ssiemonsmaParticipantJanuary 27, 2020 at 8:23 pmPost count: 4
Hello Dr. Corenman,
I really appreciate this forum that you have set up. It has been very informative, especially considering the dearth of information on direct pars repair surgeries (outside of scientific articles). I’ve known about these types of surgeries for many years, but I never had the agency to seek out someone that actually has experience with them. But I’m now already 29 years old, so I figure if I’m going to inquire, I should do it now.
I’ve had bilateral L5 spondylolysis since I was around 16 years old, but spondylolisthesis has not yet crept in to any noticeable degree (although all of my affected family members have eventually had spondylolisthesis progress and required fusions). I believe my disk is still healthy (please correct me if I’m wrong there) and it doesn’t look like there’s much of a gap/erosion at the fracture sites.
I would just like to know if it’s foolish for me to be wanting this type of surgery at my age. And if not, would I be someone that would stand a good chance of a successful procedure? Have you had other patients in my age range with good results? Or do you usually discourage them away from surgical intervention? I can live with the pain/discomfort, but if I have a chance of decades of a relatively symptom-free life, I’d like to explore it before it is off the table for good.
I recently had a set of X-rays done and have them available if you had time to peek at them. I’m in the middle of a flair up, but my doctor wasn’t too interested in my spondylolysis (he’d forgotten I even had it until I prodded him about how it looked on the X-rays).
I greatly appreciate you time. Thank you.Donald Corenman, MD, DCModeratorJanuary 29, 2020 at 7:53 amPost count: 8460
You have some extenuating circumstances for a pars repair. First is your age. Pars repairs heal better in an adolescent than a young adult. I have fixed “20 somethings” (and a rare 30 something) and the results are OK but generally not as good as younger individuals. I reviewed the X-rays you supplied and you don’t have much slip but any slip means the disc is at least ‘stretched” if not torn which can lead to problems down the road. You would need to have an MRI delineating an intact disc and a CT scan noting no pars atrophy or distraction (empty space between the pars fracture ends).
Dr. CorenmanssiemonsmaParticipantJanuary 29, 2020 at 11:06 amPost count: 4
Thanks for the reply! I don’t think anyone in this area does this type of surgery (at least non-pediatric surgeons). So what would be the best way to arrange the suggested imaging? Can I just request it through the orthopedic surgeon that I just saw, or would this be something that could be arranged through your office (hopefully at another center for the actual imaging though since it’s quite a long drive). Either way I’d be hoping to have it covered by insurance.Donald Corenman, MD, DCModeratorJanuary 29, 2020 at 3:25 pmPost count: 8460
I can suggest imaging but without a doctor/patient relationship which only occurs with a face-to-face meeting, I cannot order these tests. You can ask your family provider to order these imaging studies.
Dr. CorenmanssiemonsmaParticipantJanuary 29, 2020 at 4:29 pmPost count: 4
Ok, I’ll look into having the suggested imaging done with either the orthopedic clinic or my primary physician. Once I have those results, I’ll want to do a proper consultation with you. Do you think I would need a referral to get that covered by insurance?
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