Thoracic spine...what a nightmare...

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barca
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February 5, 2013 at 12:10 am

Post count: 5

#7914

Hi,
off and on for years I have struggled with pain in the middle of my back (between shoulder blades) but within the past year my pain has gone from a nuisance to really affecting daily life badly. For instance I cannot handwash dishes without bad pain, cut vegetables, cook, I cannot carry my kids, etc…work has been affected as I cannot sit for more than 30 minutes without the back screaming at me.

I also have been experiencing some strange neurological issues like constant muscle twitching in calfs, some sharp needle like pains in calfs and feet, feet fall asleep very easily driving the car or sitting at my desk, and many nights I wake up and my hands are numb and some bizzare numb pain predominately in my ring fingers, but affecting all of them. I know arm nerve issues should not be caused by T-spine but I am at a loss for an explanation. Neurologist ruled out some of the scary diseases but didn’t have a diagnosis for me.

sorry for the long background story but I did have a complete spine MRI done and some of the major findings were in my T-spine…the report says:

There is straightening of the normal thoracic hyphosis. The marrow signal is normal. There are no compression fractures. The thoracic cord is intrinsically normal. There is no abnormal enhancement whithin the thoracic spine or thracic cord at any level.

At T6-7 there is a small superiorly migrated right-sided protrusion effacing the right ventral aspect of the thecal sac and mildly impinging upon the right ventral surface of the cord without central canal spinal stenosis or neural foraminal stenosis.

At T7-8 there is a moderate-sized right sided inferiorly migrated extruded disc measuring 4mm in AP dimension and extending inferiorly almost to the level of the T8-9 disc level effacing the right ventral aspect of the thecal sac and resulting in mild to moderate right-sided cord impingement and mild canal spinal stenosis without neural foraminal stenosis.

At T11-12 there is a small 3mm left-sided slightly superiorly migrated extruded discc and annular tear effacing the left ventral-lateral thecal sac without cord compression or central canal spinal stenosis or neural foraminal stenosis.

I consulted with one spine doctor and was told to take aleve and try to live with it, since I don’t have bladder issues or paralysis they won’t do surgery. He didn’t even recommend phyiscal therapy as he did not believe it would help in my situation….i felt hopeless leaving his office. I did see a chiropractor a few times but after three adjustments I felt as if things were being made worse. I have done about 8 weeks of physical therapy with very little if any effect positive or negative. NSAIDs barely help. I have a few questions that weigh on my mind:

– If this extruded disc herniated quite some time ago and calcified is this a situation that can be fixed or at least substantially improved by conservative treatments?
– would ES Injection help someone in my situation? i have sharp specific back painaching…no pain wrapping around rib cage
– is spinal cord impingement the same as compression?
– would the MRI have shown myelopathy or is a CT scan needed to show that?

I feel rather hopeless and afraid as the doctor I saw gave me the impression that there wasn’t anything that can be done and I basically am in a no-win bad luck situation with the T-spine. I’m 36 and feel like i need to adjust my lifestyle to that of a 70 year old man. Any advice is appreciated.

Donald Corenman, MD, DC
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April 14, 2013 at 10:50 pm

Post count: 8660

#8436

Your thoracic spine displays degenerative changes associated with disc herniations at multiple levels. What is somewhat surprising is that you have a reduced kyphosis as most patients with this condition generally have an increased kyphosis from degenerative disc disease or Scheuermann’s disorder (see website).

In general, your spine surgeon is correct in that you should try every therapeutic method before you should consider surgery. I think that epidural steroid injections can be quite helpful for these disorders. Extension strengthening exercises are important (rowing type exercises) to reduce the load on the discs and get the cord away from the herniations.

Medications like NSAIDs, muscle relaxants and membrane stabilizers (Lyrica and Neurontin) should be tried.

If extension (bending backwards) feels worse than flexion, you might also have facet syndrome. Facets blocks can diagnose a facet disorder if extension yields no relief.

I will assume that you do not have long tract signs in your legs (imbalance, hyperreflexia and clonus) as your cord is working well.

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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Thoracic spine…what a nightmare…