[sailorone]

#6386

The second surgery was done, not stabilize but complete a failed discectomy but as soon as the surgeon cut into the back he discovered the pars fracture, so the surgery took a different coarse. It was not until after the second surgery that they went back and looked at the x-rays and MRI’s and discovered the par fracture had existed after the first surgery.

The pars was not thinned or effected by any disease as stated in a deposition that the second surgeon gave. In that same deposition the second surgeon stated that the first surgeon was negligent in not recognizing the fracture and not repairing it, but was not negligent in causing the fracture because it was an inherent risk of the procedure.

So, the patient had no thinning of the pars and no disease of the pars, and the pars was diffidently fractured during the surgery. If it is within the acceptable risk of the procedure, what are odds?

There was no work up done after the pop. The patient now has no insurance and hasn’t worked in 3 years do to the injury and suffers severely. He sees a pain management doctor, but cannot afford anything other than pain meds (barely). They have suggested a nerve stimulator but he has no money and is reluctant to let anyone operate again. No one has determined the cause of the pain, although there had been a peer review done between the first and second surgery by order of workers compensation 2 .5 years ago and the 3rd party doctor had suggested that a second injury may be present lower in the sciatic region, but this has never been explored.

“We have some of the best spine surgeons in the world here in the USA”. Before the first surgery, the patient requested a minimally invasive laser surgery that his relatives and doctor friend had undergone for the same initial problem and they had reported great success, but the workers compensation insurance adjuster told him that it was unrecognized in the medical profession as a legitimize procedure and it was rejected. If there is good surgeons out there, he has not met them. You have already spent more time on this case than any of them.

My friend is fighting thoughts of giving up entirely as the pain and loss of his active life is wearing him down. He is angry, depressed and a shell of the man he once was. Who would have thought that such a common procedure could have such grave consequences.

[Donald Corenman, MD, DC]

#6389

A fractured pars that occurs during surgery without thinning of the pars for the surgical approach does not make sense. When I have to remove the pars to perform a TLIF (removal of the facet), it takes great force as this bone is thick and strong. Unless there was a preexisting fracture or the surgeon thinned down the pars substantially to perform the decompression, I cannot see a pars fracture occurring in those circumstance.

The comment to repair the pars also does not make sense. I repair pars fractures in children and adolescents commonly. The amount of work and preparation to repair this structure is significant and any surgeon that finds a pars fracture serendipitously while performing a decompression will not be prepared to fix that problem immediately.

The comment of “minimally invasive laser surgery” being a good choice is in my opinion, not a good choice. I just took care of a patient yesterday that had “minimally invasive surgery” with a resultant pars fracture from thinning down the pars during the original surgical approach. I have seen many patients who have not had good results.

If your friend could possibly be seen at a university spine clinic that might have reasonable indigent care, a new MRI might be revealing.

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.

[sailorone]

#6395

I must confess it is not a friend that is the patient it is me. The facts are that the surgeon had caused the pars fracture which went undiscovered for 6 months until the second surgery. I have no thinning of the pars or any disease that would be the cause. The second surgeon fused the disk and used rods and screws to stabilize. The second surgeon testified at a med mal deposition that the first surgeon was negligent in causing the pars fracture, and later changed his testimony stating that he was not negligent for causing it but was negligent in not recognizing and treating it. Although the difference to me is insignificant but legally it was very significant and ended the suit. Either way it does not change the fact that the pars was fractured during what should have been a relatively common procedure and I am now left with extreme pain, unable to perform the physical tasks that were the core of who I was and the things that I enjoyed doing.
The first surgeon had set up a production line of surgeries to maximize the profits and had allotted only a certain time slot for my procedure. This was why I did not see him in the hospital post-op and why he did not take the time to do it correctly or recognize and repair his mistake. Having me discharged 2 hours after the procedure was a setup to make it appear that all was well and that I could not wait to go and withholding pain meds also added to the illusion that I was fine after the procedure. It was a conscious decision on his part.
I know many people that have had great success with the same procedure, invasive and laser, but my experience was not the same.
I have pain that is far worse than the ruptured disk that started it all and wish that I had never allowed it to happen.
None of the surgeons that I have talked with have ever taken the time to have any discussions as you have in this blog and for that I thank you.
I can’t believe with all of the knowledge on this planet that no one can figure out why I am in pain and can fix it. I have been passed on through the system and with no insurance now and a pre-existing condition and no income for 3 years; I am left to suffer, because after all it is money that greases the wheel.
Thank you for the information.

[Donald Corenman, MD, DC]

#6396

I am sorry to hear that you are the actual patient. I cannot comment on the first surgeon. As I noted before, pars fractures are rare but can happen in even the best of hands (two of the iatrogenic pars fractures I had seen were from very good surgeons). There might be a higher incidence of these fractures with the “minimally invasive” approach as this is a sideways approach with more chance to thin the pars.

There must have been some injury to your back two months after your fusion surgery that caused significant increased pain. There are some areas of the country (mainly universities) that have resident education programs and accept patients without insurance. You need at least an MRI and X-rays of your lower back.

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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