with this disorder have more pain with loading and vibration (unfortunately, airplane vibration compounds this problem).

Scheuermann’s disorder is associated with degenerative disc disease. In this disorder, which initially occurs when the patient is young, the endplates of the vertebra deform but the pain might not develop until later in life. This disorder which is more common than you think is recognized by the irregular endplates and wedging of the vertebral bodies.

Finally, herniations that cause cord compression are not typically severely painful (but can be). Symptoms are mainly pins and needles in the legs along with imbalance (legs do not function well).

The good news is that as long as there is no cord compression, this condition is not dangerous. Chiropractic manipulation can be helpful to manage the symptoms. Since, typically the symptoms occur with prolonged sitting or standing, extension strengthening can be helpful. Lying face-up over an exercise ball to stretch the spine and then lying face-down and doing back extensions (reverse sit-ups) can be helpful.

There are portable seat pads made of sorbothane, a viscoelastic polymer that might be helpful to reduce the vibration imparted by your occupation.

Medications such as membrane stabilizers (Lyrica and Neurontin) can occasionally help with symptoms as long as side effects are minimal. These meds work in about 30% of patients effectively without significant side effects.

Facet blocks can relieve pain. If these blocks temporarily eliminate pain (see facet blocks and keeping a pain diary on the website), you might be a candidate for rhizotomies. Rhizotomies are a more permanent procedure to relieve pain.

If nothing else works, surgery could be considered but that would be if everything fails and the pain is absolutely debilitating. I won’t go into details but surgery is the last resort if nothing else works and a work-up indicates you are a candidate.

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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