Recent Diagnosed Bilateral Pars Fracture with Pain

Viewing 6 posts - 1 through 6 (of 67 total)

1 2 3 … 10 11 12 Next

Author

Posts
salve97
Member

March 25, 2012 at 12:02 am

Post count: 32

#5839

Hello, I’m a fireman who was had and injury on the job and was diagnosed with a bilateral pars fracture 10/15/11. Since then I have been thru 2 rounds of shots, epidural and facit joint injections. I saw a nearuosurgon who found the fracture and a otho surgon who both said they do not want to do surgury because I have a very athletic build and I’m young. The mri showed 2 degen discs with minor bulges with no impingment. but L3 bilateral pars defect. Im in PT now with some pain improvement but Im in pain most of the time and now its in both calves. I really want to go back to being a firemen but with this heal on its own. or will it only fuse back with surgury. I’m very confused and woulld love some input. I can be reached at 774xoxoxox.

Donald Corenman, MD, DC
Moderator

March 25, 2012 at 12:57 am

Post count: 8660

#5841

Most likely, you have had this isthmic spondylolisthesis of L3 for some years and the injury aggravated this condition. That is unless you took a significant fall or had a severe impact in which case these fractures could be new (traumatic spondylolisthesis).

You have had 6 months of treatment including, I presume, physical therapy as well as the noted epidurals and facet injections and have failed treatment. After 6 months of failed conservative care, further therapy is much less likely to bring you back to full duties.

The chance of these fractures healing on their own is highly unlikely. More likely is that the fractures have been present since the age of 12.

I will assume that there is a degenerative disc at L3-4 and a small slip noted on the standing flexion/ extension X-ray films. If that is accurate, you are most likely a candidate for a fusion of this level. If the disc is normal at this level without a slip, the pars fractures can be repaired but that scenario is unlikely.

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.

salve97
Member

March 25, 2012 at 3:22 am

Post count: 32

#5844

The xrays show that there is no slippage with extention/flexation. I MRI said I had a very very spondelethesis slip almost not enough to be noted. The CT scan said there was NO Spondolesethes and the 2nd MRI said the same NO spondy. Yes L3-4 has the degenerative and the small buldge. Im confused on what you stated “If the disc is normal at this level without a slip, the pars fractures can be repaired but that scenario is unlikely.”
Do you mean they can be repaired on its own or with surgical intervention. I know this is just a forum. And who would do the surgury the Neoro or the Ortho ? What is strange also is that the Ortho ordered a Bone Desity Scan and that came back with no fractures??? The CT Scan clearly shows a sharp fracture. Should I have had a Bone Scan instead. What questions should I be asking the Ortho on my next visit in april??? Is there a way to find out if they are old or new fractures or is that of no use anyway. And Finally as an unbiased opion do you think I will ever go back full duty with or without surgury? Sorry for so many questions.

Donald Corenman, MD, DC
Moderator

March 25, 2012 at 4:36 am

Post count: 8660

#5845

You would not be a candidate for a direct repair of the pars fractures as the disc at L3-4 is degenerative and this would preclude a direct repair of the fractures.

You could have surgery from either a spine surgeon (orthopedist with a fellowship in spine surgery) or a neurosurgeon. The speciality does not matter as much as the experience and technical ability of the surgeon you choose.

You most likely did not have a bone density scan (used to determine osteoporosis and normally used for older individuals) but had a bone scan. A bone scan uses an injection of Technetium 99 which concentrates in areas of high bone turn-over. This test is useful for adolescents to determine if a recently found fracture will heal in a brace. I find it to be less useful in an older population as the fractures don’t heal.

A one level fusion most likely will allow you to return to work with no restrictions. Most of my firefighter and law enforcement patients return to full time work after six months.

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.

salve97
Member

March 25, 2012 at 6:31 am

Post count: 32

#5846

is there an email address that I send you a quick pick of my CT scan ? and yes I did get a bone desity scan and it said no fracture. Not a bone scan. Why he had me do that I don’t know. I’m seeing a doc in the Mass General Spine Clinic and a Neauro In Providence RI. Initially they thought it was a disc bulge causing pain until we got the ct scan and that showed the pars fracture. So The PT and Injections were focased on that diagnosis. My Pt had me doing alot of extention excersises which brought on the leg pain so I stopped that treatment. . I just started (3 weeks now) a new pt person and we are doing alot of core excersises the pain is now not as bad and actually getting better.. Do you think that this might help or is it too late because the injuy occured 10/18?

Donald Corenman, MD, DC
Moderator

March 25, 2012 at 5:49 pm

Post count: 8660

#5847

With a spondylolisthesis, it is never too late if there is no motor weakness. You do not burn any bridges with conservative care. Changing the therapy to avoid extension is the correct pathway and it is possible to rehab using core strengthening and extension avoidance to stabilize the spine. I have some concern that with your profession, when under a stressful situation, you may not be able to avoid extension and aggravate your back. Continue down this course and try to retrain your brain to avoid any backwards bending.

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.
Author

Posts

Viewing 6 posts - 1 through 6 (of 67 total)

1 2 3 … 10 11 12 Next

You must be logged in to reply to this topic.

Donald Corenman, MD, DC

Average rating:

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.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel