One in a Million? T9-T10 Symptomatic Disc Herniation

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hart
Member

November 14, 2012 at 7:37 am

Post count: 34

#7400

It would have been easier with the films! Again, I am sorry you don’t have them. Incidentally, the films and other bits and pieces are on their way. You should have them tomorrow…if you are still inclined to have a look. I hope to get in to see you in the not so distant future…reassurance, in person, will go a long way.

Many things aren’t getting done here. And I am no longer in the kind of pain that should preclude just getting on with it! I have a feeling this inertia is not uncommon following painful spinal injuries.

It is a little hard for me to get my head around the idea that I got this “injury” spontaneously with no apparent trauma. You have mentioned Scheuermann’s disease (even in the absence of exaggerated kyphosis) as a possible contributing factor. Radiographically, some characteristic changes are reported at the lower 5 or so levels of the T-spine. If you have to have a large thoracic disc herniation, this might be the one to get, despite the hideous pain. I am aware there is another presentation of large thoracic disc herniations…a painless…and much more sinister scenario! Somewhat assured that any future protrusion at T9-T10 would most likely herniate through the same defect, I am concerned about the other 4 or 5 lower thoracic discs. I am trying not to think of them as jelly filled time bombs!

OK, I had this terribly painful episode, unable to sleep much, unable to eat much for months on end, wasting and then a prolonged case of shingles on the other side higher up, I would say T5, that seemed prolonged. (I have some photos of my shingles on my i Pad — wow that is a “bad word” for the sensor — for any doubters…and there have been a couple! I refrained from sending them to you. I did have the ripe shingles seen and documented by a local internist. In the event that I developed disabling PNH, I wanted to make sure I had access to treatment.)

It was inevitable that I would be incapable of getting on with my life for a time. I was a sick puppy! But now?! How do people shake these things off and get on with it? Do you have psychologists or other clinicians at your center who help people with this? Can you recommend strategies, stuff in the literature, books, etc? Of course, it doesn’t help that I have seen a couple doctors who have told me I am doomed for more such problems. But they have said things that don’t jive…one surgeon after mentioning the oft quoted one in a million number went on to tell me how many such T-spine herniations he had repaired…mentioning that he had success with a number of techniques, rattling off the names. Simple arithmetic…he is pulling my leg OR he is doing a lot of surgery that doesn’t need to be done! I should be able to reject his dire predictions as well, right?

Hart

Donald Corenman, MD, DC
Moderator

November 18, 2012 at 3:56 am

Post count: 8660

#7433

You can stress about being hit by a falling meteor but the odds are against that experience. I understand your real fear of recurrence but the chances of another disc herniation is still only 2-3%. If you were in Las Vegas with a 97% chance of winning in roulette, you would empty your purse onto the table for that bet. You need to learn to look forward without too much fear. Focus on other situations in your life and with time, the fear will lessen and then disappear. A psychologist can help.

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
Member

November 22, 2012 at 5:53 am

Post count: 34

#7481

Thank you, Dr. Corenman.

That puts it in perspective…sort of.

One thing has been puzzling me for a while, an “academic” matter at this point. The moment I had an MRI in hand, my Dad, a surgeon, consulted a spine surgeon colleague who he holds in high regard. This is a guy he operates alongside on occasion in the context of “access” and trauma at a university hospital.

The spine surgeon (a neurosurgeon) suggested decompression of the nerve via laminectomy. I am told he mentioned that most surgeons would probably suggest thoracotomy and fusion. One does not have to delve very far into the literature to discover the dismal history of thoracic laminectomy. I was like…NO WAY! At that time, I also did some reading about the anatomy of such lesions. I concluded that the location of my lesion was somewhat unusual, statistically speaking. (By the way, my films have made it to Margaret, not that I expect you to look at them right away! Clearly, there are people on this board who need urgent help.) Maybe the precise location of the lesion made this an option?

I am not overly impressed with academic credentials in and of themselves. However, this would have been an operation performed on a colleague’s daughter under the nose of his peers, talked about at M&M, etc.

Is there a role for thoracic laminectomy in modern spine surgery? Do you think he could have pulled it off? Would you try it?

Cheers,
H

Donald Corenman, MD, DC
Moderator

November 22, 2012 at 6:20 am

Post count: 8660

#7483

A simple laminectomy is generally not advised unless there is signficant central stenosis without anterior cord compression. There is a technique called a costotranseverectomy that can get into the canal by resecting the rib head and transverse process but that is a difficult approach and has limitations too. I have used that technique with some success but the disc herniation has to be in the posterolateral position and not under the center of the cord. Most patients with pain and without cord compression signs (myelopathy), I recommend to use epidural steroid injections and therapy. Generally, over time the symptoms abate.

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.

ezwicki
Member

April 17, 2013 at 10:00 am

Post count: 1

#8451

Dr. Corenmam,
I’m a 56 yr. male post operative from a T9-T10 disk herniation by 41/2 weeks. I’ve been following the recuperative protocol for the most part (97% compliant) but have begun to experiencing some rt. radicular discomfort and occasional moderate back pain at the surgery site. I’m up to 1 1/2 mile walks with 1 lbs. wts and nothing else. I spend most of the day sitting, lying down and some standing. My question is what am I to expect in the way of pain relief and recuperative period. Also, to what level of physical activity do you think I’ll return to. I’ve led a very active life up to this herniated disk. Thanks in advance for your response as well as for hosting this discussion site.
Ernest

Donald Corenman, MD, DC
Moderator

April 20, 2013 at 10:09 pm

Post count: 8660

#8469

This answer depends upon the surgical approach taken. Was the approach from the front or the back of the spine? Post-operative symptoms will differ depending upon what side the surgery was performed. Was a fusion performed?

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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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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