Post Surgical Pain ACDF Spect imaging

Tagged: chest pain, thoracic spine, vertebral tumor

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JBoz
Participant

February 27, 2015 at 9:38 am

Post count: 51

#12315

Hello, Dr. Corenman,

I found out today, that my posterior fusion will be done with two rods, and six screws… titanium. The manufacture will be Globus. I’m really starting to have a good feeling about this surgery. I think I mentioned a plate and six screws in this thread previously. It really would be a neat thing, if the chest pain and left arm pain diminished during recovery. I’ve been all cleared through my cardiologist… ready for surgery.

I’m so glad you have taken the time to answer my questions. You are top notch for taking such time to do this for people.

I think… I would rather have the rods than the plate.

John

Donald Corenman, MD, DC
Moderator

February 28, 2015 at 9:50 pm

Post count: 8660

#12320

Please keep in contact and let us know how you do with surgery.

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

September 18, 2015 at 6:53 pm

Post count: 51

#20364

Dr. Corenman, it’s been awhile. I have been meaning to get back to you on my surgery. Surgery went well, but I have been having severe pain in only the bottom right on my surgery site. This is about 1/2 inch to the right of the bottom of the incision. I can feel the typical neck pain my surgeon told me I would probably have the rest of my life. This one spot has been very problematic, and is severe compared to the mild pain along the shoulders and remainder of my neck. I had 3 sets of trigger point done, and 30 sessions of therapy to try and see if the muscle was knotted up.

I don’t know what this 6 month post operative neck pain might be at this point, we have tried everything. Another disappointment was the remaining severe chest pain, in which I have been to three specialists to try to figure out. Angiogram, Bravo Endoscopy, multiple chest X-rays, three years of unknown severe chest pain. I was really hoping for this to be resolved.

I do believe the C3 C4 will finally fuse, as well the step off at C4 C5 in time. I don’t have any clue on the stabbing type pain in the spot I mentioned above. This pain is as bad as the pain I had prior to surgery, just in one spot.

That is the surgery update, and perhaps you might know the reason for the one location of severe pain at the bottom right of the posterior incision. It feels deep to me, the therapy works for awhile, but it comes right back. Dry trigger point needling was even performed, with no real improvement.

Any idea’s would be wonderful. I hope it’s not hardware related.

My pain doctor ordered a MRI of my thoracic spine, to see if there could be a connection to the even worse chest pain. This is what they found on the MRI.

The spinal cord has normal signal characteristics. Negative for intradural or extradural masses.

Vertebral height is anatomic. Vertebral height is maintained at all levels. Negative for compression fractures. Vertebral marrow is negative for infiltrating processes and osseous destruction. Benign hemangioma in T7 vertebral body. Paraspinal soft tissues are within normal limits.

T3 T4: Very small left paracentral disc protrusion, not clinically significant.

T4 T5 small central disc protrusion causes ventral thecal sac compression with localized cord effacement. No spinal cord edema.

Remaining intervertebral discs demonstrate age- appropriate mild desiccation, but are otherwise normal. Central canal and foramina are patent at all levels. Mild facet arthropathy at lower thoracic levels.

Benign hemangioma in T7, not sure how they know the tumor is benign. It is a circle size, from one end of the bone to the other.

Impression: T4 T5 central disc protrusion with spinal cord effacement, but no cord edema.

My concern is traditional methods, epidurals, and perhaps nerve burning have all failed on me in the past. I have also read about T4 syndrome, and the chest pain symptoms all seem on the mark. I guess I hope this is the answer to my chest pain. I truly love your website, and the time you put in to help others. Your knowledge has been spot on so far.

I must say I had a very good surgeon, and I pray this new finding is the cause of my chest pain. I would do anything to have this chest pain taken off my shoulders. Perhaps this could be the answer. I just can’t live with this pain the balance of my life, as a single father of 49 years of age.

I appreciate your time Dr. Corenman, sorry to have taken so long on my surgery follow up.

John

PS, You have a very interesting video of the thoracic spine as well. I have told my surgeon of the MRI, he will be reviewing the report and images.

JBoz
Participant

September 18, 2015 at 8:34 pm

Post count: 51

#20367

Dr. Corenman, I should add my left arm and shoulder still have patches of the feeling of being punched. The left two digits on my hand have tingling and numbness as well, almost constantly. Left arm has always been one of the problems as well. That along with the chest pain was always a very scary combination.

Thanks Again

John

JBoz
Participant

September 20, 2015 at 8:01 am

Post count: 51

#20372

In trying to research issues with the thoracic spine, I came across this article. It describes the T4 to T9 as the critical zone. I wonder if there is any truth to this statement. I’ve had ongoing bladder issues, along with my severe chest pain. I also feel left shoulder, behind the shoulder pain, around the front of the neck too. I also feel my organs are failing at times, so I drink a large amount of water. I wanted to leave nothing out. Everything I’m finding is telling me this severe chest pain and several other problems, may be a result of this disc protrusion at the T4 and T5 location. I can also say my chest pain just keeps progressing. It always comes with very bad left arm pain, which in return causes severe anxiety, and a rise in my blood pressure.

I think that cover about everything Dr. Corenman.

Thanks again, for your past information, it was so very helpful.

Sincerely
JBoz

http://www.houstonmethodist.org/orthopedics/where-does-it-hurt/upper-back/thoracic-disc-herniation/

Donald Corenman, MD, DC
Moderator

September 20, 2015 at 4:33 pm

Post count: 8660

#20376

T4-9 is somewhat a critical zone for the thoracic spine. There is more pressure (bending forces) here so the stress is greater.Bladder issues could possibly originate from the thoracic spine but that would be a rare occurrence. You would have signs of myelopathy (see website) along with other problems. Chest pain can also originate from the thoracic spine either from nerve compression which would cause pain, numbness and paresthesias (pins and needles) radiating around the chest wall or from the spine itself (degenerative disc disease and hyperkyphosis-see Scheuermann’s disease on this site).

Back of the shoulder blade pain (scapular pain) can also originate from the cervical spine (neck).

I cannot comment on your feeling that your “organs are failing at times, so I drink a large amount of water”. I am unclear what that can be.

Chest pain can also occur from the heart, lungs or aorta so I will assume you have checked these sources out.
Your statement “I can also say my chest pain just keeps progressing. It always comes with very bad left arm pain, which in return causes severe anxiety, and a rise in my blood pressure” concerns me. This could be pain of cardiac origin so you need to get this checked out at least by your family practice physician if not a cardiologist.

Your herniation in the thoracic spine could be causing chest pain but you need to check all the other possibilities out now.

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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