Pars Injections

Tagged: pars fractures

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Donald Corenman, MD, DC
Moderator

May 4, 2016 at 8:03 am

Post count: 8660

#22105

Prolotherapy is the injection of a damaging substance into ligaments or tendons to create injury. The injury heals with scar tissue, which is non-distendable. Scar contracts, which stiffens the structures injured. I do not like prolotherapy as the injection is placed blindly and can damage unintended structures (nerve or blood vessels).

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

May 4, 2016 at 9:54 pm

Post count: 130

#22113

Understood! Thank you again.
Can you please respond to the below ? Thank you so very much !

Kind of interesting how many surgeons, (especially the younger surgeons) will tell you that there are no bone spurs 99% of the time and the pars fracture doesn’t need to come out vs. more experienced surgeons such as yourself that say there are always bones spurs that need to be removed.

1.) What are your thoughts on this discrepancy ?

2.) If I’m not having leg pain, is it safe to say that I have no bone spurs ?

3.) I thought I read that 75%-80% of the your weight is carried in the disc space and the rest is posterolaterally. Is this accurate ?

Thank you !

Donald Corenman, MD, DC
Moderator

May 5, 2016 at 11:02 am

Post count: 8660

#22114

The surgeons who don’t notice bone spurs off the pedicles must be exclusively performing anterior surgery (ALIF) as there are almost always bone spurs projecting off the inferior pedicles. Generally, neurosurgeons use the anterior approach and spine surgeons use the posterior approach but this can vary.

No leg pain does not mean no bone spurs. The spur could come off at such an angle that it does not compress the root, the size of the spur could be small or there might not be a spur. The sagittal T1 or T2 image at the foramen would help to define the foraminal narrowing.

You are correct in that generally, 2/3 weight is carried in the disc and 1/3 in the facet. This rule is eliminated with an isthmic spondylolisthesis where the facets are “disconnected” from the main body. With the L5-S1 level sitting at about a 40 degree angle facing downhill, the loss of facet support starts to destroy the disc. The disc cannot resist this downhill slide (shear force) and this is why the vertebra starts to slip forward.

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

May 6, 2016 at 11:38 pm

Post count: 130

#22130

Sorry but what do you mean by sagittal T1 or T2 image?

If facets are not connected then wouldn’t I need posterolatersl fusion to carry the other 20% of my Weight ?

This seems pretty straightforward. I don’t see how surgeons could differ in opinion on this.

Donald Corenman, MD, DC
Moderator

May 7, 2016 at 8:17 am

Post count: 8660

#22137

The sagittal images are “side view” images of the spine. There are generally only two views taken of the spine; top-down (really bottom-up, the axial images) and side view (the sagittal images). Rarely, there are front to back images (called coronal images) taken.

Once you have a solid fusion from the front or from the back, you don’t necessarily need the other side fused. I know it seems weird that you could have only a posterior fusion (the facets and transverse processes only) but this fusion carries enough forces through it that it unloads the disc in front in many people. A solid anterior fusion generally carries enough forces to unload the posterior facets (or pars fractures).

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

May 28, 2016 at 11:23 am

Post count: 130

#22266

I had diagnostic pars injections yesterday. I wanted to be sure of the pain generator before surgery as I also have a herniated disc with annular tear that is degenerated.

Surprisingly, the injections worked quite well for 8 or so hours! It was the first time in a long time, I could walk normally without pain. It did not hurt to stand either. I usually do not have any leg pain, but I do get some numbness down my right leg to my foot, no pain however.

However, I could see that my core and paraspinal muscles will need lot of work to get back to where I once was.

The intervetionalist did not want to put steroids in to the injections because he wanted to be sure of the diagnosis with just marcaine and also didn’t think steroids would help the fracture at this point. Although the nurse originally had me scheduled to receive 80 mgs of steriod on both sides !

1.) I felt so good after the marcaine that I am now curious if the steriod would have given me longer term pain relief so I could work my way out of this? Thoughts ?

2.) It would appear that the relief I have from the injections would give me a good result after TLIf? Thoughts ?

Hope you are well !
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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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