T12 burst fracture complications

Tagged: burst fracture, traumatic kyphosis

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gm1973
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September 21, 2016 at 8:44 am

Post count: 10

#23013

Dear Dr. Corenman

I had cause to contact you last year about an injury to my back and the subsequent post-traumatic kyphosis. I wonder if I could get your opinion on the following?

It seems my case was worse than originally thought. I fractured L5 this year and it was revealed to be an osteoporotic fracture which was surprising given my age. This was treated successfully with a kyphoplasty to restore the bone and a lumbar epidural to relieve the buttock pain that I was getting when standing up following the fracture. I am still awaiting treatment for the osteoporosis. The suspicion is that it is hormone related.

I was also diagnosed with early degenerative scoliosis and forminal stenosis at L2-L3 which was also a result of my original injury. I have had an L2-L3 xlif with lordotic cage and plate and that seems to have cleared up the referred pain from the stenosis very well. Now I am left with my original T12 injury to deal with.

About two weeks ago (which was six weeks post-xlif), I was putting out the trash and started pulling backwards on the wheelie bin. I had done this several times already without incident but on this occasion I felt/heard a click in the thoracolumbar area (I am not sure if it was the T12 or above or below). I was seeing my current surgeon for a follow-up that day and he punched me in the back a few times for a percussion test and it seemed negative. Okay I felt him punching me but it didn’t hurt. He said to report back if it gets worse and I can get an MRI.

However since the ‘click’ I have had severe mid-back mobility problems. All the problems seems focused in a halo around the T12. If I am standing or with a straight back, it isn’t too bad, but anything involving a slight trunk rotation or lateral bending is extremely stiff, painful and uncomfortable. Lying down used to be extremely comfortable but now getting out of bed or off the floor is really slow and difficult and is accompanied by a wave of pain that takes 10-20 seconds to dissipate. I tried swimming but found it difficult. Ibuprofen helps but I am reluctant to take it because of my fusion. I am not sure that I am any worse but I don’t seem to have got any better either.

Do these symptoms suggest anything to you? I wondered if it could be the facet joints but flexion/extension doesn’t seem too bad. The aggravation comes from rotation and lateral movement. How long would be reasonable to wait to see if symptoms improve before getting an MRI?

One other question if I may. The proposed treatment for my T12 is a reconstruction with expandable cage done through a lateral extra-cavitary approach. My surgeon wants to avoid it but I still think that I want my back to be straight. I don’t want to live like this for the rest of my life. How long is the recovery from such a procedure in your experience and how successful is it? I have been told that I would be off work for 6-9 weeks on one occasion and 6-9 months on another. And what are my prospects for returning to a reasonably active life-style again? I would at least like to scuba dive and ski again (sticking to the groomed runs only).

Thank you very much for your help. I bought your book and found it really useful.

Best regards

Donald Corenman, MD, DC
Moderator

September 21, 2016 at 9:07 pm

Post count: 8660

#23017

Many questions. How much is your kyphosis in degrees? Is there any scoliosis associated (curve in the front to back view)? Why do you have osteoporosis? This is very important as any future treatment depends upon you severe the osteoporosis is. It is measured in a “T” score. What is your score? How much is your kyphosis from L5? What do the other vertebra look like? Why were you loading your spine only 6 weeks post XLIF? This is a period where the bone actually is softer before it gains strength. Were you given instructions that allowed loading?

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.

gm1973
Participant

September 22, 2016 at 1:09 am

Post count: 10

#23018

Dear Dr.

Thank you very much for your time.

The kyphosis measures 30 degrees (or even slightly more) at T12. You previously recommended to seek surgical repair for this level of severity.
There was some early degenerative scoliosis due to disc collapse at L2-L3. This has been straightened by the xlif. There is perhaps a mild concavity still in the thoracolumbar area due to the shape of the T12 verterbra. It is crushed slighty more on the right hand side.
The reason for the osteoporosis has not been fully established although we believe it is possibly due to low testosterone brought on by elevated prolactin levels. I am still undergoing tests. My T-score measured 2.8 when I was tested after the L5 fracture. (Can a fresh fracture negatively impact a DEXA scan? I never did ask that question).
I don’t believe there is kyphosis associated with the L5 fracture. I think the repair was successful. The height of the verterbra was maintained. When it fractured, there was a central hemispherical depression like an egg cup. I think the other verterbra look reasonably normal. My surgeon commented that the endplates look okay in other levels.
As for the loading, I was told no BLT of course but I didn’t realise that standing and pulling on something light would load my spine. My L2-L3 area feels fine. Great in fact. I used to have a lot of problems in that area which I don’t have any more. The problem feels higher up.

Donald Corenman, MD, DC
Moderator

September 22, 2016 at 6:24 am

Post count: 8660

#23021

The kyphosis of 30 degrees is a surgical curve that probably needs correction. It very well could be that the L2-3 level needed to be addressed surgically due to the increased strain from the upper kyphosis.

You have osteoporosis (T score less than -2.5) which is very unusual in a male, especially a younger male. I would hope you are going through the full work-up to determine the cause and are also getting treatment concurrently.

A fracture of L5 can give false readings if the lower lumbar spine is selected to check bone density. The readings will be higher (indicating more bone density than is really present) due to compaction of the trabecular bone secondary to the fracture which blocks more of the X-ray beam. Now that you have cement in the L5 vertebra, readings from that level will be inaccurate (as well as the operated L2-3 level).

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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