[rdg426]

#7241

I am sorry to say that I also suffer from T9-T10 disc herniation. I am a healthy 44 year old woman with significant back problems. My problems started 8 years ago, at night, much like yours. Because I am asthmatic I thought I was having an asthma attack given the location of the pain and the fact that I had never experienced any back issues. My general practitioner told me it was indeed back pain and suggested ibuprofen. Usually I need 800mg to touch the pain.

After a long rough weekend in 2006 I called a friend of mine that was an orthopedic surgeon. He figured I pulled some muscles, gave me prednisone, pain meds and prescribed PT. After 2 weeks of PT the therapist sent me back to the doctor because the pain was worse. An MRI was performed and the disc herniation was found. Like you, I have no great story, the pain just started. I was referred to one of the best spine surgeons in Ohio who immediately said “absolutely no surgery” which was also the recommendation of my friend (the first physician). I was sent to a spine center and underwent a series of injections, physical therapy and was prescribed a portable TENS unit, something I strongly suggest.

I have to say, the injections work! They are not a cure but pretty close. I managed 3 years (most of it pain free with NO treatment) before I had to go back to the doctor.

In the course of that 3 years I moved to California and had to beg a doctor to take me on. They thought I was crazy, they said there was no way my diagnosis was correct. After my third phone call begging them to take my case they agreed and quickly sent me for an MRI to confirm that I was wrong… To their surprise I was right, I do have a disc herniation. This doctor said the same thing, no surgery. They actually told me that if a doctor suggests surgery to run the other way, the risks are too great. This doctor performed another round of injections and I have been good for the past 2 years until now.

Unfortunately I found this site because I was awakened at 3am this morning with that horrific pain once again. I keep hoping for a miracle cure but there is none. I will probably need the injections again but I am thinking that I may need to go to San Francisco for better treatment. Because this condition is so rare the doctor I was using (the best in the town I live in) struggled to get it right and actually missed with one on the injections, hit a nerve and caused additional pain.

Nonetheless, I recommend the injections. They do work and combined with PT and a TENS unit I can stay pain and med free with the exception of ibuprofen at the onset of what I call an “episode”.

Good luck with your treatment.

[Donald Corenman, MD, DC]

#7253

There are surgical options for thoracic disc hernations but the surgery is long, extensive and sometimes the surgery can cause new pain by itself. This is why most surgeons do not recommend thoracic surgery for disc herniations.

Now if the cord is compressed and causing myelopathy (chronic cord injury), surgery is generally recommended as the bad effects from cord injury are greater than the problems generated from the surgery to remove the disc herniation.

Your history for treatment is spot on. Epidural injections by a skilled injectionist, therapy and medications are important treatment guidelines.

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.

[rdg426]

#7255

I know that at some point surgery will probably be in my future but I will do my best to avoid it as long as possible. The last MRI did show that the herniation is already beginning to press on the spinal cord which is why the pain was worse 2 years ago then in the past. When an episode happens I lose all strength in my arms and legs and constantly drop things.

My biggest frustration that I face here in California is a shortage of doctors. When you call a specialist that have to agree to take your case on. Unfortunately for me I have not been able to get a physician in a big city to agree to do that which leaves me with an inexperienced injectionist. As I stated earlier, the last series of injections had some hiccups, they did not go smoothly and I was beginning to believe that this physician had never done thoracic injections before. Even the after care instructions they gave me were on lumbar injections. Because I had such an incredible injectionist in Ohio I have learned what they should be like. My husband and I are actually considering the options of traveling out of state just to get the quality care that I need for my back. And again, unfortunately the current physician has stated that because this is a chronic problem he is not sure that PT is a good idea any more and is hesitant to prescribe it for me. Luckily my daughter is a PTA and forwards the exercises to me that I need to be working on.

It’s a frustrating injury, I just wish there were easy answers.

[Donald Corenman, MD, DC]

#7259

Be careful with what you assume are symptoms from a thoracic disc hernation. You note that “with an episode” you lose all “strength in arms and legs”. Compression of the cord will not cause arm strength to diminish or even cause radiation of symptoms to the arms. You should not “drop things” from a thoracic disc herniation.

There may not be any easy answers.

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.

[hart]

#7264

Dear rdg426:

Thank you for sharing your story. I am sorry to hear of your spinal woes! I have had a difficult time but am doing reasonably well.

