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  • salve97
    Member
    Post count: 32

    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
    Post count: 8460

    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

    salve97
    Member
    Post count: 32

    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
    Post count: 8460

    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

    salve97
    Member
    Post count: 32

    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
    Post count: 8460

    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

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