bitmerkleMemberApril 25, 2013 at 1:05 amPost count: 4
I’m writing because I am completely frustrated and in need of some advice. I grew up playing soccer, running, triathlete,etc..I had a compression fracture when I was 14, and continued with my active lifestyle. I have always had lower back pain, but always “played” through the pain. Now, at 35, about 8 weeks ago, the pain got sooo bad that I was not sleeping, sciatica pain when I ran, stopped all exercising and can’t walk for more than 1/4 mile without excruciating lower back pain. I am in boulder and currently seeing a doctor who ordered xrays (nothing), MRI-showing the Pars Interacticulas fracture-L5. He then ordered a bone scan and all he told me was that it was an old fracture (cold). He then offered steroid shots into my back. This was two weeks ago(i believe on the sides in the narrowing) both sides. It did not help at all. During that procedure he noticed an extra vertebrae. He said there is nothing he can do for that…He has now ordered another injection today on L3, L4, L5 and S? , MBBS.(the RX reads like that.)
I have been in so much pain for almost two months now and I don’t think these injections will work either. I can’t do anything without pain. No normal activities let alone exercising. Is there something else that can be offered? What are your thoughts? I’m thinking of going to see a nuerosurgeon….in boulder? Is there a surgery option? I’m over this pain!!!!!!!!Donald Corenman, MD, DCModeratorApril 25, 2013 at 4:21 amPost count: 8465
A pars fracture of L5 occurs typically in about 5% of the population. See the section under isthmic spondylolisthesis under lumbar spine. Also typical is the ability to tolerate the back pain this fracture generates until one of two things happen. Either the disc at L5-S1 will disintegrate and the patient will develop significant lower back pain or the L5 vertebral body will collapse on the L5 nerve roots and leg pain will occur.
The injections you underwent were appropriate as some patients can improve from these. The MBBS was probably medial branch blocks, an injection used to see if you were a candidate for facet rhizotomies (see the section under facet injections). These are not typically very effective for this diagnosis.
Surgery is normally very successful for this disorder. See the section under TLIF to understand what surgeries can be used to alleviate the pain and stabilize this slip.
Dr. CorenmanbitmerkleMemberApril 25, 2013 at 10:41 pmPost count: 4
Thank you, Dr. Corenman for getting back to me so quickly.
I do have a question though. Are you saying that surgery would only be an option if I had some disc problem in my back and if the vertebral body collapses on the L5 nerve roots that is causing the pain? I had my shots yesterday as explained in my previous email yesterday. he told me the most important thing to note is the first 24 hours to see if any pain goes away 70-80% then he would do the facet rhizotomies..So far, nothing has improved?…
My question is why if I have an L5 fracture that is clearly NOT healing for over 20 years, can’t we fix it now? Something is causing this pain and I’m tired of the PT, the steriod shots, the brace, the not being able to do any day to day activities. How long should I wait to see if these shots I got yesterday should work before contacting a neuro?
How likely is surgery for me with just the info I gave you?
Thanks for you time.texasspondyMemberApril 27, 2013 at 5:01 amPost count: 25
Bitmerkle, have you read the literature on Dr. Corenman’s site, it’s very useful info on spondy.
I’m not answering for Dr. Corenman by any means, but I also have l5 pars fracture, bilateral. My fracture is also very old, since I’m 42 now and it probably happened around 15 years old I believe. The bottom line is, is somewhat healed itself over the years by scarring up. So you and I have pannus or scar/bony tissue that is holding that lower pars joint together.
You can get it fixed now, with surgery, more than likely a TLIF, fusion. That is my option too. My pain is from muscle fatigue, 24/7 the low back muscles spasm from trying to hold that joint together. I work out and try to keep the low back strong without overdoing it but, honestly anything much more than sedentiary lifestyle will overwork the low back. I’m trying to deal with it as long as I can before I give in to surgery, due to the task that surgery will impose on ones personal life, job, finances, etc.
I have changed my profession from a physically demanding mechanic job to an office job, as well as modifying my habits, like bending over, I bend down, etc.
I hope this helps some and you can get some relief. The shots, did nothing for me, corisone, epidurals, nothing. Trigger point injections helped calm the muscles down but that’s just a temporary bandaid, at least in my case.Donald Corenman, MD, DCModeratorApril 27, 2013 at 10:28 pmPost count: 8465
It is my opinion that the facet injections were not going to work in the first place. The painful disorder is not facet mediated. In fact, the L5-S1 facets are “disconnected” from loading in the first place. The original pars fractures have disconnected these facets. During surgery, when these disconnected facets are removed, they are normally pristine as these facets had not been loaded since the pars fracture.
The injection will declare itself successful in the first three hours only. This is the period of time that the anesthetic agent is active (similar to the length of time the jaw is numb from the dentist office after an injection). Waiting any further length of time for relief negates the diagnostic window (see pain diary).
Surgery at this point will not “repair” the pars fracture. This presence of this fracture produces other degenerative changes that are irreversible such as degeneration of the disc space and the slip of L5 on S1. Also, eventual L5 nerve compression occurs due to the collapse of this segment. All of these changes precludes direct repair of the pars fracture.
The solution of pain produced by this degenerative segment is a TLIF fusion (see website). Success rate for this procedure approaches 90%.bitmerkleMemberApril 29, 2013 at 2:05 amPost count: 4
Thank you again, for your reply.
I wanted to give you my “direct report” from the MRI to see with all my pain that I’m having, symptoms that I would be a candidate for some sort of surgery? (TLIF). My concern is that my spine doctor who has been doing all of my injections said that there would be no option of surgery?? I just don’t understand? I can’t live like this much longer.
Okay, so here is the report. Let me know what your professional opinion would be
￼Findings: The vertebral bodies maintain normal height and alignment. Small foci of bright T1 and T2 signal within the L2 and L3 vertebral bodies corresponding with hemangiomas or focal fat are noted. Bone marrow signal is otherwise w/in normal limits. The conus ends at L1. No evidence of of arachnoiditis. The paraspinal soft tissues are normal.
T11-L4 – No annular buldge, central canal narrowing, or neural foraminal narrowing
L4-L5 Mild annular bulge without central canal narrowing, minor bilateral neural foramina narrowing .
L5-S1- Mild annual bulge without central canal narrowing. Mild bilateral neural foraminal narrowing. A left L5 pars defect is noted on sagittal image 12 w/out marrow edema. The right L5 pars interatricularis is elongated although appears intact. Mild bilateral facet arthropathy.
Impression: 1. Left L5 pars defect w/out marrow edema. Elongation of the right L5 pars interarticularis is intact. mild bilateral facet arthropathy and neural foraminal narrowing at L5-S1. No significant spondylotisthesis or degenerative disc disease at L5-S1.
2. No Disc herniation or central canal narrowing throughout the lumbar spine.
I have been inactive for 9 weeks now, have had all but the ESI injections, a brace on and the spine doctor doesn’t know what to recommend now? With these findings, would TLIF truly be an option or am I stuck with this pain forever?
Thanks again! Sorry to keep bothering you with these questions.
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