Post Surgical Pain ACDF Spect imaging

Tagged: chest pain, thoracic spine, vertebral tumor

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JBoz
Participant

September 20, 2015 at 5:47 pm

Post count: 51

#20381

Dr. Corenman I have had extensive workups the last three years for the issue of my chest, in which led me to have the thoracic spine MRI.

The chest pain has brought about 4 ER visits with about a dozen negative EKG’s findings, Nuclear Stress Test, that found nothing, Echocardiograms, all good, all the way to an angiogram of my heart. They ruled the heart out all together. Cardiologist reports possible spine relation.

My lungs have all been checked in the last 3 years, with CT scans and follow up CT scans two years later. I have some nodules that are stable, and nothing going on with the lungs that would cause the chest pain. Pulmonary doctor as well referred me to a GI doctor, as he could not find any relation to my lungs as the cause. I underwent many tests with my digestive track, including a bravo endoscopy, and barium swallow x-rays, many studies to find the source of this chest pain, in relation to the GI part of the body. They could find any relation to the chest pain.

My pain doctor suggested the MRI, as my chest pain is getting worse, and it ties to the thoracic spine in many ways, both sympathetic, and possible radiating pain to the chest wall. I don’t feel too much from behind with the thoracic spine. My neck is still causing me some serious pain, but has been reduced to one location of pain. I do get tingling sensations in my left arm, and fingers, as I already mentioned. My left chest pain is right under the pectoris area, or the region under the breast, sorry… the best I can explain. This can radiate to the center and far right, all along the same path, but only rarely with the center and right, it is always on my left side, along with the shoulder and arm pain.

This chest pain came on at the same time my neck and left arm pain came on in August of 2012. This led to the anterior C3, and C4 surgery that failed, and my March 25th posterior C3, C4, and C5 surgery, which has left me with that one location of moderate to severe pain, along with all the other symptoms remaining. I cannot explain the organs part. I get pain in my abdomen at times, on the left side of my body. The chest pain is what I’m really trying to resolve at this point. Since there was no mention of myelopathy on the MRI findings. I guess that is found in some other way.

Now that you know every workup possible has been done to find the source of this chest pain, with no success. I’m curious as to if you think these MRI findings represent a concern in your opinion. Just based on the MRI description. I understand you may believe it could be the cause for the chest pain, now that all has been ruled out. Is there anything else that could be troublesome? T4 Syndrome?

Plus how do they know tumors are benign without testing?

Thank you again for your time Dr. Corenman. You and your website have really been a great source of information. It’s wonderful you find time to help people with this blog. I find it a true blessing.

John

JBoz
Participant

September 20, 2015 at 7:51 pm

Post count: 51

#20385

Dr. Corenman. I did make two posts after I dictated my MRI result of the thoracic spine. I wanted to be sure you caught the MRI report. I also wanted to add, I don’t see any curvature as shown with Hyperkyphosis and Scheuermann’s findings on your site. I have found that all radiologist’s dictate so very differently. it’s tough to know in my thoracic MRI report. They never used any words, such as mild, moderate or severe. I’m use to seeing those types of words in my reports.

Thanks again Dr. Corenman

Donald Corenman, MD, DC
Moderator

September 21, 2015 at 11:20 am

Post count: 8660

#20390

Did you get a standing X-ray of your thoracic spine? I will assume that you did and the curve was less than 60 degrees. MRI’s are not good for measuring the curve (unless the curve is large enough that lying down when the MRI is taken is not enough to reduce the curve substantially).

Pain generation can be from the thoracic spine. Probably in your case, it is from degenerative disc disease but still could be from nerve compression. The best and easiest way to determine if this is the pain generator is with diagnostic epidurals in my opinion.

Make sure you understand the mechanics of how to aggravate your symptoms prior to the injection and make sure prior to the injection that you flair-up your symptoms. Then take the injection (with little to no sedation) and keep a pain diary (see website). If you have good temporary (2-3 hour) relief of pain, the diagnosis is most likely from the injected levels. If you have no temporary (3 hour) relief but do get longer standing relief (1-3 weeks or more), the steroid has given you systemic relief but the diagnosis still remains elusive.

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 21, 2015 at 4:30 pm

Post count: 51

#20392

They only ordered the MRI Dr. Corenman. I have not had standing x-rays. I have made notes with previous epidurals on my cervical spine, and they all seemed to be ineffective long term. I wonder if you see anything on my thoracic MRI report that would be of a serious concern. Meaning I should be careful at this moment.

My thoracic image closely resembles the one you have with the protrusion on your website, except mine is at the T4 and T5 area. I was thinking epidurals would be the first step to narrow down the chest pain, as you suggested. I guess it would be obvious if the chest pain went away the first few hours. My symptoms are rather constant on my left side. They are very bothersome in no small way. If they don’t reside within those first few hours, it’s going to get challenging. I just want to know I’m safe at this point, based off the MRI report. Still awaiting my surgeons response, so it must not be too bad.

Thanks again, and I like the diary idea very much.

Donald Corenman, MD, DC
Moderator

September 22, 2015 at 6:39 am

Post count: 8660

#20395

Please let us know how this problem is handled.

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

October 16, 2015 at 6:01 pm

Post count: 51

#20524

Dr. Corenman, I wanted to ask you if the benign hemangioma in the vertebral body of T7 is an issue in your view. I don’t know how good the information is from Mayo, but they say a tumor regardless of being benign is not good in the vertebral body, please see.

http://www.mayoclinic.org/diseases-conditions/vertebral-tumor/home/ovc-20117364

The term, (Whether cancerous or not, a vertebral tumor can be life-threatening and cause permanent disability), has me rather concerned. I’m still awaiting my surgeons take on this thoracic MRI. I don’t know how true this information is, I thought you could provide further concerns about tumors inside the bone. My pain doctor wasn’t sure what to think about the tumor, but did say the T4 T5 disc protrusion could be the cause of my chest pain, very much a could.

Thank you again Dr. Corenman, perhaps one day I will move back to Colorado. I use to live in Boulder as a child. I have some very good memories living in Colorado, and I watch Manning as much as I can, Elway went out in style, I’d like to see Payten do the same. I don’t see how you juggle all of this work and your blog, but you are the best on the internet for allowing advice, and the amount of characters allowed. It’s a gift to get this type of advice, it truly is a blessing to many I imagine.

Anyway, I guess you have seen your share of tumors, and perhaps you know if this website is telling the truth or not.

Again, thank you Dr. Corenman
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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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