Thoracic spine issues

Tagged: thoracic spine pain

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Donald Corenman, MD, DC
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April 8, 2018 at 6:59 am

Post count: 8660

#28040

Sorry I’m late to this thread but work gets in the way sometimes.

To Robin555: Contrast (Gadolinium) in an MRI is important if there has been prior surgery as scar tissue will “light up”. Also, neoplasms (tumors) will also illuminate. If you have had a prior thoracic MRI without any changes noted, sometimes gadolinium will help to define vascular neoplasms (tumors with veins and arteries in them). Why a radiologist would override a surgeon who prescribes an MRI with contrast is a first for me. If I needed contrast, I would not presume someone would override me.

To Casper: Yes, thoracic facets can cause pain and many times, the MRI will not show abnormalities the would lead to this diagnosis. Facet disease is normally a diagnosis of history and direct physical examination (tenderness of the facets associated with extension pain). A diagnostic facet block can reveal the diagnosis and radio frequency ablations can be helpful.

Thoracolumbar pain can originate from facets but more commonly in this area, pain is generated by Scheuermann’s disorder. This disorder is noted by endplate malformation and changes sometimes on the STIR images. Unless you have pain that radiates around in a discrete band distribution, it is unlikely that you have radiculopathy and that an intercostal nerve block will be useful. Associated with a thoracic radiculopathy should be foraminal stenosis or a lateral disc herniation.

HLA B-27 gene is associated with ankylosing spondylitis and much more common in males. The hallmark symptom is morning stiffness that disappears with exercise, also reduced with non-steroidal anti-inflammatories. There are spondyloarthropathies that are not associated with HLA B-27 like the gastrointestinal spondyloarthropathies associated with irritable bowel syndrome and Reiter’s syndrome. See https://neckandback.com/conditions/rheumatological-conditions-affect-spine/.

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.

robin555
Participant

April 8, 2018 at 7:00 am

Post count: 12

#28041

Hey
I am 27. Had HLA B27 checked through blood work. Don’t know if I should go to rheumatologist for further testing or not (your opinion?). Actually, not my whole spinous process is sore but the left part and further out. When I hunch forward, I can feel pain right beside the spinous process where the rib heads are attached to the spine and also in the front where they attach to the sternum. When I sleep on my side I feel pain in one of the top ribs (t2-t3). When I bend forward my lower ribs give me problem. I am actually experiencing both abdominal pain and issues. On occasions I have felt pain and tingling wrap around one of the lower rib to the front where exactly I feel the abdominal pain. I also further think that this is causing me my abdominal issues as well. Did you test positive for HLA B27? It’s interesting what you said about the CT scan. I will give that a go as well. As for the pain, I usually take Tramadol, Tylenol 3 or sometime Percocet. Also take lyrica and a muscle relaxer. I used to take naproxen but it didn’t do much. I am holding off on the injections till my next mri, which is next month. Hopefully, the mri reveals the problems. Might get the intercostal nerve blocks though. Don’t know what prp injections are. Are you booked for your second mri yet? If so, when is it?

robin555
Participant

April 8, 2018 at 7:20 am

Post count: 12

#28043

Hello Doctor
Thanks for replying. Just wanted to ask you as to how should one go about in figuring out if they are experiencing joint dysfunction in their thoracic spine or not. Be it the facets, rib heads or other joints. What diagnostic tools and injections can be helpful?
Thanks.

Casper
Participant

April 8, 2018 at 8:59 am

Post count: 10

#28046

Thank you doctor. To Robin: I had an injury and my rheuma tests are fine, do not have morning stiffnes. I also have this tinggling wrap in my lower ribs. Prp are platelet rich plasma shots, from my blood, and it is a regenerative method for joints. I have MRI scheduled next month.So are you HLAb 27 positive? Do you have also low back pain? I think you should do MRI first so then decide if go to reumathologist or not. Maybe it will show something.

robin555
Participant

April 8, 2018 at 10:50 am

Post count: 12

#28051

Hey Casper
No I am HLA B27 negative and no I do not have morning stiffness. My pain is not bad in the morning but gets worse with movement as the day progresses. I read from your other post that prp shots helped you for a couple of months only. Did you try it again? Also where do they inject those? I am also due for a mri next month. If you don’t mind, please let me know how those prp shot (if you decide to get a second batch) or intercostal vertebral joint shots work out for you in the future after your mri. I would appreciate you letting me know if anything works out for you since I am fed up with this. Like you I have tried a lot of conservative treatments without much success and have no clue where to go from here. Also, ONLY IF YOU DONT’T MIND if you could let me know your e-mail via my e-mail so that I can ask you about your recovery in the future. Like I said I am fed up and don’t know where to turn.

Donald Corenman, MD, DC
Moderator

April 8, 2018 at 6:03 pm

Post count: 8660

#28053

Sorry but personal identification cannot be noted on an anonymous forum. You can call the 888 number and if Casper wants to call the same number, I can get you two in touch with each other.

PRP is similar to steroid injections, inject the correct structure (AKA pain generator), and the pain will diminish or recede.

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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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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