Post Surgical Pain ACDF Spect imaging

Tagged: chest pain, thoracic spine, vertebral tumor

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JBoz
Participant

September 12, 2016 at 5:37 pm

Post count: 51

#22966

I did mean laminoplasty after T4, and I left it out together after T5. I will discuss the stimulator with my pain doctor. I think he is going to stand his ground on my need to see a surgeon though. He told me this condition is rather rare, I just have no idea if the herniation caused the myelomalacia or the surgery. I only know it is a very painful situation more so now, then it was before surgery.

I did write down what the surgical report said the procedure involved. I believe the surgeon told me it was going to be a microdiscectomy with laminectomy before surgery, but I have no idea why that would not be dictated on the report, instead of the words used above. This chest pain was bad enough that the pain outweighed the risk of the surgery, as I already mentioned before. I truly have no idea how many of these type of surgeries and symptoms occur in the US, but I seem to be an unusual case from what I have heard and seen. It is just so hard to find any real information about the condition. I did find a interesting video online by a Ken McKim, explaining myelomalacia, it offers a support group as well. I guess it is considered damage to the cord, they said a little fender bender would have caused possible paralysis, had they not performed the surgery. I just have a couple more questions.

Is there any possible risk for a pain doctor to go poking around in this area with treatment?

Is it too late to give up hope on the possibility it will improve within another year or so?

If I get a second opinion, do you think this moderate to severe myelomalacia is worth keeping tabs on with imaging? I’m just scared by the fact my symptoms seem to be getting worse, and/or unchanged as the follow up MRI shows.
I do appreciate all of your valuable time Dr. Corenman. You have shed much light on my situations in the past couple years. I cannot thank you enough.

JBoz

Donald Corenman, MD, DC
Moderator

September 14, 2016 at 5:25 am

Post count: 8660

#22981

Laminoplasty has the possibility of closing down the “open door” and recreating stenosis. If is commonly used in the cervical spine but I am uncertain why this technique was used in the thoracic spine as the motion of this region is very little (laminoplasty is used to try and maintain motion while at the same time decompressing the segments).

Decompressing the thoracic spine is uncommon but not all that unusual. I probably only do about one/year. A second opinion by a spine surgeon is essential for you in my opinion. Interventional pain doctors who are well experienced and meticulous should also be part of your team.

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.

JBoz
Participant

May 30, 2017 at 6:20 am

Post count: 51

#24988

Hello again Dr. Corenman.

I have recently been seen by two neurosurgeons. My thoracic spine where the myelomalacia is moderate to severe, they are now saying I have TCS, and want me to do a CT mylogram. Dethering is the surgery, and the approach is the same as listed in my previous thoracic posts. I have been having far worse symptoms, and I truly just want to know what the future holds for me. The told me they cannot tell me that until they get the image done. My spine situation at T4 T5 has become rather a mess. I was told that the scar tissue and fluid buildup have caused the tethered cord syndrome. I wanted to see how much of this you have seen in patients post op. I’m at 20 months now, and the pain is far worse, same issues as listed above. I don’t know what to do anymore, as I fear the risks of surgery as much as I fear the risks of not doing the surgery.

Thanks Jon

Donald Corenman, MD, DC
Moderator

June 2, 2017 at 10:10 am

Post count: 8660

#25104

A CT myelogram can be helpful to determine if there is cord tethering but I have to say that tethering is probably not what your condition is. Get the CT myelogram and then make sure the films are read by the neuroradiologist as well as the surgeon. Read carefully what the report says.

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.

JBoz
Participant

June 15, 2017 at 7:38 am

Post count: 51

#25210

Dr. Corenman, I’m wondering if there is any other effective imaging that can be done to find what this neurosurgeon is looking for in the CT myelogram. I have had so many CT’s performed on my spine in the last 5 years. I will let you know what the report says, they want me to have it done at the outpatient facility on site at the hospital. This surgeon handles TCS, is it even detectable in a MRI? Because that is where he feels he found it, but wants the further imaging to get better results.

Thanks again,

Jon

Donald Corenman, MD, DC
Moderator

June 16, 2017 at 1:16 am

Post count: 8660

#25214

The two imaging studies that I know of for your condition are MRI and CT myelogram. I don’t think a PET scan will be helpful.

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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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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