pars defect - stress fractures

Tagged: pars fractures and isthmic spondylolisthesis

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laura
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April 23, 2013 at 9:03 pm

Post count: 3

#8492

Hi Dr. Corenman,

My 15 year old son began having lower back pain in July 2012 after playing baseball and football a lot in one week. He is also a wrestler. He has seen 2 orthopaedic doctors since then and has had several xrays, 3 MRIs, and one CT scan.

In September he saw an orthopaedic surgeon specializing in the spine and was treated for a stress reaction/fracture of the pars at L3 based on edema at the pedicles of L3. He had xrays and an MRI. He was shut down from football and all activities and placed in a brace for 6-8 weeks. Following that, he had PT/core strengthening for 6 weeks. His back pain was better and he was released to return to all sports without restrictions. He gradually reentered wrestling practice and did not actually compete until January. He wrestled without pain during December and half of January, when he began weightlifting class, added to wrestling. He began having pain again and after qualifying for State in wrestling, asked to be seen by the doctor again.

At that time we were reminded that he also has disc desiccation of L4-L5 and a presumed Schmorl’s node superior aspect of L5 with irregularity at the anterior aspect of the superior endplate of L5. The dr. wasn’t sure if the presumed pars fracture at L3 was causing the pain or the disc degeneration of L4-L5. He said we could either do an epidural injection both for treatment and possible diagnosis, but he didn’t recommend due to his growth plates still being open; or he could shut down again; or he could continue with baseball and just do activities that didn’t hurt.

We weren’t satisfied with this plan so we decided to visit a pediatric orthopaedic surgeon. He ordered a CT scan, which he felt revealed a bilateral pars fracture of L3, although the official report said no evidence of acute fracture or dislocation of the lumbar spine. He feels his pain is from the pars fracture, not the disc issues. He has prescribed rest for 2-3 months, followed by PT, stretching, core strengthening, and gradual reentry to sports, which by that time will be football again.

Our son is a very competitive athlete who is becoming somewhat depressed at his predicament. I’m just wondering if this is the course of treatment you would recommend or if there is something else we should be doing? Also, we live in Mid-Missouri. Is there someone who specializes in these issues that you would recommend? We have seen Dr. Craig Meyer and Dr. Daniel Hoernschemeyer in Columbia, MO thusfar. Do you think he will be able to return to sports, and if so, how long does it usually require rest?

Thank you for your time and opinion!

laura
Member

April 23, 2013 at 9:06 pm

Post count: 3

#8493

One more question…..do you think rest and conservative treatment is the way to continue to go, or when should we consider surgery to help either the pars fracture and/or the disc issues? We sure don’t want to have surgery, but we can’t IMAGINE him spending his high school career without sports! :(

Thanks!

Donald Corenman, MD, DC
Moderator

May 12, 2013 at 9:18 am

Post count: 8660

#8642

If your son has pars fractures at L3 and the MRI or bone scan does not indicate any attempt at healing, these fractures will have little chance of healing even with rest and bracing. If the L3-4 disc is still normal appearing on MRI and there is no slip on flexion/extension X-rays, you could consider pars repairs. If there is degenerative disc disease present at L3-4, there is a slip of L3 on L4 or the gap between fracture fragments is large (greater than 3mm), pars repair will not work and fusion will have to be considered.

If fusion is considered, a work-up may need to be undertaken to see if the L3-4 level is the only pain generation level due to the degenerative changes below this level.

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.

laura
Member

May 12, 2013 at 11:05 am

Post count: 3

#8645

I’m not sure if the CT and MRI indicate whether it is attempting to heal or not…..the pars defect is at L3 and the degenerative disc is between L4 and L5. There doesn’t seem to be any disc issues with L3-L4, just L4-L5. There is no slippage noted. He has had one session with a college athletic trainer with a light force laser treatment. Said we should have 3-4 treatments and it could help. Any experience or opinion on this?

Donald Corenman, MD, DC
Moderator

May 12, 2013 at 11:11 am

Post count: 8660

#8646

Superficial light laser is worthless for structural changes of the spine.

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.

sheryltc
Member

June 2, 2013 at 9:45 am

Post count: 6

#8771

Read our story at the beginning of this post. Since posting this, someone contacted me privately to tell me their story. His son had a similar incident to my son’s. He actually lives in our area and his son had surgery in October for the pars defect. We were able to get an appointment too!! This dr is a neurosurgeon at a spine center in Atlanta, GA. My son is actually scheduled for the repair this month. We are so thankful for this site and that someone reached out to us. After seeing a total of 8 doctors (chiropractors, pain management, orthopeadics) we have found a specialist that feels very confident that he can help my son through this surgery! Please let me know if you’d like more information – I cannot post details here – but I can contact you privately.
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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