T12 fracture recovery

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lip26
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January 25, 2012 at 4:16 am

Post count: 5

#5453

in July 2011, I fractured t12. After 2 months i started therapy 3x/wk. in dec i started acupuncture 1x/wk as well as massage therapy 1x/k. i have an e-stim device that i use usually every other day. I stretch everyday.

i have a dropped right foot which causes an off looking gait. I use an AFO and a cane out of the house. i will not be using either forever and i will run again (any comments??)

can you recommend anything else you’ve seen that has helped others in my situation to add to my routine??

Donald Corenman, MD, DC
Moderator

January 25, 2012 at 4:52 am

Post count: 8660

#5456

I am concerned that you have foot drop as the result of a fracture at T12. This area of the canal contains the nerve structures conus medularis and the beginnings of the cauda equina. It is highly unusual to have a foot drop (L4 or L5 nerve root injury) with a fracture of this area. Did you have a burst fracture that caused spinal canal narrowing? Have you seen someone to look for other causes of foot drop like a disc herniation of the L4-5 disc or foraminal stenosis (see website)?

Do you have an angulation at the site of the fracture called a kyphosis and if so- what is the measure of the angulation?

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.

lip26
Member

January 25, 2012 at 5:15 am

Post count: 5

#5457

Thank you for responding so quick Dr. Corenman.

Its my understanding that there are pins are T10, T11, T12 & L1. There was also swelling and bruising of the cord involved.

A med student explained it like the swelling is blocking the nerve signals to/from the brain. As the swelling goes down I will see improvement…?! He also said that if nerves are compromised at T12, that everything below that is also compromised to some degree…?!

No doctor has mentioned kyphosis to me, and I have no problem sitting or standing up straight, well except my balance!

Also, my neurologist recently did an MRI and said that there is healing in the thoracic area, which is great news. How long does the thoracic usually take to heal completely? I have an appt on thurs. to ask more specific questions about the MRI – like if there’s scar tissue potentially blocking signals; how the lumbar region was affected; was there a blood clot; what was injured that caused the foot drop, etc.

Donald Corenman, MD, DC
Moderator

January 25, 2012 at 11:36 pm

Post count: 8660

#5460

Now I understand. You had a significant fracture of T12 (most likely called a burst fracture) and canal compromise from fracture fragments pressing in the canal. You underwent surgery to correct the angulation (kyphosis) and remove the fragments from the canal. You were left with motor deficit of the L4 or L5 nerve root on one side resulting in a foot drop.

The end of the spinal cord (where the injury occurred) contains the nerves to the bowel and bladder. Do you have difficulties with those functions?

You are now about 6 months from surgery. The fusion at the injury level must be healed or close to being healed now. The foot drop could be permanent but it might take another 6 months to know. Make sure that there are no other problems lower in the lumbar spine that could cause a secondary compression to these nerves. An EMG of the affected leg might be helpful at this point.

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.

lip26
Member

January 27, 2012 at 3:16 am

Post count: 5

#5468

I understand that L4 & L5, even S1, control the legs and toes. My Physical Therapist explained to me that even though my injury happened at t12, it makes sense to say that i’m functioning at level L4/L5, because thats where I start having difficulties. I do have trouble with Bladder & Bowel functioning; not as much control, i do have residual urine but my urologist says its not so much that he’s pushing me to cath, as long as I continue to manage going to the bathroom before i feel the need.

My neurologist did an EMG on both legs and said that I was going to be fine…but to be patient cause it’ll take awhile. I’ll quote him, “You won’t be a tennis star or anything, but you’ll be able to do mostly everything as before”. Do you recommend another EMG at this point? When I told the surgeon I had an EMG, he asked why because we already knew that the nerves just need to regenerate…!!?

Donald Corenman, MD, DC
Moderator

January 28, 2012 at 2:49 am

Post count: 8660

#5470

The injury was at T12. The bowel and bladder injury makes sense as this is the level of the conus medularis which is the “nerve center” for the bowel and bladder. The fact that you have a reasonably functioning bladder is wonderful and you dodged a bullet with this injury.

If you have an intact gastroc-soleus muscle group (the calf muscle- meaning you can walk on your tip toes without heel drop), this means that the S1 nerve is functioning well. Why the L4 or L5 nerve would be damaged but the S1 nerve right next to these nerves would be intact is an unanswered question. There are always unusual injuries that can’t be explained well and this most likely is one of them.

The EMG can determine if there is active denervation (possible continuing compression and nerve injury) vs. chronic denervation. I have to assume that the neurologist found only chronic denervation. I also assume the lower lumbar spine was imaged to make sure there was no lower spine disorder (HNP or fracture) that could also cause the L4 or L5 radiculopathy.

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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