Bilateral pars defect with strange noise

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erikb
Member

March 29, 2013 at 8:21 am

Post count: 2

#8295

Hi Dr. Corenmen,

I am writing you because I have had some strange happenings.

HX: 160lb, 34 male. No prevoius spinal trauma.
I had injured myself at work pushing a 150lb cart. I always turn left into a room and leave a room turning left with this cart. I noticed there was something wrong (12-19-13). Much like the rest of us I disregarded the pain and went on. By mid feb (2-13-13) I decided to see our hospital’s employee ARNP. She has referred me a D.C. The DC asked to get x rays (ap & lateral) the reading came back with bilateral pars defect with 7-8mm of anteriorlethesis. From here I was referred to ortho/spine. The ortho sent me to PT and stated for no lumbo sacral manipulation by chiro (3-14-13). Chiro continued to adjust. I feel worse after adjustments. My body is saying no.

Rad impressions:
3-6-13
Bilateral pars defect are seen at L5, there is about 7-8mm of anterolisthesis of L5 on S1. Other wise remainder of the examination is unremarkable.

3-13-13
8mm of anteriolisthesis or L5 on S1. Bilateral pars defects. Mild narrowing L5-s1 disc and posterior aspect of L4-5 discs. No other fx, malalignment or focal bone lesion. Normal bondy texture. With flexion and extension, there is no significant change in the relative postion of the vertebral bodies.

(Strange the diff between radiologists impressions?)

signs/symptoms:
L4 spinous process is depressed visually on inspection.
Numbness/tingling down lateral left leg to pedis. This was present for 1 day only (3-11-13). Not painful or loss of function.
Mid-line pain over L4 is now chronic @5-7 no referral to other areas
flexeril (10mg) will not alleviate pain but does aid in lost sleep
Had 2 good days since initial injury 3-22 and 3-23 (actually wanted to do some normal activities)

Had 2nd check/reeval today 3-28, still constant pain over spinous process no change until arrival at home. I parked the car turned left to exit, legs first followed by upper torso my L4-5 region clicked. Pain in minimal now? Felt like bone on bone click.

When I was first dx I was interested in getting the pars repaired, my ortho Dr is not familiar with direct pars repair. I know you need more info to do an eval…I’m wondering if I would be a candidate with anteriolisthesis? I don’t know who to talk to anymore. I feel like I’m in the acute phase here and not on the mend to recovery. I did mention a pars block…? She seemed hesitant and wanted to wait 2 more weeks.It has been over 3 months in total. Any help would be appreciated!

BTW I do not have an MRI yet???

Sincerely,
Erik

Donald Corenman, MD, DC
Moderator

March 29, 2013 at 6:01 pm

Post count: 8660

#8298

You are not a candidate for a pars repair with that slip associated with the spondylolisthesis (see website under pars repairs). You have had this isthmic spondylolisthesis for years and it has only now become symptomatic. This is the most common presentation of this disorder. The scar tissue (or pannus) that holds the two pars fracture ends together has held for so many years and a small torsional activity caused the pannus tear and subsequent onset of pain.

Chiropractic care is contraindicated for this disorder as manipulation can prevent the potential “healing” of the tear in the pannus.

I have found in some patients that “pars blocks” or injection of steroid around the pannus can yield relief in some patients. Therapy consists of what is called a “neutral spine program” to allow reduction of stress on the tear and possible healing. If nothing is effective in reducing pain after some further time passes and the pain prevents you from most normal activities, you could be a candidate for a fusion.

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.

erikb
Member

April 2, 2013 at 12:31 am

Post count: 2

#8322

Thank you for the help/info. I really appreciate it. Kind of unfortunate that this wasn’t caught sooner, maybe the outcome would be different.

I’m not sure about fusion? I haven’t heard negative things about long term outcomes. Then again you only usually hear negatives never positives. I would really hate to loose mobility or any more cushion than I have already. I’d hate to have that done then find out it did not relieve the pain or caused a new pain.

Thank you again.

Erik
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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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