Post Surgical Pain ACDF Spect imaging

Tagged: chest pain, thoracic spine, vertebral tumor

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JBoz
Participant

November 11, 2015 at 6:09 pm

Post count: 51

#20706

Hello Dr. Corenman, I have another question. I have found several approaches for this thoracic surgery, but I’m not certain which are suited for the upper T-spine. I know my surgeon is coming in from the posterior approach, for a laminectomy and discectomy. I also found what you suggested earlier, the lateral approach, or lateral extracavitary, as well as transpedicular, transthoracic, and costotransversectomy. The lateral seemed to be the most popular.

I’m wondering which really is the best surgery for a left lateral T4 T5 protrusion, I know there is many factors that are unknown here. Sometimes the internet can be the worst. I understand the words laminectomy and microdiscectomy in my surgery type. I however find it hard to find the posterior approach in any articles or information on this procedure with the T4 T5 spine. You agreed this is the least morbidity rate surgery. Since thoracic spine surgeries are rather uncommon at this level. My thinking was this choice has been made due to the risks of all the above mentioned surgeries. I have a very low quality of life due to this protrusion, or I would not be seeking this surgery out at all.

It’s very hard to find information on this type of surgery in this one location. Have you ever performed a posterior T4 T5 laminectomy and microdiscectomy? If so , how strong do you feel about this approach?

Thank you once again Dr. Corenman

JBoz
Participant

November 11, 2015 at 6:40 pm

Post count: 51

#20707

I should add to the above. I’m not second guessing my surgeons choice. I’m only looking for as much information as I can get. I do have complete trust in my surgeon, and I cannot imagine dealing with the chest pain any longer, and I’m thankful I have someone on my side to help rid me of this long term health crisis. Rather hope the other issues may be related, but only if the chest pain was removed, I will be one step closer to being a healthy father.

This is a quality of life situation, in a very large way.

JB

Donald Corenman, MD, DC
Moderator

November 12, 2015 at 12:37 pm

Post count: 8660

#20720

There really is no “posterior approach” to decompress a disc herniation in the thoracic spine. All approaches go along the “side” of the cord as the cord cannot tolerate retraction. It probably is a matter of “degrees” as to how the approach is considered. The basic principle is to take off the lateral boarder of the spine (pedicle and facet), to visualize the side of the cord (really-the dural sac), work down to the level of the disc and undermine the vertebra and remove the herniation.

I am sure he intends to do this surgery in this fashion.

I do include a fusion with this surgery as removal of the facets and pedicle can destabilize the spine. Also, you don’t want a recurrent disc herniation to occur (rare but possible).

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

November 12, 2015 at 4:12 pm

Post count: 51

#20721

I think I have a better understanding now, after reading what you are saying. I figured posterior meant the same as my posterior cervical fusion, which is right down the middle. I’m assuming that is not possible with the T4 T5 now. So it must be off to one side, left in my case. I have been thinking down the middle the entire time, since he mentioned spreading the muscles. I only know he said from that back. Now I see that can be the case still, just off to one side, by what you said… in degrees. I know the word lateral was never used, but he said from the back. I’m assuming I would be laying on my stomach then. Perhaps I need to ask a couple more questions.

You are saying that a T4 T5 laminectomy and microdiscectomy cannot be performed from a direct incision down the center of the back?

Is that correct thinking Dr. Corenman?

Thank you again Dr. Corenman

JBoz
Participant

November 12, 2015 at 8:06 pm

Post count: 51

#20722

Dr. Corenman, on top of what I said above. Would the severe chest pain, shoulder pain, numbness in the left hand and arm pain be considered myelopathy? I also have the bladder issues, and lower neck pain. I’m wondering what is radiculopathy, and what would be considered myelopathy. On top of that, is it possible to have a central posterior incision with a lateral approach after that point to get to this left sided protrusion? I really do appreciate all your time. I find that I have enough issues to warrant this surgery, regardless of risk. It’s been well over three years now of constant chest pain, that is the primary issue.

I don’t know the exact % of risks involved, but my surgeon has no reservations about doing the surgery.
This has turned into a very informative thread, that I hope helps others at some point. Truly I do.

JB

Donald Corenman, MD, DC
Moderator

November 12, 2015 at 8:33 pm

Post count: 8660

#20723

Myelopathy is generally not painful. However, compression of a nerve root is painful.If you have left-sided chest pain, especially if it radiates in a band around the chest, that would fit with radiculopathy. As I stated before, I like to have a selective nerve root block performed to know what pain will be potentially relieved with surgery and what pain won’t.

The incision can be made in the lateral position (1 inch off midline to the left) but I typically make the incision midline as I include a fusion with the 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.
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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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