Pars & Facet fractures

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Silverback
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December 21, 2012 at 6:49 am

Post count: 2

#7632

Hi, I’m 17, male 6’2 and 190lbs. I have been dealing with back pain since October 2010 (I suspect a possible herniated disk at that time which seems to now be gone, because the type of pain in comparison to now was of a different nature). However I’m pretty confident it wasn’t until mid 2011 I developed the fracture.

I had a “PET/CT NAF BONE” scan on 07 December 2011…

Technique: “Satisfactory images have been obtained 1 hour following intravenous injection of 240MBq of 18F-Sodium Flouride (18F-NaF) combined with a low dose high resolution bone windowed CT”

Findings:
“There are five lumber vertebra with a transitional segment at “S1”
There is a fracture of the pars of S1 on the right extending into the inferior margin of right L5/S1 facet.
There is less pronounced activity involving the pars of L5 on the left with a very subtle lucency evident on the high resolution CT in keeping with a fracture or incipient fracture.”

Conclusion: “Transitional vertebra at lumbosacral junction :-S1 if one assumes five lumber type vertebrae
Fracture of the right pars of S1 extending into the right L5/S1 facet.
Very subtle incomplete fracture, left L5 pars”

Between 07 december 2011 and approximately september 2012 I was receiving physio care to strengthen core muscles etc. Around that time of finishing physio I was able to lightly kick a bag, deadlift 260lb 95% pain free and go about daily life pain free. However my pain has returned.

Description of pain; I have been getting worse over the past 2 weeks
The right side of my lower back most of the time is bearable however still prevents me from weightlifting and kicking, the pain is dull and usually 90% recovers within 1-2 days of exercise.

The left side of my lower back however is extremely painful, I have not been able to exercise in the past 2 weeks due to it. Rolling around getting comfortable in bed is a mission, the type of pain it illicits is a power jolt which I can only describe as similar to a electric shock or stabbing sensation. Which immobilises me, last night I could barely walk from my room to my bathroom. I have had this pain in the past but it usually recovered within 2-3 days however this has now been going on for 2 weeks even though I have resting those entire 2 weeks.

So I have decided to take at-least 1 month off pretty much all physical activity, alcohol (not that I drink frequently) and caffeine and have also invested in calcium and osteoseal supplements. I should be getting another CT around February

My questions;
Is it wise of me to take 1 month off physical activity ?
What are the chances of my bones making a full natural recovery, given that they have been fractured for 1 year + ?
Have I already or what are the chances of developing spondylosis and/or spondylosisthesis?
What are my chances of returning to kick boxing and weightlifitng ?
What are my other options if I don’t make a full natural recovery?
Why has my left fracture spontaneously gotten painful over the past 2 weeks and doesn’t show any sign of healing?
Does the fact that I have an extra vertebrae effect any of this?

In advance;
If anyone managed to read this far and possibly answer my question I cannot express via the internet how grateful I am to receive some feedback, thank you very much!!!
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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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