Thoracic back pain

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zahul
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May 9, 2013 at 8:57 pm

Post count: 8

#8617

Dr. Corenman, I’ve been having back pain for over a year now. I’ve had an MRI of my entire spine and it showed multiple disc herniations. The one I’m more afraid of are the ones in my thoracic spine due to the risk of myelopathy and invasive surgery that can cause more chronic pain after.

The MRI report said there is no radicular contact but I feel like I have a knife stuck in my upper back. The pain doesn’t radiate down my ribs but it’s constant (goes away when lying flat).

A few images of my thoracic MRI can be seen here: imgur.com/a/vHXrd
The last three images are from the T8-T9 disc which looks the worst.
I’m confused because my MRI report also said there is cord compression without myelopathy but I’ve seen two neurologists and the both said the MRI doesn’t show any sign of cord compression and I don’t have any neurological signs, only brisk reflexes.

I would really like your opinion regarding whether or not I have cord compression. I’m only 24 and I don’t understand how I’ve got so many disc herniations.

Thank you very much for the support you give to those with neck and back pain

Donald Corenman, MD, DC
Moderator

May 10, 2013 at 7:01 pm

Post count: 8660

#8618

Thoracic disc herniations can cause numerous symptoms. The typical three types of symptoms are cord compression causing myelopathy, radicular pain (from nerve root compression) causing radiating pain around the chest wall and finally local spine pain from pain generated by the disc itself.

Myelopathy is covered on the website but suffice it to say that myelopathy is by itself painless as the cord does not have pain nerve endings in it. The symptoms are unusual paresthesias, imbalance, incoordination of the legs and bowel/bladder dysfunction.

Radicular pain is radiating pain, normally only found only on one side (unilateral) that radiates from the spine “down and around” the chest wall into the front of the body. This pain is normally accompanied by numbness of that particular dermatome in a three inch swath.

Disc pain is local spine pain that increases with loading (prolonged standing, lifting or impact) and is relieved with extension (bending the spine backwards or retracting the shoulders) or lying down.

You do have some distortion of the anterior cord by the herniations but no compression. I rarely see any evidence of myelopathy with that type of cord presentation. More likely, you have local disc pain from the degenerative discs. Your disc hernations at your young age are most likely from genetics along with your advocation or occupation.

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.

zahul
Member

May 10, 2013 at 7:51 pm

Post count: 8

#8619

Thank you for your prompt and detailed answer.

I also thought I can see a little distortion of the cord but I hoped I was wrong. Is this distortion an indication for future surgery? Should I get periodic MRIs to make sure it doesn’t turn into myelopathy ?

My pain does get worse with loading and it’s almost gone when lying flat so I guess it’s the disc themselves hurting. I didn’t even know dics could hurt.

I often get paresthesias in my hands and feet, much more frequent in my hands (when waking up from sleep) and in my feet only when siting in the same position too long but I didn’t gave them too much importance.

Can I do anything to stop these herniations from expanding or even get them to shrink? The pain is bearable but the though of myelopathy and extensive thoracic surgery (that causes more chronic pain) makes me very anxious.

Donald Corenman, MD, DC
Moderator

May 10, 2013 at 8:15 pm

Post count: 8660

#8620

“Distortion” of the cord is really of no concern generally. Spinal cords can tolerate some pressure without malfunction. You do not obtain serial MRIs to look for myelopathy. This is done with a visit to a knowledgeable surgeon who can monitor you on a biannual basis.

Paresthesias in both hands and feet would not be generated by spinal cord compression in the thoracic spine as the “arm nerves” originate higher and are not affected by the thoracic spine. There are entrapment neuropathies having nothing to do with the spinal cord (carpel, cubital tunnel syndrome) that cause hand numbness and are aggravated by sleep.

Do not worry about the disc herniations in the thoracic spine causing cord injury at this point. Most likely this will never become a cord issue.

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.

zahul
Member

May 10, 2013 at 8:54 pm

Post count: 8

#8625

Thank you again for another great answer.

I have one more question. Should I see a surgeon every 6 months or once every two years? English is not my native language and in my language the word biannual is a little ambiguous.

Donald Corenman, MD, DC
Moderator

May 10, 2013 at 9:00 pm

Post count: 8660

#8626

Every two years.

There is a section on this website describing myelopathy. Understand that this section also discusses cervical myelopathy. I assume that you do not have cervical cord compression and so when revewing that section, ignore the symptoms in the arms and concentrate on the thoracic and leg symptoms (along with bowel and bladder).

If you understand what symptoms can be generated from compression of the cord, you can “monitor” yourself as well as any spine surgeon. The exception is that there are signs which can occur that can only be revealed by a physical examination.

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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