sacralization of L5

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jamiemlake
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February 27, 2012 at 3:57 am

Post count: 2

#5669

Hello my name is Jamie. I am female 25 years old. I have had lower right back pain for 2 years now. My most recent MRI showed a transitional vertebra at L5 and partial sacralization of L5. I have been treated at the pain clinc for 1.5 years. They have been treating me for SI joint pain. They diagnosed me with sacroiliitis. I have had no known injury to my SI joint and they seem unable to determine why I would have SI joint pain. I honestly don’t think that is where my pain is coming from. The pain is above the sacrum on the right side. It feels like something is constantly stabbing my right hip and the pain radiates down my right leg along the lateral side down to my ankle. I am a nurse and have had to go out of work because of this pain. When I get an SI injection it doesn’t help. I have had 4. I don’t understand why they are telling my that is where my pain is coming from. Is it possible the pain is coming from this abnormal vertebra and abnormal wear on this joint? The MRI report said mild osteoarthritis and the sacralization of L5. Aparently the bones have rubbed together enough to sacralize. The MRI I had done in 2010 did not show sacralization of L5. The pain clinic has refered me to an orthopedic surgeon for SI joint surgery to fuse that joint. I am not convenced that is my problem. I don’t want to have this major surgery if it is not the problem. Is it possible my pain is coming from L5-S1 and if so is there a surgery to correct this? I have tried PT with no success. Thank you for your help in advance. The pain clinic keeps telling me that sacralization of L5 is not an abnormal finding and it does not cause pain.

Jamie

Donald Corenman, MD, DC
Moderator

February 27, 2012 at 8:43 am

Post count: 8660

#5672

The origin of SI pain is very rarely the SI joint. If you have had SI blocks without 2-3 hours or temporary relief immediately after the injection, the SI joint is not the cause of your pain. Typically, SI joint pain originates from the disc or nerve root at L4-5 or L5-S1. I have however seen three cases of pain originating from the transverse-alar articulation at L5-S1.

This articulation is also known as sacralization of the L5-S1 level. What this structure really is turns out to be an enlarged transverse process of L5 that creates a new joint with the ala of the sacrum on that side (hence: tranverse-alar articulation).

To discover the source of your pain, you need diagnostic blocks of all of the potential pain provoking structures. You need to keep a pain diary (see section on pain diary on the website). Once the suspect structure is anesthetized and is the obvious source of pain, then if needed, a surgical plan can be established.

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.

jamiemlake
Member

February 27, 2012 at 11:47 am

Post count: 2

#5673

Ok thank you so much for your time and help! I can’t get my doctors to even listen to me. You have been a great help and now I know where to go from here. I certainly didn’t want a major surgery that I don’t need. Thank you again!

Jamie Lake

Cindy Sue
Member

October 9, 2012 at 10:44 am

Post count: 2

#7138

I too have sacralazation/lumbarization. I began to have chronic pain in my pelvis and supra pubic region 16 months ago. It is still undiagnosed but after months of PT on my pelvis and hips, my sacrum is now inflamed. I have had injections in L5 S1 which helped the sacral pain and a transverse alar injection. Neither changed the pelvic pain.

It’s been 4 months since the L5 S1. And my sacrum keeps me from leaning back in a chair or car seat. Should I have a series of injections. Have been trying yoga to open the area, but not much relief.

The real question is. Can the impingement in my back cause the pelvic and groin pain?

Thank you so much

Donald Corenman, MD, DC
Moderator

October 9, 2012 at 4:49 pm

Post count: 8660

#7142

Even though I have seen three case of painful transverse-alar articulation pain, the vast majority of these articulations are not painful. Suprapubic pain generally is not related to the spine. Some individuals can have hip impingement syndromes which can induce these type of symptoms. A visit to a hip specialist and MRI and an intraarticular injection that yields temporary relief can diagnose this disorder.

L5-S1 injections that help the sacral pain could indicate radiculopathy, degenerative disc disease or even facet syndrome. The injections have to be specifically placed to diagnose which disorder is causing the sacral pain.

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.

Cindy Sue
Member

October 10, 2012 at 9:31 am

Post count: 2

#7148

Thank you for your reply.. I also have degeneration of L3 & 4. Speculation is that the connection to the psoas may be shortened thereby causing the torque on my right hip

Any activity – standing, walking, swimming increases my pain. Sitting is impossible. I cannot exercise at this time nor even take a short stroll.

I am truly desperate for a diagnosis and proposal for solution.
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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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