Recent Diagnosed Bilateral Pars Fracture with Pain

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SpinelessWench
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September 13, 2012 at 5:35 am

Post count: 38

#6939

LuckyStar68,

My apologies for posting a reply within your conversation with Dr. Corenman. Yet, having had a Workmen’s Compensation case related to a back injury some years ago, I just wanted to briefly post a comment as a prior (and current) patient just like you.

If your back injury is related to an incident while working, and you continue to experience pain and symptoms from that injury, please think twice before closing your current WC claim. No matter how low or high your pain levels are, you’re still enduring physical discomfort from that incident involving the adjustment of your patient. From your posts, I’m gathering that there’s still some discrepancy between doctors as to the nature of your injury, and as to what tests and treatments you may require.

If this injury is still not completely resolved, and if you’re still seeking treatments or appointments with specialists, keep your claim “open”, and do not allow the employer’s insurance company to pressure you into returning to work until you’re absolutely sure this issue has been addressed to its fullest. The WC insurance company, in order to avoid having to pay for further visits and treatments, will offer patient-employees a settlement to close their cases. This settlement might sound tempting, because it sounds like a decent amount of money at the time. But, if you close your case and accept the money, you are prohibited from ever having that same injury paid for again. In other words, when they tell you, “…until you’re injured again”, they’ll make absolutely sure your current injury isn’t re-claimed as something new.

I accepted a $12,000 settlement to close a back injury case years ago, which negated my ever being able to claim further medical intervention on that specific injury. Eight major spine surgeries later, and medical bills approaching $500,000, I wish I’d never done it. Every surgery I’ve had since I closed my case and settled has been directly related to the first injury. In retrospect, WC would’ve been required to pay for everything up to this very day.

Just look out for your best interest, and don’t close your case too soon until all treatments and diagnoses and potential surgeries have been 100% completed.

Take care, and I’m sorry for the interruption.

S.W., NC

Donald Corenman, MD, DC
Moderator

September 17, 2012 at 1:04 am

Post count: 8660

#6962

I appreciate the comments. I agree in general with the comments.

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

October 30, 2012 at 10:06 am

Post count: 32

#7300

Hello Doc, it has been quit a while since my last posts. Since my last post I have gone thru a nerve ablation from l2 to s1 bilaterally. That was on August 17th of this year. I did get very little relief from that proceddure but nothing significant. Since that proceedure I got a 2nd opinion from a Dr. at a differnt spine center because I have been leaning towards fusion for my defect. Per our last conversations I did request a discogram and I was told by the Pain clinic not to do it as the benefit will not outway the pain and that is strictly presurgury. So this New Orth Surgeon had me do another Pars Diognostic Injection wth Cortizone and Lidocaine from a radiologist instead of the pain clinic. Well it worked!!! He used a ton of lidocaine and My pain went from a 4 to a 1. I still had some leg pain and foot discomfort but all together my back pain has still been at a lower lever since the injection last friday. My origianl injury was over a year ago and I have had a total of 6 transforaminal and 2 rounds of facets with no releif. I quess you were right about a lot of false negatives with the pars injection. My question is , now what do I do. Since te cortizone is working and the panus has settled down is it likely I will have a full recovery or it it more likely I will reinjure the Panus (since I am a firefighter and extension will be inevitable? ) Or does this relief mean that Im now a candidate for the fusion. I have been denied fusin by 3 different surgens. and also the city IME stated Im not a candidate for surgury and he suggests that the city retire me from full duty? Or do I go thru life with pain of 1 or 2 and live with what I have (non active life) please advise on your opinion on what you think is my next steps?

Donald Corenman, MD, DC
Moderator

October 31, 2012 at 7:25 pm

Post count: 8660

#7306

The pars blocks do indicate that the pars fractures are your pain generators with a caveat. If the injectionist used large volumes of lidocaine, there is the possibility that some of this volume “leaked down” to another level and the test is a false positive (pain relief of the pars when really the pain relief is of another structure at a different level).

It is possible but less likely that this injection will yield a “cure”. Loading the pannus again in the normal course of your duties as a firefighter will probably aggravate the pain nerves. Nonetheless, if you really want to return to firefighting, you should consider starting to load your spine in the controlled environment of physical therapy. An aggravation again will indicate you should either consider surgery if you and your surgeon are convinced that the pars fractures are truly your pain generators or find another line of work that is less taxing to your spine.

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.

texasspondy
Member

October 31, 2012 at 7:39 pm

Post count: 25

#7307

“I have been denied fusin by 3 different surgens. and also the city IME stated Im not a candidate for surgury and he suggests that the city retire me from full duty?”

This part just makes me scratch my head in disbelief. As I recall salve97, you are on a workman’s comp case. It’s contradictory, kind of like “There’s nothing wrong with your car (black smoke pouring out the back), but I would suggest you start taking the bus….

I have a co worker, I just spoke with yesterday, has l4/l5 herniation problems and he’s on workman’s comp. To make a long story short, things are moving at a snails pace and he’s got one surgeon to choose from, that’s it, take it or leave it. When it comes to the spine, I want the best of the best working with me, not restrictions/limitations on what care I can get.

Anyway, following the thread, and wish you much success salve97 with your treatment plan….

Donald Corenman, MD, DC
Moderator

November 1, 2012 at 5:18 am

Post count: 8660

#7309

Different states have different regulations. Unfortunately, with workman’s compensation cases, there are a very few patients who try to “game” the system and this is why the rules are so arbitrary. The system also varies state by state. Colorado is actually reasonable for work comp treatment. I know California has some crazy rules. I do not know how New York rules work.

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.
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Donald Corenman, MD, DC

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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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