L5 S1 pars defect

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Novak
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January 24, 2015 at 7:52 am

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#12050

My name is Christian, I am a division 1 softball pitcher and I have been having back pain since I was 16. The most recent episode of back pain came about around March/April of last year. My original diagnosis was in early 2012 where I was told I had a stress reaction somewhere in my back (I don’t remember this exactly, I was fairly young) and with rest it would heal and I could be back to normal activity and would likely face no back pain for the rest of my life. It went away after around 2 months and I was back to playing softball. I had a few other instances where I had pain but it always went away within a few months. I was told in April 2014 just from x-rays that nothing was seriously wrong and I would be fine with core strengthening and cardio work and that I could continue playing. After a couple of months of my pain only worsening, I went to the Laser Spine Institute in Oklahoma City to find that I had a series of issues with my back but none of them should be operated on until all measures were taken, I had still not been told of my pars defect. In September I was finally referred by our team doctor to a spinal specialist in the city I live in, who ordered a CT and bone scan, both showing a spondylolysis to the left side of my L5 S1 pars, and the bone scan showed another stress reaction to the same spot on the right side. I was prescribed an anti-inflammatory and given 6 weeks of rest. After the pain did not go away, I went back to the doctor and was given a very strong anti-inflammatory and told to wait another month. This did not work either, as I began to develop a stomach ulcer after two weeks of taking the medicaiton. I returned to the doctor in December and was given some kind of steroid shot (I believe they called it a flourine shot but I’m not completely sure) on both sides, since my pain comes from both sides of my back. The anesthetic worked for about 6 hours, giving me no pain, after that the shot never worked either. After 3 more weeks, I took matters into my own hands and saw a chiropracor who is supposedly a specialist on this type of injury and he did 10 sessions of therapy on my back within a weeks time, and I was still feeling no better, having pain at severe levels after nearly 4 months of doing nothing. I returned to my doctor and brought up the hook and screw surgery that I have heard has been successful if there is no other defect on the back, but after reviewing my MRI once again they spotted a spina bifida of the S1 vertebrae and I was told that that surgery would not be a success and if I went the surgical route that fusion of the pars would be basiclally my only option to live a somewhat normal life. I was also told that there was no slippage of the spondylolysis so that was a good sign, but those scans were taken 4 months ago so I’m not sure exactly how accurate they are. I am being given a bone stimulator in hopes that they can heal the right side of my pars to allow me to continue playing softball. I’m hopeful that this will work, but also I’m somewhat sick of sitting around and waiting for an answer. I’m only 20, so obviously surgical routes are not the easiest for anyone in this case, but I’m just looking for some answers. If you have anything different that you know of that can fix this problem, please let me know. I’m fairly desperate. As I want to continue playing softball, at this point I honestly just want to be able to get out of bed and walk to class with no pain, and to stand for more than 10 minutes without feeling like someone is stabbing me. I also know that it could be easier to fix and allow me to play if I wasn’t a pitcher, because of the amount of extension that happens with each pitch. Any advice or answers would be appreciated.

Donald Corenman, MD, DC
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January 24, 2015 at 11:32 pm

Post count: 8660

#12054

You have had a unilateral (one-sided) spondylolisthesis for years. I am unclear about the location of the spina bifida occulta (split in the back of the lamina) but this does not matter if it is in S1. The spit would have to be in the L5 lamina to make a difference in treatment.

If your disc is still intact and you have no slip, the pars can generally be repaired surgically. If you have any substantial slip or you have a degenerative disc at L5-S1, you would need a TLIF fusion. You could then reestablish yourself in sports after recovery from a successful 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.
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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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