Thoracic disc herniation T6/T7

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blondie03
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September 20, 2014 at 12:15 pm

Post count: 8

#11465

Hi! Found this site and the forum seems very helpful and informative.. I have some similarities with other posters but have some direct questions. I have had a full work up and repeat ct’s and mri’s and they point to the disc protrusion at t6/t7 and t7/t8 as the pain generator but not sure all the symptoms are from that…
– burning pain mid back and sometimes in chest and around bra strap line ending around my breastbone between my ribs
-Hard time catching my breath or cough with any force
-weakness in legs, they have gone limp on me a few times
-numbness and tingling down the backs of both legs and in the perineal area
-bladder issues, retention mostly
Not all of the symptoms are there 24 hours a day but the burning is almost always present. How seriously should I be taking this? What is the probability that this can resolve on its own?
Thanks in advance

Donald Corenman, MD, DC
Moderator

September 21, 2014 at 3:20 am

Post count: 8660

#11466

Disc herniation in the thoracic spine can cause a variety of symptoms. Small herniations can cause local thoracic pain. Larger protrusions can compress the nerve root and cause radicular pain manifested by radiating pain around the chest wall with some associated numbness.

Finally, a big enough central herniation can cause myelopathy or compression of the spinal cord. This can produce symptoms of numbness, weakness, imbalance and weird dysesthesias (water trickling or bugs crawling) in the legs.

The physical examination for myelopathy would demonstrate long tract signs (see website). If those are not present, the chance of myelopathy drops considerably.

Without myelopathy present, thoracic disc herniations should always be treated conservatively as surgery to resolve this disorder is not a small undertaking.

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.

blondie03
Member

September 22, 2014 at 7:29 am

Post count: 8

#11470

Thanks for answering me back. Those water trickling sensations have been occurring and the other synptoms have been present for over a year and the pain and symptoms have been progressively getting more frequent and intense. On the axial view (terminology I got from your website thank you) my spinal cord looks like a kidney bean instead of being round or oval shaped. The constant weakness in my legs and numbness and tingling is getting much more difficult to deal with. At what point do I need to consider going further with my doctor to find a solution. I don’t want to get to a point where there is irreversible damage. At this level could decreased sensation in the perineum be attributed to this problem?

Donald Corenman, MD, DC
Moderator

September 25, 2014 at 10:33 pm

Post count: 8660

#11479

I think you have enough symptoms to obtain a consultation from a spine surgeon. You might not be a surgical candidate but at least you should have more information regarding your condition. Numbness around the perineum can be related to cord compression.

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.

blondie03
Member

October 17, 2014 at 12:45 pm

Post count: 8

#11548

Well, since receiving your last response I have followed up with a spine surgeon and there were a couple options on the table. I have an exaggerated kyphosis and a herniated disc at T6/T7 as well as anterior wedging of T7, so that being the case one of the options presented is to correct the kyphosis posteriorly thereby letting the cord drape away from the herniation hopefully reducing the indentation on the cord, the other two options being percutaneous discectomy, percutaneous screw fixation, or direct lateral kyphosis correction and interbody fusion. With an increase in neuro symptoms including hyperreflexic lower extremities, weakness/heaviness in both lower legs and sensory changes would you suggest considering any of this at this time? Or do you have any other potential suggestions given the scenario? Thanks in advance

Donald Corenman, MD, DC
Moderator

October 17, 2014 at 10:41 pm

Post count: 8660

#11549

First-make sure that this thoracic disc herniation is causing your long-tract signs (“hyperreflexic lower extremities, weakness/heaviness in both lower legs and sensory changes”). The cervical spine is more commonly involved in cord compression. An MRI of the cervical spine would rule this condition out.

If the thoracic disk herniation is causing the cord compression and myelopathy, then you do have some choices. Kyphosis of this level should be over at least four and hopefully five to six segments to make a posterior correction viable. If the spine is not kyphotic over at least four segments, the correction probably would not allow the cord to drift far enough posteriorly to decompress it.

Percutaneous endoscopic discectomy is a good procedure performed by a well experienced surgeon. It is technically demanding procedure (this is one I do not perform) but has the least amount of dissection necessary.

The “direct lateral” is also known as the transpedicular approach and also can be successful.

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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