Post Surgical Pain ACDF Spect imaging

Tagged: chest pain, thoracic spine, vertebral tumor

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Donald Corenman, MD, DC
Moderator

October 23, 2015 at 8:03 am

Post count: 8660

#20542

CT scans are valuable for bone anatomy. The MRI is acceptable but some surgeons want more information and a CT scan does give different and probably more helpful information.

A VATS is a video assisted thorascopic procedure where a number of tubes are used through the chest to visualize and remove the thoracic disc herniation. Many times a fusion is added but some surgeons do not feel a fusion is necessary.

Recovery will depend upon whether the fusion is used as it takes 4-5 months for a fusion to mature to allow load bearing.

Understand that this surgery will not relieve neck or arm pain as the T4-5 level contributes no nerve supply or referral pain to the neck or arm.

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 23, 2015 at 9:06 am

Post count: 51

#20549

Dr. Corenman, thank you for your response. It’s my understanding that this T4 T5 protrusion is rather rare, but I’m not certain of this information. I wanted to ask a couple more questions, since you mention fixing this compression would not help with my neck or arm pain.

Would it help with the severe shoulder pain?

Is there a reasonable chance it’s causing the chest pain, knowing all other chest issues have been exhausted with many specialists?

Is there a remote chance it could mimic cervical disc pain, or cervical disc disease?

I only ask because this has been going on for over three years, and the thoracic protrusion has been there the entire time, it was never discovered though, until now.

I was truly hoping this was going to be the single issue that was the root of the severe chest pain (over three years), and continued C5 C6 area severe neck pain, as well the entire left arm pain. Being almost 7 months post opt from my posterior cervical fusion, I was praying this could be the answer to some of these continued issues.

Thank you again, The part about the arm and neck now have me a little disappointed. You can probably relate. Only the three questions, and I will let you know how this all pans out after I meet up with my surgeon.

Sincerely,
JB

Donald Corenman, MD, DC
Moderator

October 23, 2015 at 9:41 am

Post count: 8660

#20552

Thoracic nerve root decompression might help with with posterior scapular pain in the area of the nerve distribution but if this pain is in the top of the shoulder (the trapezius muscle area), decompression most likely will not help with this pain.

It is highly unlikely that T5 nerve pain will mimic cervical nerve pain. You need to look towards your neck and shoulder for some answers to pain generators.

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 23, 2015 at 5:03 pm

Post count: 51

#20584

Dr. Corenman, thank you again. You give very sound advice. The shoulder pain is lower, and both front and back pain. You never mentioned any relation of chest pain with the T4 T5. This is the real mystery I’ve been trying to solve for a very long time. Is it possible the T4 T5 compression is causing this chest pain? In all your years have you ever seen severe chest pain related to the spine? This is mostly left chest pain.

Again, tremendous advice.

Thank you,

JB

Donald Corenman, MD, DC
Moderator

October 24, 2015 at 6:19 pm

Post count: 8660

#20585

What you really need is an epidural steroid injection at T4-5. This injection will anesthetize the level and reveal in the first three hours what could be expected with surgical decompression. Yes-chest pain can be caused by a T5 radiculopathy and if this herniation is more left-sided, it would correlate with your symptoms.

Without the ESI, it is more of a guess with some anatomic validity. I am a big advocate of the diagnostic injection (see pain diary). I think that without this injection, the surgical success rate drops by about 20%-a significant decrease for spine 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

October 26, 2015 at 7:05 am

Post count: 51

#20591

Dr. Corenman, the EPI was in the process of getting approved. My neurosurgeon told me to hold off. He wanted to see me sooner than later. his findings were a left lateral protrusion at the T4 T5. I have history of high blood pressure from injections, and most all of my injections have failed. I’m talking about a large amount of injections, facet, epidural, medial branch blocks (limited relieve), nerve burning, all very limited relief.

The thoracic spine has not been diagnosed with injections though. I’m not certain why my surgeon doesn’t want me to proceed with the epidurals. I imagine he must have some good reasoning. I will be getting my CT report of the thoracic spine today. We meet on the 3rd, to discuss the MRI and CT of my thoracic spine.

Thank you for your input on this matter. I will keep you posted.

JB
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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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