Pars defect after L4-L5 laminectomy, discectomy

Tagged: Pars defect post surgery and psuedoarthrosis; necessary revision of fusion L4-5; Saw my doc today; any danger in not doing anything

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Lollipop
Participant

June 8, 2015 at 9:10 am

Post count: 31

#19934

Posterior TLIF not at CCF, by orthopedic surgeon. Thanks!

Lollipop
Participant

October 30, 2015 at 4:02 pm

Post count: 31

#20618

Hi Dr. Corenman!
I had my L4/5 fusion on September 21 and am doing FANTASTIC! Surgeon did not do TLIF at L5/S1 because my body is already working on fusing it naturally. All prior symptoms are resolved. Looking forward to getting back to full activity. See him again in 6 weeks for another x-ray. He says bone formation is going well. I have worked hard at walking and making the best recovery…walked 102 miles since surgery. :)
I ran my most recent DEXA scan results by him, as my femoral neck score concerns me. He wants me to see an Endocrinologist for further evaluation. I received Reclast in 2013 and 2014. ( PMH gastric ulcers) My PCP did not see a need to do it this year. My lumbar spine is great with T score 0.1, left hip is ok with T of -1.4 but per the report, “there is focal significant osteoporosis of the femoral neck region with a T score of -2.5.” The overall density measurements increased by 8% compared to my prior study in 2013. My mom’s femoral neck fractured at 83 years of age and I have already had a pars fracture. I’m 57, post menopausal for 7 years, 5’2″, 137 pounds and of European decent and don’t smoke.I usually get 10,000 steps or more in a day and weight trained prior to surgery… I will get back to that.
Just curious if you have any thoughts about my risk of femoral head fracture… Thank you, as always.

Donald Corenman, MD, DC
Moderator

November 1, 2015 at 11:34 am

Post count: 8660

#20622

I am happy to hear that your recovery is going well. This is generally to be expected with the right patient and the right surgery.

Your DEXA scan is worrisome. Do not rely on your spine density numbers to be accurate as degenerative changes can increase density artificially (a false negative). Unfortunately, genetics is the most important factor in your osteoporosis. I think you still need treatment to prevent future fractures.

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.

Lollipop
Participant

November 1, 2015 at 3:29 pm

Post count: 31

#20623

Thanks so much Dr. Corenman! You are a blessing to many!

Lollipop
Participant

March 29, 2016 at 10:09 am

Post count: 31

#21778

Hi Dr. Corenman,
I have an update regarding my TLIF of L4-L5 done this past September. I saw my surgeon for my six month follow up. I am doing well but I did mention that I have an intermittent “stinging” sensation at my left low lumbar area now. It is a strong “sting” when it happens. I sometimes get random burning/aching down my posterior left thigh and into my lateral left calf when sitting or laying down. It is different than the radiculopathy prior to my fusion. The low grade general ache/pain in my lower lumbar region is starting to return.
My surgeon did tell me that he sees some lucency around a pedicle screw and if it bothers me, he can take it out. My fusion is solid and he has released me at this point. I didn’t think to ask what removing the hardware entails and the recovery process. I can not find anything online. Can you please explain what it involves? At this point I am going to hang in there and see if it gets worse. It’s aggravating but not limiting. Thank you so much…AGAIN! :)

Donald Corenman, MD, DC
Moderator

March 29, 2016 at 8:39 pm

Post count: 8660

#21782

I am concerned that you have a halo around a screw. This generally means motion so I would be concerned that the fusion is not solid at this point. There is an outside chance that the fusion could be solid but you them must explain why there is loosening of a screw. Did you get either x-rays with flexion and extension views or a CT scan? These can be the only way to determine if a fusion is solid with the CT scan as the gold standard.

Removal of hardware is common in about 3% of post-fusion surgeries but I would not recommend removal if there is a question about fusion status.

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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