Pars Injections

Tagged: pars fractures

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Renee123
Participant

April 17, 2016 at 9:58 am

Post count: 130

#21988

Sorry for the back and forth.

when you say I “stretched” the fibrous union from working out before being rear ended, why would that cause pain ? where was the pain coming from exactly…are there nerves that run through the pars defect ?

Yes, you are correct, I don’t believe I had a disc tear before the accident but now I do, however I have no leg symptoms whatsoever. Thoughts ?

I believe my pain symptoms do not completely match up to a grade one spondy with disc collapse because the nerves are compressed and I don’t get leg pain or symptoms and the disc is not causing leg symptoms or sciatica but could be causing back pain !

I do however have instability and problems standing erect, which I assume would necessitate a fusion, however before I go through the surgery I want to be sure I am going to get pain relief, therefore, I am still trying to identify the pain generator, which sounds like it could be the pars defect.

Please let me know what your thoughts are on the above and if you think a pars injection might do anything for me. The slip has not progressed in years.

As always, thank you for being so gracious as to spend time speaking to me. The service you provide is invaluable and changes people lives !

Donald Corenman, MD, DC
Moderator

April 17, 2016 at 10:53 am

Post count: 8660

#21992

The pars fracture is not two bones with nothing in-between. The body tries to heal this fractures but is generally unsuccessful. Instead of bone uniting the two ends (as occurs with 98% of all the fractures in the body), fibrous tissue grows in-between the two ends. This tissue can be imbued with pain fibers.

Normally, for the first 10 or so years after the fracture occurs (which occurs between the ages of 8-15), the fibrous tissue between the pars (called the pannus) is strong enough to hold the ends snug. If an activity such as a fall, a lift or an accident occurs that creates just the right trauma, this pannus tears and the patient develops instability (sharp pain with certain bending or loading motions). Even if the pannus is intact, the disc can tear and create the same type of pain. All of these patients will have only back pain.

Eventually, in certain patients, the foramen narrows (as the disc degenerates or the spurs off the pedicle grow larger) and these patients will develop stenotic L5 leg pain. This is leg pain with standing and walking that starts in the buttocks and can radiate into the top of the foot in some patients.

Some patients present with lower back pain only and some present with only leg pain. Of course there are those who present with both.

If there is not clear evidence of pain generation (single level problem having history and symptoms consistent with isthmic spondylolisthesis), then a pain work-up is indicated. This might include pars blocks, selective nerve root blocks or even discograms.

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.

Renee123
Participant

April 17, 2016 at 1:11 pm

Post count: 130

#21997

I had a an epidural years ago. did nothing but create more pain. where else would you suggest injections as facets are not loaded ? all other levels are perfect.

Donald Corenman, MD, DC
Moderator

April 17, 2016 at 6:04 pm

Post count: 8660

#21998

You probably went to an injectionist that had less than great technique which is not uncommon. The injection has to be placed in the right spot and injected slowly. Find someone with good word of mouth and also has lots of experience. You could undergo both a pars block and small volume SNRB bilaterally. Read pain diary to understand how to aggravate the pain and keep track of pain levels after the injection (https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections/).

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.

Renee123
Participant

April 18, 2016 at 9:24 pm

Post count: 130

#22004

Where would the SNRB be ? At L5,S1 facets or foramen or right on the nerve root ?

It would appear that I have three potential sources of pain:

1.) Disc

2.) Facets

3.) Pars fracture

I had a pain management Dr. suggest facet injection because he thought the steroid would leak into the facets. Makes sense to you ?

If I found the pain generator, would I be able to stand erect? Seems like a pointless exercise with a spondylolisthesis. what is the real benefit of the pain diagnosis ?

Renee123
Participant

April 18, 2016 at 11:22 pm

Post count: 130

#22005

I meant to say the Dr. Recommended facet blocks with the hope that the steroid would leak into the pars fracture ??

Very frustrating because pain is well
Controlled as long as I’m not moving around too 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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