[Donald Corenman, MD, DC]

#19463

I assume that you had an ALIF (anterior lumbar interbody fusion) at L5-S1 along with the L4-5 ADR. I will assume you had no posterior surgery (decompression or fusion or instrumentation) as there was no evidence on the CT scan.

You make two statements that make me nervous. “Doing more of anything makes it worse” and “Right after the surgery, i knew something was wrong. To the left of my lower back, My pain levels were extreme in that area. with terribly painful sciatica all the way done to my left foot”.

If you only had anterior surgery, the L5-S1 level becomes distracted by the ALIF procedure. If the root is caught by the distraction (by a pedicle spur which is somewhat common), the nerve root could have been stretched. If there is a lack of fusion, this can cause the pain. A re-fusion would be needed. If the root is still trapped (it could be by these pictures), then the solution is a simple decompression. If the root was inadvertently injured, then hopefully time will heal this root.

You do not need a pars repair in any case. The fusion should have taken care of this problem.

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.

[Donald Corenman, MD, DC]

#19464

You have a unilateral pars defect meaning the other side of the ring is intact. The cause of your pain is not from the fracture although the small spur that projects out of the fracture could cause lateral recess stenosis and pain. I would suspect a pseudoarthrosis, a lateral recess stenosis or possibly failure of the artificial disc/bone interface of the level above.

You can have selective blocks performed to try to get to the bottom of this along with a new CT scan.

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.

[Donald Corenman]

#19467

bwink23,

To protect your privacy, I removed your images since they had your name on them.

NeckandBack Admin

[bwink23]

#19469

Dr. Corenman,

Although you believe that a direct pars repair would be overkill, what happens to the forces that normally would be exerted on the pars interarticularis go to? It caused my problems to begin with. Doesn’t an anterior fusion just absorb that energy and send it to other structures, like the SI Joints? Wouldn’t a pars repair not only decompress that nerve root, but also add additional posterior support like it’s intended to, which you have mentioned is your preference to treat pars defects, and easing those energy tranfers to my SI joints? Could i have localized pain solely from the entrapped nerve? I would like to resume an active lifestyle again if at all possible. I appreciate your time talking to me.

I don’t think anything with the surgery has anything to do with what’s going on…i had these problems before surgery, and after. The surgery helped with some leg pain and disc pain.

[bwink23]

#19471

Also, could you please describe a little how a lateral recess decompression is performed? would bone need to be removed to achieve this? Can it be done minimally invasive without removing an entire bony structure?

[Donald Corenman, MD, DC]

#19481

If you have a solid anterior fusion, the force of weight bearing goes through the old (now fused) disc space and very little goes through the posterior elements (which includes the pars fracture). Repairing the pars fracture (especially a unilateral one) would be similar to using a q tip to clean your car after you go through a car wash. You can do it and you could find more dirt but the difference would be negligible.

What you need really boil down to is to find the current pain generator. The best bet is the nerve root as you had significant pain after your surgery in this leg. When the nerve becomes less irritable, it “centralizes” (the pain retreats to the SI and buttocks region only). Since you never had a posterior surgery, the nerve still could be compressed. In addition, as we discussed before, you could still have a non-union of the L5-S1 segment and you need a CT scan to determine this possibility.

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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