Thoracic burning and other odd symptoms

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April 4, 2014 at 12:07 am

Post count: 15

#10665

Hi Dr. Corenman,
I am new here and have a few questions and wonder if you could help clear things up. I was in a car accident 2 years ago and had lower and upper back pain the lower back pain was resolved after discectomy but the upper back pain has been persisting and increasing. In January there was an episode of urinary retention as well as burning pain in the upper and lower back as well as numbness and tingling down both extremities and buttocks/perineal area as well as tripping and several falls where my legs just lose all strength. I had a recent MRI to rule out MS and there is no demyelination but it states there is a “central herniation at T6-T7 moderate in size with mild flattening of the ventral cord”. What does this mean for me? It had been progressively worsening over the last several months and it’s altering my daily life. I am only 34 (female) and most days I don’t want to get out of bed since as soon as I am standing or in any form of being vertical (sitting) causes extreme pain and burning in my midback.

Donald Corenman, MD, DC
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April 4, 2014 at 8:31 pm

Post count: 8660

#10670

Thoracic disc herniations normally cause local pain (mid-back spine pain and radiation around the chest wall). If this herniation compresses the spinal cord, you can develop symptoms of myelopathy (see website).

Your symptoms do sound like myelopathy could be in the differential but “mild flattening” of the cord would be more uncommon to develop this myelopathy.

Has anyone checked the cervical spine for cord compression? The most common area of cord compression is the cervical spine and this compression can be asymptomatic (non-painful) for any cervical spine symptoms?

A local epidural injection that yields good short term relief of your local thoracic pain (see pain diary) can both give you a diagnosis of how much the thoracic disc herniation is causing local symptoms and can give you long term relief on occasion.

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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April 4, 2014 at 8:58 pm

Post count: 15

#10673

Thanks for your reply. My cervical spine MRI impression reads: “small osteophyte complex at C5/C6 that minimally flattens the subarachnoid space but does not touch the cord” In my obviously untrained opinion I disregarded this one as significant, should I have? Or should I pursue it? Also they are regular mri’s would the stand up/weight bearing ones do anything to clarify the significance of these areas? Also, if the injection in the thoracic area comes back diagnostic for this area what options are there for relief of symptoms if there is myelopathy involving the T6/T7 disc? Thanks again for your quick reply

Donald Corenman, MD, DC
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April 6, 2014 at 4:54 am

Post count: 8660

#10681

The report for the MRI of your cervical spine indicates there is no significant cord compression in your neck.

Stand-up MRIs are not helpful in the majority of cases.

The injection will help with pain and numbness but not with dysfunction of the cord if this dysfunction is present. If you actually have myelopathy from this cord compression then surgery is the treatment of choice in most cases.

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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April 6, 2014 at 5:36 am

Post count: 15

#10684

Thanks again for getting back to me… I was afraid of that answer as I don’t really want to consider surgery as it seems very dangerous in that area… What type of surgery would be available to that area for a cental herniation? Which approach? How dangerous is it? I feel too young to be consider staying this way permanently… What is the potential if I do nothing? I have had urinary retention and leg weakness that had me admitted for 4 days where they were working me up for cauda equina but it was ruled out… I have the numbness and tingling and fairly consistent mid back burning pain… Is there a chance it will resolve on its own? I have a fairly physically demanding job so it concerns me… Looking forward to your reply. Thanks again!

Donald Corenman, MD, DC
Moderator

April 6, 2014 at 9:38 pm

Post count: 8660

#10690

For thoracic disc hernations, I like using epidural injections as this is a direct confirmation that the herniation is at least causing the local thoracic pain and chest pain. The injection can on occasion also help the myelopathic symptoms.

I do worry about your myelopathic symptoms “urinary retention and leg weakness” but this needs to be confirmed that these are related to the cord compression.

Surgery for this can be performed in two ways, anterior or posterior. The anterior surgery involves going through the chest, deflating the lung temporarily and removing the disc from the front as well as fusing this level. This approach can cause some residual chest pain from intercostal nerve manipulation. For the posterior approach, there is no need to go through the chest but there is some increased danger of cord injury from surgical manipulation.

Can it resolve on its own? The answer is yes if there is no cord compression. If myelopathy is also present, there is more danger of permanent residuals.

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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