pars defect - stress fractures

Tagged: pars fractures and isthmic spondylolisthesis

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texasspondy
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September 26, 2012 at 7:40 am

Post count: 25

#7018

My injury, I’m guessing happened about 25 years ago. I worked at a grocery store at the time, and was in the stock room getting a bail of bags (about 50 pounds of paper bags sandwhiched together). Lifting them up high from overhead and stepping backwards, when I lost my footing and starting falling backwards, hyperextending I think it’s called my back backwards. Went to doctor, they took an xray, and gave me some probably antiinflammatory and said I had no problem. I swear to this day, that’s when I fractured my L5 pars. But, I seemed to be fine after a couple weeks.

When I turned 30, my left leg was going numb, saw a chiropractor, and he did several adjustments, got the numbness out. I’ve spent the last 10 years since, just going to a chiro once in a while for maintenance. Last year, something happened. I think from what I’ve gathered, I tore the pannus (scar/bony) tissue from the fracture.

Since then, I have maintained a flat back approach to not retear/aggrivate that area, tried to avoid heavy, heavy lifting of objects, which is difficult since my job is physical. I stretch my hamstrings/front flexors daily, do some minor core work for low back and abs. I take a antiinflammatory daily, as well as a muscle relaxer at night a few times a week because the muscles get wadded up in knots from trying to hold the spine together.

I have developed a high tolerance for pain, so I guess 3-5 on my scale. That allows me to work, and pretty much get done what I need to, however my hobby’s, social life, quality of life, have just about all dwindled away, for fear of more pain, further degridation of the site. Not as young as your son but still pretty young at 41, and the only fix is a fusion for me. Thanks for asking and I don’t mean to deter from your thread here but you can take some of my post and maybe apply it to your sons situation. Honestly since last year, my led heating pad is about my best friend, it helps relax the muscles .

sheryltc
Member

September 26, 2012 at 9:08 am

Post count: 6

#7019

So you’ve dealt with the pain for over 25 years? Have you suffered from depression? So you’ve not had any surgeries? Will you? Have you gone to see Dr. Corenman on this sight?
As for the anti-inflammatory, have you had any problems with taking those daily?

texasspondy
Member

September 26, 2012 at 6:47 pm

Post count: 25

#7022

My pain for the last 24 years has been 0-3 on a scale. Very, very tolerable, and therefore had no impact on my activities or lifestyle. Tweleve months ago is when it went to about an 8, I could not sleep, get comfortable without pain. I’ve managed to get it back down to 2-5. If I do too much (Walking, lifting, work, living), it goes to a 5 for a week, then rest, muscle relaxers, heat, etc, bring it back down to a 2.

I’ve only taken AI for the last 12 months, and I hate taking anything other than vitamins. I get a full workup of bloodwork 2x yearly for health and also to check liver/kidney levels due to the AI. I’m dilagent about taking them with food, and lots of water. As of so far no issues or problems with bloodwork, however, I don’t believe it’s in my best interest to take them on a daily basis forever. Though I only take mobic 15mg, which to my understanding is not real potent. My job will not allow narcotics, and honestly I enjoy being in control of my mental thoughts so I’d rather not take themn to dull the pain anyway.

Depression, as I mentioned above I hate to take any pill that is not good or healthy for me. So I do take St. Johns Wart, which is suppose to help with depression. It’s a healthy approach to working with it. Honestly, I try to keep myself busy, I feel depression has it’s strongest impact when one is sedentary for too long. Believe me between a recent divorce, sale of the home I loved, downsizing to an apartment, I’ve had my work cut out for me, ha.

As to Dr. Corenman, I’ve seen one nuerosurgeon locally, and they say it’s very wise to get a second opinion. Dr. Corenman will be my second opinion, when I have the opportunity to consult with him. But out of respect for Dr. Corenman, if I have surgery under his care, I will one of the Testimonials on his site or Patient Stories, not on his forum, that would be a small price to pay for restoring my life, :)

I can understand your son’s feelings, especially at his age. I think a fusion is something that if you have compramised the disk, or the nerve, the question is easy to answer. But if you have not, and at your son’s age, probably hasn’t, it’s much more difficult to give the green light for a fusion, that is just my opinion of having this procedure done. Let’s face it, your son has 20 years of living to do catch up to me, and in those 20 years, I’ve jumped out of airplanes, water ski, snow ski, moved myself and others many times, and a host of other things. Now, half of those things, I wouldn’t do ever again, though another 15-20 years from now it would be an even easier question for me to answer.

Donald Corenman, MD, DC
Moderator

September 26, 2012 at 7:06 pm

Post count: 8660

#7024

Sorry for the delay responding. I am not sure how many surgeons use this new technique for repairing these pars defects. There are some who still use the older technique but the success rate is lower for that procedure. Possible you can call to some local surgeons offices to see if they repair pars defects and what techniques they use.

The hospital they work at has to have an O arm and Stealth in order to perform the repair as I describe it. That might help to differentiate who can do this.

Normally, certain spine surgeons would do this repair but I assume that possibly there is a neurosurgeon or two who can also perform this 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.

salve97
Member

March 29, 2013 at 10:23 am

Post count: 32

#8296

I am curious if any one of you had the surgery, and what was your outcome. As I have a pars defect also and gave been suffering for a while now and most likely will be turning towards fusion.

Donald Corenman, MD, DC
Moderator

March 29, 2013 at 5:50 pm

Post count: 8660

#8297

Fusion is a time tested surgery with generally good results for this disorder. Good luck.

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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pars defect – stress fractures