[shannanpc]

#12232

Dear Dr Corenman
My Low back pain started 3 years ago and slowly got worse over the coming months. Finally went to an Orthopedic Surgeon, my first Exrays showed i was diagnosed with BI LATER PARS FRACTURE on L5/L4. Latest MRI Radiology report didn’t mention the pars fracture not sure why maybe they missed it (see below).
Injections, acupuncture, physically therapy, massage therapy, chiropractic care, nothing worked to fix the pain, i take tramadal and morphine daily just to try to function.

The two Orthopedic Surgeons suggested fusion on my pars fracture, fuse s1/l5 and L4 or install artificial disc in L4.

Recently decided to get a 3rd opinion from a Neuro surgeon, he suggested only fusing the pars fracture and fusing s1/L5, which is not as extreme as the previous surgeons.

MY QUESTION: Is it possible to repair only the broken bi lateral pars fracture WITHOUT fusing the upper and lower bones on the pars? AND not fusing S1/L5 ?

Every Doctor i spoke with says you cannot simply repair the pars fracture without doing real fusion of the pars bones and fusing my s1/l5.

Here is my latest MRI

MALE
39 YEARS OLD
MRI LUMBAR SPINE WITHOUT CONTRAST

General
The lumbar vertebral bodies show normal height without compression deformity. Normal alignment of the lumbar spine is seen. the conus medullaris is not well visualized but terminates at the T12-L1 Level and is unremarkable.
The viualized intr abdominal and retroperitoneal structures are unremarkable. Urinary bladder appears moderalty distended and visualized on sagittal and axial images.
L1-2 No significant findings.
L2-3 No significant findings.
L3-4 No Significant findings.
L4-5 There is desiccation of the disc space with mild diffuse disc space narrowing. Focal linear increased T2 signal in the posterior annulus at the 6 o clock position measure 8 mm transverse. Minimal broad-based disc bulge flattens anterior aspect of the thecal sac without significant central canal stenosis or foraminal encroachment.
L5-S1
Desiccation of the disc space with mild posterior disc space narrowing is seen. There is a 2 mm broad based disc bulge asymmetric towards the left with a linear annular tear on the left at the 5 o clock position. No central spinal canal stenosis is seen. There is mild to moderate bilateral foraminal encroachment more prominent on the left.
Impression:
1. Mild disc disease at L4-5 and L 5-s1
2. Central annular tear with minimal disc bulging at L-4-5 is seen.
3. Mild disc bulging asymmetric towards the left posterior left annular tear L5-s1 results in mild to moderate left and mild right foraminal encroachment.

Thanks Dr
[email protected]
214 868 9491

[Donald Corenman, MD, DC]

#12233

Pars repairs only work well if the disc at the fracture level is intact. According to your MRI report, your L4-5 disc is degenerative (“here is desiccation of the disc space with mild diffuse disc space narrowing. Focal linear increased T2 signal in the posterior annulus at the 6 o clock position measure 8 mm transverse. Minimal broad-based disc bulge”).

You cannot put an artificial disc in a level with a pars fracture so that surgical plan should be discarded.

The plan should be at least fusion of the L4-5 level where you have the isthmic spondylolisthesis. The question should be asked if the L5-S1 level needs to be included in that fusion. It seems that all surgeons you consulted want to fuse L5-S1. I assume that this level (L5-S1) looks bad enough that no one wants to leave it alone.

You could undergo a discogram (see website) to understand if L5-S1 is a pain generator but if this level looks very degenerative, it may not be wise to leave it alone.

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.

[Author]

Posts