anterolisthesis/powerlifter/lifting career

Tagged: anterolisthesis powerlifter sporting career

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thib
Participant

January 23, 2016 at 1:46 pm

Post count: 4

#21183

Hello,

I’m a 20years old, french powerlifter.
I’m in incapacity to train since several monthes (despite of 6hours/day of rehab) due to a grade 2 anterolisthesis (L4 slips forward on L5 by unilateral isthmic lysis) and discs protrusion.
The pain is not a big deal in the daily life, but is in training (wich is my life)

I want to avoid surgery but what are my alternatives?
If I must have a lumbar fusion, will I be able to go back to powerlifting, in national team?

Thank you for reading my text
Sorry for my poor English

Yours faithfully,
Thib

Donald Corenman, MD, DC
Moderator

January 23, 2016 at 4:00 pm

Post count: 8660

#21186

Your English is better than mine!

A grade 2 anterolisthesis of L4-5 is an isthmic spondylolisthesis in your case. You have to have both pars fractured to get a slip (“unilateral isthmic lysis” will not slip). You don’t indicate what discs are protruding but I will assume that it is at the L4-5 level.

At the L5-S1 level is important to know the health of the disc and facets. If this level is not loaded due to a transitional vertebra syndrome which is common in your level of slip, there would be a big difference than if this level is healthy. If it is degenerative, then other circumstances come into play.

If you want to power lift professionally, you would probably have to get a fusion. This level at L4-5 with the pars fractures and slip from a degenerative disc will not support the amount of shear forces that you want to apply in power lifting. The question then comes down to the L5-S1 level.

If this L5-S1 level is normal, you should be able to participate in competition. If this level is transitional (does not move-Bertolotti’s syndrome), then you be loading only the L3-4 level and probably will wear this L3-4 level out eventually. If the L5-S1 disc is degenerative, this disc will eventually wear out and cut your career short but you could still compete.

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.

thib
Participant

January 24, 2016 at 4:57 am

Post count: 4

#21191

The MRI showed the discs at L3-4, L4-5, L5-S1 levels are protruding.
But at the last exam, only L4-5 level is protruding (is it possible I healed 2 discs protrusion in few weeks/monthes thanks to an intensive rehab?)

I have also a congenital block vertebra at L3-4 level.
I assume it’s an issue if I have to get a L4-5 fusion ? (If the fusion induced a big load in the L3-4 spinal level)

The L5-S1 level is normal, despite of the protrusion showed on the RMI.

How long do you think it can take to be back to powerlifting from a spinal lumbar fusion? (Without compromising long term healing)
Just to get an idea!

Thank you for your help,
It’s hard to make a decision when you haven’t great knowledge of the spine.

Thib

Donald Corenman, MD, DC
Moderator

January 24, 2016 at 10:31 am

Post count: 8660

#21192

There are a number of incongruities in your history. First-you have a block vertebra of L3-4 which is also called a congenital fusion of this level. The disc here should be absent if you have a block vertebra. If only the posterior elements are congenitally fused, this disc is non-functional and will not change (degenerate) over time.

If there was a protrusion of the L5-S1 disc, I am unclear how you report that this level is “normal”.

I am not sure that you can continue to power lift competitively if you have a block vertebra of L3-4. You will have a fusion of L4-5 and a degenerative disc at L5-S1. If the L5-S1 disc is really normal, it is a matter of time before it degenerates under the load you will apply. You might have success in your career for some time or you might blow the disc out in the first year.

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.

thib
Participant

January 24, 2016 at 11:16 am

Post count: 4

#21195

Indeed, the L3-4 disc is not absent. So I assume that only the posterior elements are congenitally fused?

Regarding the L5-S1 level, by «normal» I wanted to say that there was not
transitional vertebra syndrom mentioned at the RMI (sorry for the misunderstanding).
There was actually a protrusion at this spinal level, which disappears at the last exam.

And if I tried to come back without surgery, the L5-S1 disc will eventually wear out by the load apply at this level and the slip of L4 on L5 will keep going?

Thank you for your consideration,

Thib

Donald Corenman, MD, DC
Moderator

January 24, 2016 at 11:51 am

Post count: 8660

#21196

Make sure you are positive about your “block vertebra” as it is must more common to have a congenital anterior (vertebral body) fusion than a posterior fusion.

Protrusions don’t disappear generally. I would assume these two scans are by different MRI machines and different cuts (views).

L4-5 will probably not be able to tolerate the load of powerlifting but it possibly can. The only way to know is to put this level under load and see if you can tolerate the pain. There is a small chance of catastrophic failure but that would be a very small chance.

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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