Fibro Cartilage Mass in Pars Defect

///Fibro Cartilage Mass in Pars Defect
Fibro Cartilage Mass in Pars Defect
Viewing 6 posts - 1 through 6 (of 8 total)
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  • pashley
    Participant
    Post count: 4

    Dr. Corenman,

    My clinical history:
    When 14 years old sustained a L5 bilateral Pars Fracture. At age 35 underwent posterior fusion without instrumentation/decompression of S1-L5. Fusion did not take. At age 59 ALIF of S1-L5 without decompression because of anterior approach. ALIF surgery done 3/16/17. Goal of surgeries to allow me to be more active and allow me to play golf, tennis, etc. Immediately after ALIF surgery noticed lower back stiffness on right hand side. Pre surgical symptoms did not resolve. 9 months after surgery CT scan shows fusion occurred and all instruments in place. Pre-surgical symptoms still persist -back soreness, instablility (however never experienced radicular pain in my life). Two weeks ago had bilateral pars block injection with Marcaine and Kenalog. 60% immediate relief with level of relief still persisting.

    Question:
    Can Fibro Cartilage Mass in Pars Defects be a source of pain? Could my persistent pain be a result of either the Fibro Cartilage Mass physically pushing on nerve roots or even just a source of nerve fibers? Since ALIF was done anteriorly, would some type of decompression surgery done posteriorly make sense since Pars block injections seem to indicate pain is originating in the Pars Defect?

    Thank you for your consideration.

    Donald Corenman, MD, DC
    Moderator
    Post count: 6403

    If you now have a solid fusion of L5-S1 anteriorly, the pannus generally does not move and therefore does not create pain. However, the pannus commonly does compress the nerve roots and needs to be decompressed. Since you already have a fusion, a simple decompression would allow these roots to have the pressure removed. Remember that pars blocks also block the nerve roots. Compression of the roots can cause local pain that does not radiate into the thighs.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    pashley
    Participant
    Post count: 4

    Dr. Corenman,
    Thank you for your prompt and clear response. Could the decompression be done using minimally invasive techniques rather than an open incision?

    Besides removing the pannus, would the decompression also include removing any ragged edges of the Pars Fractures or any other procedures?

    Thank you.

    Donald Corenman, MD, DC
    Moderator
    Post count: 6403

    Minimal invasive techniques (MIS) would require a larger incision when added up than a small central micro incision so don’t get too fixated on MIS. I would say that you need to have the roots fully decompressed so a partial Gill procedure would be indicated. This removes the entire pars defect to then fully decompress the roots.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    pashley
    Participant
    Post count: 4

    Dr. Corenman,

    Again thank you for helping me understand my condition and options. Your assistance has been invaluable.

    One last question, would there be any need to also fuse my S1-L5 posteriorly as a result of the Gill procedure?

    My post-op 9 month CT scan shows the anterior fusion in place.

    Thank you.

    Donald Corenman, MD, DC
    Moderator
    Post count: 6403

    An anterior fusion is a solid fusion. There is no need for a posterior fusion when you have your decompression.

    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.
    If this forum has helped you, please let Dr. Corenman know!

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