Recent Diagnosed Bilateral Pars Fracture with Pain

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luckystar68
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December 13, 2012 at 7:16 am

Post count: 4

#7592

Thanks! for checking “back” with me. No pun intended:)

My pain levels are manageable as long as I don’t over-do it. I’ve noticed that if I over-do it, (typically I’m a work-a-holic and very active), my back will have sharp continuous spasms. Since a couple weeks ago my doc has put me on slelaxin 500mg prn and that has been helping.
After I go to work doing my usual workload(which is turning and positioning my pt every 2-3 hrs for 13 hrs)2X week, I do still have some pinching and constant aching with some inflammation at the lower back. I usually take the skelaxin + Ultram 50mg prn when my levels are very high(pain level at 8 after work for 1-2 days).
I was taking Mobic for the past 6 months but stopped per doc order because I started having chest pain, SOB and jaw pain(last week). Also a new dx of high blood pressure was made (last week) and I am now taking a B/P pill too.
Any way, now that I have stopped taking the Mobic I have definitely noticed an increase in my pain levels,stiffness,and swelling but nothing untolerable.
I am definitely staying positive about this whole issue, and practicing some of the core exercises they taught me in therapy.
I am working 2 days a week primarily due to the back pain and exhaustion from it, until I can ascertain if my back is getting better or not.
I have just a couple of symptoms that I am concerned about that I will bring up next week at my doc appt.: I have severe foot cramps in both feet usually after walking for 30-45 min or so(shopping) and it usually happens when I sit down to drive my car. I extend my foot to the gas or brake pedal and then ouch! a very painful cramp occurs usually in the right foot but it has happened in both feet on occasion. I have to stop the car and wait for the cramps to pass and then continue.I also have sharp lower back pain on one side at times when walking from the parking lot into the store(short distance) that comes and goes. I also have a cramplike pain that starts at the ball of my foot and feels like it radiates to the outer edge of the foot and toward the heel.
Is this part of the herniated disc intenuating the thecal sac and bothering nerves there that is creating all this foot pain? Or maybe it’s potassium depletion since I just started taking Benicar/HTZ 20/12.5mg every day.
In any case I feel I am not having any severe symptoms,as long as I don’t over do it(overdoing it is like the occasion I babysat my grandson all day picking him up holding him on my hip , stooping to change him ect.for 10 hrs-he is 2yrs old and weighs only 25lbs.)This made my back have unconrollable intermittant sharp knife like spasms in my lower back. Makes it hard to function when the spasms like this are ongoing! the spasms kept up for hours, and the Mobic, and skelaxin didn’t work for this! I had to take those + Ultarm and Zanafex before I finally had some relief!
It’s when I work that my back hurts the most and my meds are doing a pretty good job of taking care of the pain so far.
I hopefully wont need a surgery, but I realize that I may have to have one eventually especially if my back pain worsens.
The insurance company is continuing to pay for my doctors visits and meds, but they have denied the epidural injection my doc ordered.
I have decided to seek legal counsel to help me through this, because they do owe me a payment and denied the epidural (of which me and my doc think is necessary-spasms!)
Anyway I’m trying to get back to my routine, not sure how this is all going to turn out yet though. The doc’s office said he will be wanting to put me on something else for the pain since I had some reactions to the Mobic 15mg.
Is there any possibility I have spinal stenosis secondary to the herniated discs, could this be causing the spasms and cramps?
Thanks for your time:) Merry Christmas to you!

Donald Corenman, MD, DC
Moderator

December 14, 2012 at 7:49 pm

Post count: 8660

#7600

Cramping of the bilateral feet is more likely to be the result of an electrolyte deficiency (you mentioned potassium depletion) than a disc hernation. Compression of a nerve root can occasionally cause cramping but almost never bilaterally.

Back pain can be caused by many structures in the lumbar spine. Look over the section on degenerative disc disease and degenerative facet disease to gain some understanding of the pain causing structures.

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

February 6, 2013 at 9:10 pm

Post count: 32

#7930

Hello Doc, here is the status of my condition now. I’m still in relatively alot of pain. The pain is worse when I over do it or try to be “normal again” if you put my pain levels in numbers my back is now a 1 on the good days and sceaming 6 on the bad days. I can say I can alomost live with it but My legs have become increasing painfull Burning, especialy my calfs , more my left than right and my feet have a burning sensation. Work Comp was approved my last MRI that showed nothing new but DDD and a Pars defect with a 1mm spondy. I’m still in no condition to return to the Fire Dept. I have 3 opinions now, 2 say that im not a candidate for fusion and 1 says yes. Well I was setting up the surgurry and I decided to get the 3rd. He is very reluctant to fuse me and scared the livig daylights out of me with the parcible complications. He said less than 50%. He said he will entertain the fusion after I get a DiscoGram (youve told me to get this a number of timess) Not one of my surgeons suggested this except the new one. Please answer me this. What is the Discogram going to tell. I know it will show the bad discs leaking but what does it show for the Pars defect?? Will it show if the discs are the pain generators and not the pars. I’m leaning away from the pars now because of my increasing calf symtems. And also now im getting pain in my buttocks/hamstrings area. I know its been over a year and im extremly deconditiond but its a pain that has some burning in it. Doesnt effect my just every once in a while I feel the hamstinngs now. Also Ive tried Yoga and my back felt ssomewhat comportable , my calfs were the real pain. Thank you for your time. What should I look for in the discogram also?

salve97
Member

February 21, 2013 at 5:29 am

Post count: 32

#8047

Hello Dr. Corenman, well after numberous post and you telling me to get a discogram I finally got one today. I had to beg my Dr.to order it but it was done. I don’t know what to make of it. I felt absolutely no pain at all during the procedure. Well not more than my ususal pain. My pain right now is thru the roof but I assume that is because of the multiple levels they injectected. The Dr. who did the injection said I do have degerative discs, but they are not the pain generators. He did 3-4 , 4-5 and 5-s1. I know all posts are being redundent, but I need to be absolutely sure that fusion is the answer. In your words what did that discogram say? And also for My Pars Defect what is the correct surgical route. Evasive (Traditional open) or Non evasive?? And also one of the surgeons stated I will need a lamanectomy also? please advise?

Donald Corenman, MD, DC
Moderator

February 21, 2013 at 12:41 pm

Post count: 8660

#8049

With no disc causing pain, this most likely means that your pars fractures are the pain generators. A fusion is the typical answer. The misnomer “invasive vs. non-invasive” is surgical marketing as both surgeries are invasive and the “minimally invasive” procedure is not what it describes.

There is a “gill procedure” where the back of the lamina is removed. I guess this could be called a laminectomy. This segment is fractured off of the top part of the vertebra (through the pars fractures) and is useless to you (except for use as bone graft which is very useful).

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

February 28, 2013 at 2:06 am

Post count: 32

#8098

Hello Dr. Corenman, I just came back with the follow up from the surgeon who ordered the discogram . He stated that the discogram ruled out surgery for my condition. He stated that with a l3 pars defect and a EMG showing l5 nerve pinch with a negative response to the discogram there are to many variables to make fuse the pars. That contradicts my opinion of the discogram. Since its not the discs , then more proof it is the pars! correct?
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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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