Thoracic Disc Herniation Questions

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syxx_35
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September 15, 2013 at 10:53 am

Post count: 26

#9383

I have several issues with my back but want to narrow in on my Thoracic Spine. I am a 32 yr old male, I have recently lost 100lbs. For reference this is what I have:

L2 & L3 Compression Fractures
Arthritis throughout my Lumbar and Thoracic Spine
Degenerative Disc Disease
Pretty much every disc in Lumbar and Thoracic spine has annular tears.
T10-T11 Disc Herniation

Thoracic Details:
1. I do know there is the start of cord impingement from this herniation.
2. I have been dealing with radiating pain around lower end of rib cage and upper stomach for nearly 3 years. I am constantly in pain, I have about 2 hours that are tolerable without pain meds in the morning. It feels like I was kicked in my kidneys in the back.
3. Easiest way to describe, giant vice grip tightening throughout day on my lower chest/upper abdomen.
4. I have done injections, PT etc.

I took Neurontin but that did not help.
I am taking ER Opioid, Oxycontin ER I believe 2 times a day. I just started this while I wait for a 2nd opinion.

I do have liver issues due to a biliary obstruction. This is fixed, but it ate my liver away. I now have portal hypertension, my liver team comprised of several heps have all agreed they are fine with this surgery.

The only thing I know to this point is they have said going in from the back and removing my rib. I was hoping to get some details seeing as I have 2 weeks before my consult. I want to have questions ready. The 1st surgeon is not a neurosurgeon, but I am thinking I will go see one that works out of Abbott Northwestern.

Could you give me some of the risks and benefits to this procedure, obviously relieving the pain is biggest on my list. I am also curious how often surgery is performed to repair this and what is involved.

It seems I cannot find much online about this as it is rare. So I want to make sure I find a surgeon who has performed this before.

Thanks in advance.

Donald Corenman, MD, DC
Moderator

September 15, 2013 at 9:21 pm

Post count: 8660

#9385

I have some questions. Why do you have compression fractures in the lumbar spine? Is this from trauma or from osteoporosis? Was the weigh loss intended? You are planning a surgery for the T10-11 region. Have you already had a workup to determine that this is the pain generator (local epidural with temporary pain relief)?

The surgery that is intended I assume is a surgery to decompress the canal at the T10-11 area. This is called a transpedicular decompression and fusion. This surgeon is most likely planning to remove the pedicle of T11 and remove the rib at this level. The lung is pushed down and the approach to the canal is from the side. The disc is removed without retracting the spinal cord (which does not respond well to retraction). Normally, this level is then fused with screws and rods.

This approach and surgery is generally easier to recover from than the traditional approach through the chest wall which has its own potential complications. Nonetheless, this surgery does have some risks including spinal cord injury, lung problems and lack of fusion (pseudoarthrosis).

This procedure is not too common. I do this procedure about three times per year and I perform about 350 surgeries per year.

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.

syxx_35
Member

September 15, 2013 at 9:50 pm

Post count: 26

#9387

Thank you for the quick response! To answer your questions.

The compression fractures are from a fall. I was getting off of a 1.5 story section of a house, as I put my foot on the ladder it slipped out and I went down. I landed in a sitting position. I did alot of damage to my right wrist, have had a few surgeries but 15 years later I am in pretty good shape there.

The weight loss was intended. About a year ago I woke up and was jaundice. Come to find out that I had stones in my bile duct partially obstructing my bile duct. The damage is done, but everything is good now. My liver enzymes are partially elevated, but will be forever due to the cirrhosis caused by the bile. I am still about 50lbs overweight, but have hit a plateau and cannot really workout any harder otherwise I am miserable. The weight loss was intended to take the pressure off of my liver as well as help my lower back.

I have had full work ups, multiple MRI’s and injections. The injections, at least the ones that immediately numb the area help alleviate the pain for a few hours. Cortisone helps reduce the pain from a constant 8 down to a 7. I would say 3 to 4 days of the week the pain increases to a 9 or 10 and if it was not for my high pain tolerance I would probably be in tears. The ER Oxycontin has helped immensely, still sore and feel the pressure around lower chest but at compared to what I normally deal with, I can handle this.

I have been putting off surgery for like 3 years. It has gotten severe enough and with my recent health issues I figure I should do it now while I am in pretty good shape. My health declining most likely will not happen, but with the liver and my degree of damage you just never know so my hep doctors said I should pursue relief.Plus then I can hopefully reduce the pain meds which would be easier on my liver.

I am scared about the surgery. It seems so uncommon. I just want to get an understanding from multiple doctors as to what is performed. I want this to be successful.

syxx_35
Member

September 16, 2013 at 4:50 am

Post count: 26

#9389

I was off by a level. I check mychart and it is T9-T10. I have had so many doctors, labs and scans I have a hard time keeping everything but appt. Scheduled.

Donald Corenman, MD, DC
Moderator

September 16, 2013 at 5:44 am

Post count: 8660

#9390

It sounds like you had the proper workup and failed conservative treatment. With the good temporary relief from an epidural, it looks like you are a candidate for this surgery. Make sure the surgeon has experience, is careful and has a good track record. You should have a good result.

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.

syxx_35
Member

September 17, 2013 at 3:48 am

Post count: 26

#9399

What is typical recovery time and stay in hospital for this surgery? I will get answers with my consult, but I am just getting an idea of things. I also want to get a list of questions to ask before hand. I will definately be asking how many of these they have performed. None will be a red flag for me lol.
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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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