Thoracic spine

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gonehiking
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February 15, 2012 at 8:30 pm

Post count: 2

#5577

Can you explain my MRI and is there a surgical option. I’ve done injections.. different types of PT..chiropratic..pain management..etc I have ongoing daily middle spine & left chest wall pain.. breathing pain, coughing, twisting, laying flat..can’t left, walking is limited to 15 minutes. Sitting. standing..etc I deal with different types of pain thoracic area. Swelling over my spine, and under my left front rib cage under breast. Told I may also have slipped rib from surgery and SI causing lower back & leg pain.. I’m a hiker that need to get back hiking, working and enjoying life. I keep hitting brick walls in treatment.. any Advise would be very helpful.. I’m not very good a figuring out this medical stuff, which makes it very frusrating when your trying to get better & back into life.
Thank you,

MRI THORACIC SPINE WITHOUT AND WITH GADOLINIUM
INDICATION: Back pain in the thoracic region. History of prior
thoracic spine surgery at T9-T10.

COMPARISON: Thoracic spine MRI 1/12 and 12/5/2006.

Pre- and postgadolinium enhanced imaging is obtained following a
left-sided laminectomy at the T8-T9 level identified on the
12/5/2006 study. Similar postoperative findings are again
identified today. There is some persistent artifact at the level
of surgery. I cannot identify that there is any ventral
abnormality at this level. On the post gadolinium axial image at
table position -99.19 there is a focal region within the neural
foramen that does not enhance, but I cannot identify any definite
abnormality on the pre-gadolinium imaging other than artifact
that might create this appearance. The preoperative MRI did
reveal a left paracentral disc herniation and it is possible
there is a small amount of architectural distortion or a small
amount of residual disc material in this location, for example on
the pre-gadolinium axial T1 image at table location -103.2. There
is some persistent disc narrowing at this level, although the
overall morphology of the endplates has not changed.

There is some new endplate edema, however, at the superior T6, T7
and T7 endplates also identified at the T9-T10 disc level. At T9-
T10 there may be a tiny central disc herniation or spur that
results in only minimal deformity of the ventral sac without any
obvious cord deformity. This is easiest to identify on the T1
axial pre-gadolinium imaging at table position -131.1. This
region undergoes some enhancement with gadolinium. I cannot
identify any significant myelopathic signal abnormality. This
does not lateralize and there is normal preservation of foraminal
fat at every thoracic level. The lateral alignment and native
canal dimensions remain normal.
IMPRESSION: There has been a prior laminectomy in the left side
at what I believe now is the T8-T9 level when counting from
above. In any event it is not obvious that there is any recurrent
abnormality at this level. There is a small central disc
herniation suspected at T9-T10 that may come in contact with the
ventral cord, but does not result in significant deformity or
myelopathy. If there are symptoms referable to this level CT
myelography may prove beneficial in further evaluation if the
symptoms are severe enough to warrant surgery There are some new
.findings of marrow edema described at the disc levels above and
below the levels of surgery.

Donald Corenman, MD, DC
Moderator

February 16, 2012 at 4:09 am

Post count: 8660

#5579

It is my understanding that you have local pain in the mid thoracic spine that radiates into the left chest wall. I assume the pain is worse with walking and lifting and better with lying down. Does vibration (sitting in a car/ on a plane) cause increased pain?

You have had previous surgery on the T8-9 vertebra (laminectomy). What was that surgery performed for? What were the results of surgery?

When did the mid thoracic pain occur? Was it present prior to your surgery and became worse or is this new pain that occurred immediately after the surgery. Did the pain develop much later?

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.

gonehiking
Member

February 16, 2012 at 10:24 pm

Post count: 2

#5580

Yes..local pain in the mid thoracic spine that radiates into the left chest wall.
Yes…the pain is worse with walking and lifting and lying down flat on back.
Yes..sitting in a car cause increased pain.

What was that surgery performed for herniated disc ..causing pain & weakness … (fell off a catwalk..broke rib..and herniated disc)

What were the results of surgery. “good surgery.. bad outcome” Adding new and increasing pain issues in the spine thoracic area & left side chest wall/ribcage area.

Woke up from surgery with this pain 2006. New and increasing pain issues that wasn’t present prior to surgery.. worse than before surgery.. Tried to get through to surgeon something wasn’t right..but no luck. So I figure I was being a spas and drove myself even harder in PT and returned to my sawmill hard labor job 7 weeks after surgery in sever pain.. PCP disabled me from the saw mill in 2007..

Its been a struggle trying to get medical help to remain active & functioning, so I can achieve my goals to work again, finishes college and thru-hike the AT. Right now, the last 6 months has become just my chair and heating pad..It doesn’t take much to spike my back pain. Just normal daily activities increase pain. Somedays are better than others depending on my activity level. Sleep is an onging issue because wake up in pain every few hours.

Injection & trigger points last a day or so.. I’ve kept myself on the
least amount of meds possible.. The thoracic issues are also effecting my breathing also.. I’m under the care of a pain management PA-c that is willing to talk with surgeons about my case. He’s doing all he can to help me. I’m trying to get back into PT again.. I’ve done it all for treatments except the RFL..because of insurance issues. I need to hike like I need to breath..somehow there has to be away to get me back doing well & active again.I know I can get better & achieve my goals.. just need a treatment plan & providers that match my drive to overcome this pain..

Lower back pain I’m told is from the sacroiliac joint because of how I stand & sit..to relieve pain. I have both Thoracic & lumbar MRIs on CD’s.

Thank you,

Donald Corenman, MD, DC
Moderator

February 17, 2012 at 2:44 am

Post count: 8660

#5581

Increased pain after thoracic pain surgery is worrisome to me if it was done for a “herniated disc”. Was there significant cord compression that called for surgery? What were your symptoms prior to the surgery?

The surgery you mention can occasionally destabilize the thoracic spine. This can cause local pain. The radiation of pain around your chest most likely is from nerve root irritation. In addition, some of the changes in your spine could be consistent with Scheuermann’s disease (see website) or significant degenerative disc disease with IDR (isolated disc resorption- see website under lumbar spine to describe this disorder).

You have had MRIs but have you had standing X-rays of the thoracic spine?
Have you undergone facet blocks and if so, what were the short term results (the first three hours)?

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.

lyndy
Member

January 13, 2014 at 2:05 pm

Post count: 6

#10140

I have just joined this site and came across this thread. I asked why my thoracic vertebrae that was crushed to the right wasn’t picked up, every specialist thought it was crushed to the front, or that my T4 was slipping out of place. Dr Corenman I noticed you asked about standing Xrays. I honestly believe my damage was not picked up because every test was undertaken in the prone position. I have researched the difference by the company that makes both and by their own statistics there seems to be around 20% miss rate for spine damage on prone MRI’s. Do you believe this as well? It seems like common sense to me.

Donald Corenman, MD, DC
Moderator

January 13, 2014 at 9:24 pm

Post count: 8660

#10141

You are probably talking about the “Stand-up MRI” company and their claim that 20% of disorders are missed due to the prone position of most MRIs. This is not really true. It is true that MRis are generally performed in the supine (face-up) position. This is because the image capture time is slow and motion artifact can cause ghost images.

This is like an old time cowboy picture where the individuals who could not stay still for the picture were blurred or “ghosted”.

The stand-up MRI does allow for the effects of gravity but the image quality is not very good and the images I have seen are generally not up to my standards.

If the surgeon does not perform standing X-rays along with a good quality MRI, I would agree that valuable information is lost. The stand-up MRI however is not the answer as any good spine surgeon should be able to recognize the diagnosis based upon a supine MRI and standing X-rays.

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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