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

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Donald Corenman, MD, DC
Moderator

February 17, 2014 at 3:30 am

Post count: 8660

#10337

Based upon your MRI images, you probably do have Scheuermann’s disease and had developed compression fractures of L2 and L3 (“resolution of marrow edema in L2 and L3 vertebral bodies, seen in prior study”). Compression fractures in Scheuermann’s disorder are quite common due to the increased angulation of the spine.

You need to know your global kyphosis measurement. This is performed by measuring the most angulated endplates from the top of the thoracic spine to the bottom of the thoracic spine. This measurement is normally less than 40 degrees. If it is greater than 70 degrees, your spine has a good chance of advancing this curve due to the normal effects of gravity.

An extension strengthening and stretching exercise program is important to keep the symptoms reduced.

Your cervical spine has some degenerative changes which are greater than I would expect for a 20 year old. Trauma or genetics is suspected for these changes unless you are a linebacker for the NFL.

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 23, 2014 at 3:23 pm

Post count: 10

#10402

Dr. Corenman,

The compression fractures where due to an automobile accident on 08/29/13. Also a thoracic herniated disc at t5-t6 level causing minimum compression of the cord and some other disc bulges. Tried pt and epidural steroid injections to relieve pain from the thoracic herniated disc

I went back to see the neurosurgeon a few days ago Scheuermann’s (thoracolumbar) was correct. The standing xray showed kyphosis measured @ 50 degrees. Could this be related to the accident?

The neurosurgeon was concerned with dull throbbing pain extending into left leg and the chest banding pain that I am having related to the thoracic herniated disc. A repeat MRI of the thoracic spine was performed and according to the neurosurgeon showed an increase in the size of the herniation and a forming bone spur. I seen the images and it shows the herniation compressing my spinal cord laterally.

I am in constant pain. Since physical therapy didn’t help and the epidural injections provided short relief (around 4 days each) the neurosurgeon has me scheduled for a transpedicular discectomy and osteophyte removal at the t5-t6 level instead of the trans-thoracic discetomy and fusion (I asked if there was an alternative), but unfortunately I cannot find any information about this surgery for the thoracic spine. He didn’t mention anything about the MRI of my cervical spine but did keep the cd to look over it. Could the cervical problems be caused from trauma. I follow back up in a couple weeks for pre-op (or sooner if they can get an opening). Can you give me some info about the transpedicular discectomy in the thoracic area.

Thanks in advance,

Travis

Donald Corenman, MD, DC
Moderator

February 23, 2014 at 11:42 pm

Post count: 8660

#10407

Thoracolumbar Scheuermann’s disorder in the thoracic spine can be more painful than the thoracic only version. The thoracolumbar spine should be “straight” from about T10-L2. If the measurement of this area is about 50 degrees, that is a very significant number and can be quite painful.

If this 50 degree number is strictly from the thoracic spine, this is a mild curve and can be treated with therapy.

Scheuermann’s disorder will make this area a stress riser. This makes the vertebra easier to fracture with a trauma and most likely that is what happened with your fracture.

A transpedicular discectomy is a procedure where the side of the vertebra is removed (the pedicle) and the disc herniation is removed without affecting the spinal cord. It is my opinion that this procedure should be accompanied by a fusion to prevent recurrence of this spur or herniation and to prevent instability.

We have not discussed the symptoms of your cervical spine. Trauma can cause non-symptomatic degenerative changes become symptomatic.

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 24, 2014 at 12:56 am

Post count: 10

#10413

Dr. Corenman,

I’m getting confused with everything that is going on. I wish I could make a trip to Colorado.

I re-examined my notes and The kyphosis measurement was 50 degrees from t2-l2. Could the surgery at the t5-t6 level w/o the fusion cause an increase in the kyphosis?

The symptoms of my cervical spine is mainly headaches,throbbing into the base of my skull. and pain extending down towards right shoulder. which didn’t start until physical therapy approximately a month after the accident. The therapist tried to do some kind of manipulation. Afterwards I had a major muscle spasm and could not move my neck at all. Since then the headaches and pain have been non-stop. I’ve tried massaging it under warm water and a heating pad but doesn’t help. Could the spasm be caused from an underlying problem ?
Here is the mri of my cervical spine as noted in a previous post.

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

Thanks again,

Donald Corenman, MD, DC
Moderator

February 24, 2014 at 8:35 pm

Post count: 8660

#10421

A fifty degree measurement in the thoracic spine means that your Scheuermann’s is a mild disorder. Yes, a decompression surgery at T5-6 can increase the kyphosis without fusion.

Headaches can be generated by the facets of C2-4 (greater and less occipital nerves). Facet blocks here can bring relief (see website). If you had treatment by a therapist and then had increased symptoms, I hope your MRI was performed after the onset of these symptoms. It is not unknown that a herniated disc can occur due to manipulation.

You do have foraminal stenosis at C5-6 which could cause the right shoulder pain. Selective nerve root blocks can both diagnose and treat this potential radiculopathy (see website).

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 24, 2014 at 9:13 pm

Post count: 10

#10424

Dr. Corenman,

Thanks for the quick reply. Yes the MRI Was performed after the manipulation by the therapist..

Thanks again,

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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