Isthmic Spondilolysthesis and Repair of Pars

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nicodipietro
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October 18, 2013 at 9:47 am

Post count: 4

#9604

Dear Dr. Corenman,
I have no words to express the joy I felt when I read for the first time about this new kind of surgery!

I am 33 years old, male.
In 1999, I was doing body building. For several months I made deadlifts (I was lifting 70 Kg) with straight legs, with the barrel very distant from the legs and the back totally warped like an inverted “U”.
After some months I broke my pars at L5-S1: it was a very painful event! I couldn’t move for several days.

I always dreaded the classical surgery… it’s very invasive!
I always wondered if were possible just to repair the natural pars, without impairing the natural anatomy of the lower back.
It has been told to me that pars are very tiny bones, so it will not be a “strong” fix.
But I always thought:
“OK it’s not strong as the fusion is, but it’s anyway better than two broken pars!!!”.

Finally I read about your technique: it’s exactly what I was hoping for!
I know my lower back will worsen because of the broken pars… so I’d like to fix them without fusion, to avoid a further progression of the slippage.

I can’t live!
I can do nothing.
I can’t work (except for office/desk works): I can’t stand for long time, can’t drive or sit in a vehicle for long time. I can’t bring anything with me, a little backpack of 2-3 kg at the most.

Now I have a bilateral isthmic spondilolysthesis. The slippage is 14 mm.
Protrusion at L5-S1 and L4-L5.

Is it possible for me to get a surgical repair of the pars?

Thanks a lot.
Nicola.

Donald Corenman, MD, DC
Moderator

October 20, 2013 at 1:22 am

Post count: 8660

#9618

The pars repair has to be performed with an intact disc and no slippage. Once the disc is degenerative or the vertebra has slipped out of normal alignment, unfortunately the pars repair will not work.

Dead lifts and cleans are very tough on the lower back and are probably the single most injurious activity that one can do to the lower back.

Do not fret however as fusion in this case is generally highly effective. The recovery period is about the same and the results seem to be equivalent. I like to say that a one level fusion of L5-S1 is compatible with competitive athletic activity.

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.

nicodipietro
Member

October 20, 2013 at 1:33 am

Post count: 4

#9619

Thanks so much Dr. Corenman, for your kind reply and advices.
I believe the fusion is effective, much more because a so good doctor like you is telling me.
Reading that after the fusion even a competitive activity can be achieved makes me happy!

But I am not scared about the effectiveness of the fusion.
I am scared about possible unforeseen accidents… because it is a more invasive operation (I was anyway scared for the Pars repair, imagine for the fusion!).

Future is always uncertain… in case of any unforeseen problem for the surgery… in case my pains will increase or my problems will increase… I will really get desperate!
I am tired of my pains and limitations.
In case of an increase… I don’t want even to imagine…

I should claim and demand to a surgeon a 100% of probability that nothing will go wrong… but this is impossible!
So I prefer avoid it.

Thanks anyway…
I hope in future technology will be able to fix the pars fixing the discs too.

Donald Corenman, MD, DC
Moderator

October 20, 2013 at 4:26 am

Post count: 8660

#9630

All surgery is not 100% effective including pars repairs. In fact I think that fusion in an older individual (above 18 years of age) is a more predictable surgery than pars repair success.

Surgery is not indicated unless you cannot tolerate the symptoms, the slip is progressive or there is motor strength deficit. If you can live with the pain and the other two conditions are not present, then you don’t need surgery.

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.

nicodipietro
Member

October 20, 2013 at 4:33 am

Post count: 4

#9631

OK thanks again.
It’s more clear now.

Talking only about the pain, I can still live with them (except in few acute episodes).

But about motor strength deficit: I have a huge deficit. I can lift almost nothing! Or do long travels… or drive for several hours… or stand for more than 30 minutes without walking… and so on.

But I am too scared by the fusion. And even if I could get operated for pars repair, if it was less predictable than fusion, I were even more scared!

Thanks again.

Donald Corenman, MD, DC
Moderator

October 20, 2013 at 4:38 am

Post count: 8660

#9633

Based upon your restrictions, you are a candidate for surgery. I can understand your fears and there are some patients who would rather live with the pain and restrictions than undergo surgery due to this fear. I think that the more you research this topic and the worse your symptoms become, you will probably find yourself in someone’s office for a consultation eventually.

Most patients who display your type of fear in my office and have surgery many months (or years) down the road almost always state that they wish they had the surgery earlier.

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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