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

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Donald Corenman, MD, DC
Moderator

January 11, 2014 at 3:50 pm

Post count: 8660

#10124

Kyphoplasty is rarely indicated. WIthout knowing the amount of kyphosis (angulation) of your fractures, I cannot comment with certainty but in general, I would significantly disagree with this neurosurgeon on this point. Kyphoplasty is not without its problems long term. You are essentially putting a non-biological “rock” into your vertebral body that will never incorporate into the bone.

Most patients I have seen with compression fractures that are not too severe have little to no symptoms post-healing. If you injured your disc in the accident, kyphoplasty would not help at all.

If you have significant angulation from the fracture and this injury has healed (after three months), then kyphoplasty generally will not be effective to restore any height of the vertebral body.

Make sure you have exhausted all treatment avenues before you consider trans-thoracic discectomy.

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

February 1, 2014 at 10:35 am

Post count: 10

#10289

Dr. Corenman,

The MRI of my lumbar spine mentions minimum anterior wedging of L2 & L3 and no disc herniation. It does not mention a degree of angulation. this was post accident in September 2013. I have yet to get another MRI approved of my L spine. I am hoping that it is approved by next week. The pain is getting worse day by day. I don’t have very good mobility in my lower back either. Could it be that the fractures haven’t healed?

I had my first thoracic epidural steroid injection. I had some relief about and hour post procedure then the Lidocaine started wearing off and the pain returned, after the first three days post injection (soreness) The pain was substantially better for 4 days after. Now the pain has returned worse than it was before the injection. I have another injection scheduled for February 5th. What are the chances that the next injection will do the same? From what I have researched there is a better chance of relief after the second injection. I am hoping so, from what I’ve read about the trans-thoracic approach for the t5-t6 level it seems pretty risky.

Thanks in advance

Donald Corenman, MD, DC
Moderator

February 2, 2014 at 3:19 am

Post count: 8660

#10294

The wedging is probably an aftermath of the compression fractures but Scheuermann’s disorder can also cause wedging (see website).

MRIs typically are not used for angulation measurements as the deformity is maximized with standing and the MRI is performed lying down. A standing X-ray is the preferred tool to use for angulation measurements.

Fractures almost always heal so I would not expect a non-union of a compression fracture.

A second injection has a reasonable chance of working if the first injection was somewhat effective. As a general rule, the second injection is no more effective than the first.

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

February 6, 2014 at 3:51 am

Post count: 10

#10317

Dr. Corenman,

Scheuermann’s could be a possibility a thoracic spine xray I had performed at my general practitioner’s office showed wedging from C7-T11.
I had the second epidural steroid injection done today. There wasn’t as much pain after the lidocaine wore off this time ( the physician didn’t have as much difficulty this time either). I am hopeful it helps.. What are other treatment options for the thoracic spine besides ESI and physical therapy before opting for surgery?

Thanks in advance

Donald Corenman, MD, DC
Moderator

February 6, 2014 at 9:54 pm

Post count: 8660

#10320

For aggrevation of Scheuermann’s disorder or from the aftermath of compression fractures, an extension exercise program is called for. This will increase the strength of the muscles that are utilized to reduce the angulation of the spine.

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

February 14, 2014 at 2:04 pm

Post count: 10

#10330

Dr. Corenman,

I really appreciate your forum and the quick responses. I am a frequent visitor.

I had a repeat MRI of my Lumbar spine and the first MRI of my Cervical spine done today.

In my first post I stated the symptoms being “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.” Additional to that I have a “throbbing like” pain that extends into the base of my skull.

Thoracic Spine details are listed in the first post.

Here are the results of the MRIs done today.

MRI Cervical WO contrast

Findings: Decreased cervical lordosis due to spasm. Vertebral body heights are maintained. Inter vertebral disc heights are normal. Posterior fossa structures are unremarkable. No abnormal cord signal seen.
C2-C3: Normal
C3-C4 Uncovertebral osteophytes and facet arthropathy causing moderate bilateral neural foraminal narrowing.
C4-C5: Mild bilateral facet arthropathy causing mild neural foraminal narrowing.
C5-C6: Uncovertebral osteophytes and facet arthropathy causing moderate neural foraminal narrowing. Disc osteophyte complex causing mild effacement of the ventral thecal sac.
C6-C7: Normal
C7-T1: Normal

MRI Lumbar WO contrast
Findings: Numbering based on 5 lumbar type vertebrae. Approximately 30-35% compression deformities of T11,T12,L1,L2 and L3 vertebral bodies without any abnormal marrow signal. There is complete resolution of marrow edema on STIR images in L2 and L3 vertebral bodies, seen on prior study.

Paravertebral muscles are unremarkable

The conus is seen at L1-L2 level. Cauda equina nerve roots are normal.
T12-L1: Moderate bilateral facet arthropathy
L1-L2: Moderate bilateral facet arthropathy and ligamentum flavum hypertrophy
L2-L3: Moderate bilateral facet arthropathy and ligamentum flavum hypertrophy
L3-L4: Moderate bilateral facet arthropathy and ligamentum flavum hypertrophy
L4-L5: Moderate bilateral facet arthropathy and ligamentum flavum hypertrophy
L5-S1: Moderate bilateral facet arthropathy and ligamentum flavum hypertrophy
Impression: 30-35% compression deformities from T11 to L3 with out any abnormal marrow signal. Complete resolution of marrow edema in L2 and L3 vertebral bodies, seen in prior study. Moderate multilevel facet arthropathy with ligamentum flavum hypertrophy.

With that being said along with the problems in my Thoracic spine do you think a fusion from C2-S1 at the age of 23 would be an appropriate solution. Ha just joking. Can you give some advice on what I should do?

Thanks again for your help,

Travis
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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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