Bone Stimulator Fracture

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cotymorris
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May 31, 2012 at 10:52 pm

Post count: 14

#6297

I play football, WR to be specific. I was running routes around Jan. 21st. went through the route tree once on each side fine. Came back later that day and did it again, but I felt a shape pain in my low back on the left side. Went a week without doing anything. On the 28th of Jan. I played in a flag game. The first bit I was fine, but later the pain became unbearable. It was clear that I did something serious. I rested it up for several weeks. I then felt somewhat good again, to where I could tolerate it. I got some training in and then it switched sides (from left to right) Again I rested. Then around 2+ months into this deal I go to the chiropractor. He said I have one leg slightly longer than the other and in a few adjustments I should be back to a active life. I thought to myself everyone has 2 different sized legs by some measurement. He did a “side poster hip/si adjustment” Later that day I notice a crazy amount of low back pain, my hamstring has been super tight. I have no medical insurance, but had a MRI, CT scan done. I have a left side 6mm and right side 2mm acute pars fracture with edema. I was wondering what I can expect and what I can do? Will this heal on its own? And will I be able to play sports again? Also could a bone stimulator heal this? Thanks

Donald Corenman, MD, DC
Moderator

June 1, 2012 at 1:01 pm

Post count: 8660

#6300

You need to state your age but I assume it is in the 18-26 range. These pars fractures have most likely been present for some time (normally occurring between 8 and 15 years of age) and your athletic endeavors have most likely caused a tear in the pannus (see website under isthmic spondylolisthesis).

Typically, these pars fractures will not heal on their own. There is an algorithm regarding treatment (see pars fractures on website). A bone stimulator will not heal the fractures.

There is a very small chance that these are new fractures and that a brace will heal them. How to interpret if these are new or not depends upon whether there is a slip present, the disc has tears or is degenerative, how big the gap between the fracture fragments is and what the fracture ends look like on CT scan.

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.

cotymorris
Member

June 2, 2012 at 10:40 pm

Post count: 14

#6303

Yes I’m 20. They said no slip. No soft tissue damage was noted.
Can I send you a copy of my scans? What about playing football in the future?

Thanks

Donald Corenman, MD, DC
Moderator

June 3, 2012 at 1:53 am

Post count: 8660

#6304

When you say no soft tissue damage, does the disc on MRI look pristine? On a flexion X-ray of the lumbar spine, is there no slip at all on the film?

If the disc is perfect and there is no slip, you have some options. You can live with this and most likely have occasional exacerbations. More likely than not, the L5-S1 disc will eventually tear. This might set up lower back pain which is chronic but some patients will get disc tears without pain.

You can also have the pars fractures repaired if everything above is true. The long term outlook of this repair looks good but the longevity is still under investigation.

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.

cotymorris
Member

June 3, 2012 at 3:24 am

Post count: 14

#6305

I have no medical insurance. So I’m not sure its pristine. The radiologist said that it was just the fractures, but I would think they could have overlooked something… I just want to return to sports and working out. Do you think bracing would get me back?

Thanks so much.

Donald Corenman, MD, DC
Moderator

June 3, 2012 at 4:13 am

Post count: 8660

#6306

Bracing will allow the pannus to heal somewhat (see website under isthmic spondylolisthesis) but the brace is only as good as your reduction of certain activities. Extension (bending backwards) will cause the healing tissue to tear apart. The brace is designed to remind you not to bend backwards but it is not perfect. You can overcome the brace’s prevention ability if you do not pay attention.

Without insurance, I would assume the cost of surgical repair might be too expensive for you. There are many individuals with this disorder that function without too much pain. You just have to be careful. Football does require torsion, loading and extension (unfortunately just the maneuvers that can aggregate this condition). Playing that game will put you at more risk than if you can avoid it. Your decision is if playing football is worth the risk of aggregation of the disorder.

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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