Thoracic spine joints

Tagged: Thoracic spine joint pain

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Casper
Participant

April 6, 2018 at 4:33 pm

Post count: 10

#28030

Hello! I am a medical doctor from Europe, Croatia. I’ve had a thoracic spine injury 11 months ago. It was a severe injury during my ballet competition (dancing for 17 years, no I am 29).Never had spine problems before that, not even muscle pain. I am very flexible, even in the rigid thoracic spine. For months nobody knew what was the exact cause of my thoracic and also severe rib pain. Pain was located from th10-L1 on the right side, radiating to the front in the projection of intercostal nerves. I also have allodynia, paresthesia. Serveral months later the MRI showed bone marrow edema of costovertebral and costotransversal joints th11 and th12 on the right (where my pain is), With formation of postraumatic arthritic changes. CT scan also showed 11th rib subluxation in the ct joint. After few doctors who never even saw something similiar, I have found a neurosurgeon experienced in thoracic spine problems (joint problems, not only herniated disc). He gave me platelet rich plasma shots in the joints and it helpped bit for 3 months. The nerve pain is present, I have paresthesia, trouble sitting and some days can’t sllep because of back pain. He did not gave me steroid shots because of the avulsion fractures of the joints. Do you have any advice? I don’t know if the cause of pain is due to postraumatic inflamated joints and this edema witch I’ve read is very painful, or is it more due to rib subluxation. I think I try intercostal nerve blocks first then maybe repeat prp? I am going to my second MRI to see is there any reduction in edema.I am worried that I developed crps of my spine, because of those symptoms that I have. Some days my pain is so severe that I can not do enything, just rest and some days pain is maybe 2-3 od ten, and I never know when this severe pain will start. Pain is the worst when twisting, especially turning in bed. Tired everything, Physical Therapy, chiropractic, osteopat, swimming(this made it worse), all kind of meds, it helpped a little but nothing really much. Do you have any advice. Thank you

Donald Corenman, MD, DC
Moderator

April 8, 2018 at 7:28 am

Post count: 8660

#28044

I think you have participated in another thread and I had some comments in that thread. This thoracolumbar area is quite common for development of Scheuermann’s disorder (endplate fractures when young that deform the endplate and cause mechanical pain with loading. See https://neckandback.com/conditions/thoraco-lumbar-scheuermanns-disorder/. Costovertebral joint disorders are very rare with the 11th rib-vertebral joint normally not a pain generator as the 11th rib is a floating rib (normally not attached to the sternum and therefore under much less stress). There is no need to avoid steroid in this area. If an un-united fracture is noted, these fractures generally don’t unite and after about three months, will not unite. Steroid is OK in these areas.

The next step is to determine if the facets are a pain generator. Facet blocks and possible radio-frequency ablations might be in order. See https://neckandback.com/treatments/facet-blocks-and-rhizotomies/ and https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections/ to understand how this process proceeds.

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.

Casper
Participant

April 8, 2018 at 8:49 am

Post count: 10

#28045

Thank you for your answers. I know this costovertebral disorders are rare, but can occur in hyperextension ballet injuries. Mine was a sudden twisting and hyperextension injury in ballet. I do not think I have Scheuermman disorder because my symptoms were severe and started after that injury and I don’t have scoliosis. Also my endplates of vertebra look fine on the MRI, no edema,there are not anny degenerative changes in my t and lumbar spine, my discs are great, no degeneration no herniation. Only thing that is changed are this 11th and 12th costovertebral and ct joints, With this bone marrow edema, other joints are just fine. Hoe can this bone marrow edema heal, what to do? The whole joint is White on T2 sequencs. This is the exact point of my pain and it spreads in the front bend like pain. So I think it is radiculopathy.my spine surgeon showed me my 3d ct and it is really 11th rib subluxation in the right side, and the rib head is more in the foramen impinging 11th spinal nerve, and when I move I can feel ot, I feel that nerve irritation, I have intercostal pain. He gave me bupivacain shots in that joints and intercostal nerve and it gave me instant relief. Thank you.
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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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