Mid-Lower back pain post MVA 08/29/2013

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Gtrgilbert541
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October 23, 2013 at 8:24 am

Post count: 10

#9666

I am a 23 yr old male current job as a Surgical Technician I had a rollover MVA after getting called in for an emergency surgery.Pr-accident I had no back problems what so ever. MRI’s have been done slowly (Worker’s Comp) but here are the results

MRI Lumbar – 09/06/2013
Impression
Marrow edema/bone contusions of L2 &L3 along with minimum anterior wedging present representing compression fractures. Rest of examination is essentially normal

MRI Thoracic Spine – 10/14/13
Findings:
Spinal alignment is maintained. No aggressive marrow signal abnormality seen. Vertebral body heights are maintained. No acute fractures or dislocations seen. Schmorl’s nodes seen at T7,T8,T9 vertebrae.
Central and left para-central disc protrusion at T5-T6 level causing deformity of the ventral cord surface. Small disc protrusions also seen at T6-T7 T7-T8, T8-T9 levels causing mild effacement of the ventral thecal sac. No neuroforaminal narrowing is seen. No canal stenosis.

Symptoms so far are bad migraine headaches, throbbing pain starting between my shoulder blades and my chest traveling down my spine and left leg. Weakness and tingling in my left leg at times, Also I am feeling an electric shock at time in my left arm and left leg. I am having no relief with muscle relaxants, and pain meds. Gets worse at night Currently taking OTC pain meds.

I have seen a Neurosurgeon for the compression fractures at L2-L3 and she didn’t recommend anything. My GP have stopped all pain meds after I had the MRI of my thoracic spine done and didn’t recommend me to see a neurosurgeon for my thoracic spine he also stated that not much can be done with that area anyway . I am 7 out of 25 days with physical therapy and I am in constant pain since the accident.
What would you recommend since I have no help/advice from my GP.

Thanks in advance.

Donald Corenman, MD, DC
Moderator

October 23, 2013 at 6:11 pm

Post count: 8660

#9671

It is time for a specialist. I think the first thing that you do is to seek out a good spine surgeon or PM&R spine-trained physician who can quarterback your care.

The fractures of your lumbar spine will heal but there is no mention of any deformity which is important for prognosis. A simple compression fracture that causes minimal deformity of the lumbar spine can be tolerated quite well but a significant deformity might be a different story. The typical imaging study to determine deformity is an AP and lateral standing lumbar X-ray.

In regards to your thoracic herniated disc, these can be quite painful. Unless there is substantial compression to the cord (rare and can be discovered by a thorough history and physical examination), most of these herniations can be treated with epidural steroid injections, medications and physical therapy. It takes some time to have these thoracic herniations “calm down”.

The symptoms “bad migraine headaches, am feeling an electric shock at time in my left arm” could indicate cervical spine involvement. Ask you new physician if you need a cervical work-up.

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.

Gtrgilbert541
Member

October 23, 2013 at 7:50 pm

Post count: 10

#9675

Dr. Corenman,

Thanks for your quick reply. As for the fractures the MRI didn’t mention deformity and f/u radio-graphs didn’t show any deformity. I believe that’s why the Neurosurgeon elected to do nothing. The only studies that’s been done on my cervical spine was a CT scan that revealed straightening of the cervical lordosis and minimum curvature of the spine to the right. I will seek out a specialist.

Thanks

Donald Corenman, MD, DC
Moderator

October 24, 2013 at 7:25 pm

Post count: 8660

#9679

Good luck and keep us posted. I think it is valuable to note your progress in the system for other forum viewers.

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.

Gtrgilbert541
Member

January 9, 2014 at 11:05 pm

Post count: 10

#10108

Update 01/09/14

I finally have gotten my GP to refer me to see a neurosurgeon the appointment is tomorrow 01/10/14.

Symptoms of migraine headaches, throbbing pain starting between my shoulder blades and across chest traveling down my spine and left leg. Considerable Weakness affecting my left leg are still present.I have been having increased pain in my lumbar spine while bending or twisting during any activity.

I just completed my 15th week of physio-therapy with no reduction of pain or symptoms. My GP re-started pain meds that provide no relief for my upper back. Any advise is appreciated.

Thanks,
Travis G.

Gtrgilbert541
Member

January 11, 2014 at 9:00 am

Post count: 10

#10122

Dr. Corenman,

I went to see the neurosurgeon today overall it was a pretty good visit, except I was told that I should of had the Kyphoplasty directly after the accident. The neurosurgeon stated that not having this done I would have pain in my lumbar region for the rest of my life. The previous surgeon told me that it would heal fine on it’s own.. Is this true? Currently I have pain in my Lumbar region whilst bending or twisting and for some days after. They have scheduled me for another MRI of my lumbar spine to see if the vertebrae still have edema present and if so they will proceed with Kyphoplasty.

As you stated in one of your previous post, they are agreeing that I need a cervical work up.

As far as the thoracic herniated disc, We decided to treat them conservatively with epidural steroid injections to see if there is an improvement. If no improvement he stated that we will proceed with a trans thoracic discectomy and fusion since I have multiple problems in the thoracic spine.

Just wondering if you agree with these conclusions? How far apart are epidural injections performed?

Thanks for your help..
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Donald Corenman, MD, DC

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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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