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  • erikb
    Member
    Post count: 2

    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
    Post count: 8460

    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

    erikb
    Member
    Post count: 2

    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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