Recent Diagnosed Bilateral Pars Fracture with Pain

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salve97
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March 26, 2012 at 7:03 am

Post count: 32

#5857

Sorry if this is redundent!! I’m not sure my last post actually posted or went thru. It’s been 3 weeks since my new theorpy started and I’m seeing a little releave from pain (very little , day to day) I have my next appointment with the Nearosurgon in 6 weeks. If there is not a considerable amount of improvement do you think it is time to start talkiing surgury (fusion). I really want to put this to bed and get on with my life. according to your site 6 months is the recoop time. Does that mean that I can run into burning buildings at six months or just be comfortable living again ???? I’m in constant pain 24/7 and I think the pain clinic only injected facets and epidural and I think only at L5. would it be wise to get a bilateral injection at the pars at l3 considering that is where the break is. But I have calf pain also that is unbearable and the pain guy says the injection should be lower??? I wish I could go to your clinic to talk to you face to face. The infoo in the last 2 days is clearing up soo much about this condition.!!!

Donald Corenman, MD, DC
Moderator

March 27, 2012 at 12:46 am

Post count: 8660

#5859

An L3 pars fracture will affect the L3 nerve root and occasionally the L4 root. Calf pain can be explained by this if the pain is increased with standing and walking and relieved by bending forward (foraminal stenosis- see website).

Patients with pain for six months that prevents work and reduces activities of daily living should consider surgery. If the surgery is performed correctly and you heal well, six to eight months would be the time to return to full duties. This is predicated on the L3 pars fractures causing all your pain and I cannot fully comment as I have not seen you as a patient.

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.

Donald Corenman, MD, DC
Moderator

March 27, 2012 at 12:56 am

Post count: 8660

#5861

Please see my last post.

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 27, 2012 at 3:05 am

Post count: 32

#5862

Thank you very much for all the info as I am much more educated with this Issue regarding the Pars Defect. Now I know what to do and what road I will need to go on if this does not get any better withing the next month or 2 with the conservative methods. I have a few more questions now. Is there a test to even find out if my pain is coming from the pars to show that they are symtommatic or active? As I might have mentioned I’m going april 4th for an injection at the L3 level with just Local Numbing Lidocaine i think. So if this makes my pain go away then we might have found the answer. But I don’t see how this will make my calf pain go away. What other tests will they do before we decide on surgury? Also I have a strong Local Union as my time out of work can go up to 18 months. Ive used up 4 for “conservative” methods so I will probably have to make a decision within the next few months. I’ve heard of a discogram for testing to see if it is disc?? Will theyy try that on me. I just don’t want to Piss off Workmans Comp as they have been quite silent with me up to this point? I’m also thinking of taking a trip to Colorodo soon for a 2nd opionion if I don’t get answers soon from the docs out here.

Donald Corenman, MD, DC
Moderator

March 27, 2012 at 11:51 am

Post count: 8660

#5863

To determine if the L3 level with the pars fractures is causing most of your pain, there are three potential tests that can be useful. One is a pars block. This is an infiltration of a numbing agent (similar to Novocain) into and around the fractured pars. This test is not as accurate as some others as the pannus may have imbedded painful nerve endings that cannot be reached by the numbing agent. A test which does not relieve pain in a case where the injected area is really causing the pain is called a “false negative”. None the less, many times this injection will relieve the back pain.

The second test is called a selective nerve root block (SNRB- see website). This will temporarily numb the nerve roots in the foramen and lateral recess (again- see website). This should relieve your calf pain if these nerves are really causing this pain.

The last test is called a discogram (again- website). This is a provocative test. It is designed to pressurize the disc and reproduce back pain if the pain originates from the disc. In a spondylolisthesis however, the back pain may originate from the broken pars and not the disc so the discogram may be considered a false negative (will not reproduce pain).

There are occasional times none of these tests would be required. For example, if your MRI is clean except for the pars defects at L3, a L3-4 degenerative disc exists and all your symptoms and physical examination findings reenforce the diagnosis of this disorder, an injection work-up may not be necessary.

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 27, 2012 at 11:00 pm

Post count: 32

#5864

I just called the pain clinic for my notes and from my last 2 injections. on 1/5/11 One was an epidural at the Left L5, which I did get some relief for about 4 hours until the Lidocaine wore off but got no other relef after from the cortizone. The Next was on 2/9/11 where he injected the right Facets L4 L5 and L5-SI. I really did get any from this maybe from the Local abit. Im pretty confused since all my pain is coming from the L3 (Pars Defect). Well maybe they were still thinking disc problems and not pars fracture. But all on the wrong levels?? Confusing. Now does this screw up my changes of getting more injections in future without waiting for months? I am going for as previously mentioned to boston for test injections of just Novacaine in the l3 levels. I wonder if they will through some cortizone in there now they know that the other levels got the drug and not the fracture levels?
thanks

Chris..
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Donald Corenman, MD, DC

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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.

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