I grew up in Ohio and I am now in California. What is the chance of that? Do you have floating 10th ribs too? Dr. Corenman, I found a professor of surgery interested in cutting off that newly protruding tenth rib. Now that my disc herniation has shrank and my belly has filled back in with muscle, the rib is tucked away and almost no bother! EXACTLY like you said in this thread! T9 spinal nerve must innervate some of that musculature? And to think I could have been stuck with another neuropathy!

Rdg426, one good thing about CA is the “pain mandate”. You have a right to pain control. Acutely, this is probably going to mean narcotics and you should be able to obtain them easily in CA. If you can’t tolerate them (like me), you can get Zofran for the nausea and a benzodiazepine (trade names are rejected as spam!) for the agitation. Of course, this is not an ideal long term solution but you can get pain relief and I think knowing this is important. I tried ketorolac IV in an ER and found it very GOOD! But it is hard on the kidneys when used for more than a few days and the oral preparation didn’t seem as effective. Ketorolac is an NSAID with some unique properties and I would recommend in an ER situation, saving narcotics until you are confident you are in good hands. I was seriously afraid of ending up with a laparotomy (getting the belly cut open) and I was determined to have my wits about me.

I saw a highly regarded spine surgeon here who told me. “It herniated once, it’s herniated twice, come see me when it herniates again and I’ll fix it. In the meantime, here are a few (undated scripts) for PT next door.” NOT FUNNY!

I have a great chiropractor. I had a great PT but I am running my own show now in that regard. I have discovered Foundation Training, a technique developed and promoted by a Santa Barbara chiropractor, Eric Goodman. He advocates strengthening the posterior chain muscles, the muscles on the back of the body as opposed to focusing on the abdominal muscles. It’s not about the six pack! If Dr. Corenman is familiar with this approach, I would be interested in what he has to say about it! foundationtraining dot com (urls not permitted on this site)

This summer, I recovered enough to walk in the Alps. I had really underestimated my fitness. I complete a week long (often outlined as a 10-12 day endeavor) hike of the Vanoise region (France) in a week. I then did the GR54, a 10 day circuit around the Ecrins that is often touted as the hardest hike in Europe. At first I was scared by the littlest slip or tumble. Little by little, I realized how robust I am.

After a week home, I was sitting on a metal chair outside at my local coffee shop innocently working at my computer and one of the front legs broke. When I hit the ground, I felt an instant shock from the level of the umbilicus through the brain stem, I guess. I have had a very sore back but no radicular symptoms for the last couple months. I obtained plain films of the entire spine two weeks later. I didn’t seek further imaging. It has been psychologically very hard! I am reluctant to do many of the movements and activities that it took so long to get back.

NO SURGERY! Except under the specific circumstance mentioned by Dr. Corenman. You CAN find surgeons who will do it, chomping at the bit to do it. It’s not an operation spine surgeons get to do every day. There are a few different options and they are all difficult. NO SURGERY!

You have found an excellent resource! This site is amazing. Check out the videos. (BTW: you can find videos of a thoracotomy on youtube if there isn’t one here!) Dr. Corenman’s book is well done. Also check out this book by an LA spine surgeon… Do You Really Need Spine Surgery by Aaron G. Filler. He has a chapter devoted to the T-spine. He indicates that thoracic spine surgery is becoming a sub-specialty of sorts. If I remember correctly, he discusses the various procedures. Don’t get conned into the less invasive procedures…they have their own set of problems! NO SURGERY!

As for going out of state, I intend to visit Dr. Corenman for advice going forward. I hope you are taking new patients! Thanks you again for the insight. I am especially impressed with your advice/prediction regarding the rib!

Hart

[Donald Corenman, MD, DC]

#7267

This is a very good reply. The general guidelines are very appropriate. Try to avoid surgery unless there is a clear compression of the spinal cord with myelopathy (very rare).

The Santa Barbara chiropractor is spot on with “posterior chain muscle” strengthening. The thoracic spine has a built in forward curve (the kyphosis) which loads the discs. Herniations in the thoracic spine will actually increase this curve which obviously increases the load on the discs. Increased disc load increases the pain.

The antagonists to this kyphosis or forward curve are the posterior thoracic muscles (the extensor muscles or posterior chain muscles). Strengthening of these muscles will reduce the load on the disc. Extensor training is as simple as using a rowing machine and extension “sit-ups” while lying on an exercise ball.

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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