Oh my achin’ Thoracic Spine

Tagged: ankylosing spondylitis

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JAO
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September 10, 2019 at 11:34 pm

Post count: 6

#31075

I’m 56 and have been dealing with chronic back pain for many years. I’m under the care of a rheumatologist and her working diagnosis is Ankylosing Spondylitis, but I also suffer from mechanical back pain and genetic degenerative disc disease. Four years ago I had a decompression surgery at T11-12 for central canal stenosis and a discectomy for a herniation at L4/5. A few months later I had new pain. A new MRI showed a new huge herniation at L4/5 and I had another discectomy. After that recovery, I continued to have pain and was chasing the pain via RFA and facet injections. I had to stop working as sitting all day combined with the pain from the AS and the mechanical back pain made working impossible. Finally, I was offered a SCS. I had a successful trial and for several months after the final surgery (done 12/2017) I experienced a honeymoon phase when I truly was doing better. I was able to cut my pain meds in half and was feeling very hopeful. Then about a year ago this insidious pain started, I describe it like a toothache in my back that just never goes away. After trying multiple procedures (RFA & facet injections) done by my pain Dr. the pain will not relent. Here is my recent MRI. I’ve not seen my neurosurgeon to follow up on the MRI results. The idea of yet another back surgery overwhelms me. I’m curious if these results would warrant treatment or are just an indication of further degeneration I’ll be living with. Thanks so much.

Impression

Interval placement of a spinal stimulator at T7-T8.

Stable lower thoracic degenerative changes resulting in multilevel neural foramen stenosis and mild to moderate spinal canal stenosis at T10-T11.

Status post T11 laminectomy, with focal kyphosis and degenerative endplate marrow edema at T11-T12.

Released By: KEIRSUN CROCKETT, MD 8/29/2019 12:00 PM
Narrative
EXAM: MRI THORACIC SPINE WITHOUT IV CONTRAST

CLINICAL INDICATION: M96.1 (Postlaminectomy syndrome, not elsewhere classified)

TECHNIQUE: Multiplanar, multisequence MR imaging of the thoracic spine without IV contrast.

COMPARISON: 7/10/2017.

FINDINGS: Interval partial resection of the T7 and T8 spinous processes and insertion of a spinal stimulator at T8-T9 via an interspinous approach. The stimulator leads are positioned at T7-T8 in the dorsal spinal canal, presumably in the epidural space
though magnetic susceptibility artifact from the hardware prevents definitive evaluation.

Status post T11 laminectomy. Focal kyphosis at T11-T12, with height loss of the T11-T12 intervertebral disc, mild chronic T11 and T12 vertebral body wedging, and degenerative endplate marrow edema. This results in focal kinking of the spinal cord at
T11-T12. Otherwise normal thoracic spinal alignment. Otherwise normal vertebral body heights. Several small chronic Schmorl’s nodes in the lower thoracic spine.

Degenerative changes predominantly at T10-T11 with bilateral facet arthrosis and ligamentum flavum thickening resulting in mild to moderate spinal canal stenosis. No other levels of significant spinal canal stenosis. Multilevel mild facet arthrosis in
the lower thoracic spine, resulting in multilevel mild to moderate neural foramen stenosis.

Normal size and signal intensity of the thoracic spinal cord.

Donald Corenman, MD, DC
Moderator

September 11, 2019 at 5:06 pm

Post count: 8660

#31076

Where is this toothache pain located? is it in the thoracic or lumbar spine? Please describe how the pain is aggravated. Is it increased with load, time of day or position?

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.

JAO
Participant

September 11, 2019 at 10:54 pm

Post count: 6

#31078

The toothache type pain is almost as high up as my waist height. At times there is a spot to the left of the spinous process that is very tender if you push on it. In July I had some facet joint injections in L2/3, L3/4, L4/5 because I have DDD and a bulging disc in my lumbar too. That pain Doc said, “Judy, if this doesn’t really help your pain, we need imaging of your thoracic spine.” Standing and sitting aggravates this pain. But there are many nights when I’m laying in bed and my back just hurts and hurts. I have pain at times in my left groin, hip, and front of thigh. I’ve also started having pain on the outside of both calves. That particular calf pain is new for me. Overall, the leg pain is more of an inconvenience. The pain in my back is debilitating. I am working on a disability claim with the SSA and had an FCE done last winter. I know I’m limited, but it was difficult to read the long list of all the things the medical professional said I can’t do in a sustained effort. Can’t sit or stand more than 15-20 minutes. Can’t walk a city block. Can’t lift xx pounds to chest height, or over my head, etc. My world has become very small and the couch and my ice packs are my new best friends.

JAO
Participant

September 11, 2019 at 11:01 pm

Post count: 6

#31079

Most days I wake up feeling very stiff in general, not just in my back. This particular toothache pain is aggravated with most all upright activities, not so much based on time of the day. Although, the pain often keeps me awake at night…. like right now even though I took all the pain meds I’m allowed, my back is just killing me.

Donald Corenman, MD, DC
Moderator

September 12, 2019 at 7:45 am

Post count: 8660

#31081

If you could better describe the location of your most severe “toothache” pain, that would be helpful (right/left, central or off midline, right above the pelvis or at lowest rib level, buttocks). Ankylosing spondylitis could be causing your stiffness. Did you test positive for HLA-B27? Do you have high CRP and ESR labs?

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.

JAO
Participant

September 12, 2019 at 8:22 am

Post count: 6

#31088

The pain is just left of what I would call my spine. So it’s not far left, like the flank pain I had when I had a kidney infection once. It’s close to my spine, but to the left of it. I’m sure the stiffness and the SI joint pain I struggle with at times is from the AS. I typically get bi-lateral SI joint injections twice a year and they do help. I was negative for HLA-B, but do have elevated CRP. Last test done in August was 37, and it’s been as high as 49. Last ESR done April was the highest at 28. I have pain in peripheral joints as well as axial. Right now my elbows are really flaring.
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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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