Recent Diagnosed Bilateral Pars Fracture with Pain

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texasspondy
Member

April 1, 2012 at 9:03 am

Post count: 25

#5928

Hello, I have been following your thread since it shares similiar diagnosis as my circumstances, l5-s1 pars defect with left foraminal stenosis.
I have had two ESI to date and the PMS injected the first bilaterally at the pars and the into the canal from the left side, the the second, at the pars bilaterally and then centrally in the canal. Both gave me about a day of relief. Between the cost of each, the day off work, being real sore for a week from the injection, scheduling of injections, getting a ride to the injection, and the lack of results, I chose not to do a third injection.
As of now, they have me going in next monday for a bone scan, something to do with seeing if the pars area is laying down new or old bone/scar tissue, and then discussing RFA depending on the bone scan results.

I think I’ve just concluded that I have tried all conservative measures, including PT, diet, vitamins, injections, bracing, time off work, light duty, good posture, heat, cold, chiropractic, etc and the true fix would seem a TLIF at l5-s1.

You know, I feel that even though the pars wasn’t broke necessarily from work itself, that the repetive nature of my career being a mechanic has thrust it into a state of being retorn or more damaged than if I had a sedentary job. I did not go workmans comp on this because of the nightmares I have had on other injuries wc and though costing me more, I don’t want a panel of folks deciding what and how I might get treated for something as serious as my back.
Best of luck and success with your back.

salve97
Member

April 1, 2012 at 9:51 am

Post count: 32

#5929

good luck also!!! I got a good feeling I’m going to have tfe fusion too . But let’s look at the glass as being half full . My work doesn’t have light duty so I hope work comp will want to do every thing possible to get me back running into burning buildings!! I’m estimating it’s costing the city 5k a week between my pay and overtime! Let’s hope they stay on idle .

Donald Corenman, MD, DC
Moderator

April 1, 2012 at 11:58 am

Post count: 8660

#5932

Getting a bone scan in your situation is probably not a worthwhile test. The fracture could possibly be new if you had a significant injury such as a fall from a roof or an impact with a tree while skiing. However, in almost all individuals who have a diagnosed isthmic spondylolisthesis, the fractures had originally occurred between the ages of 8 and 15 and healed with a pannus (see website) that can be quite tough.

With heavy lifting or heavy torsional activities, the pannus can tear and cause symptoms. In my opinion, if the tear occurred at work, the tear is work related and any treatment including surgery should be part of the workman’s compensation company responsibility.

RFA (radio-frequency ablation) as i noted earlier is not indicated with an isthmic spondylolisthesis as the nerve endings in the pannus are inaccessible to the RF needle. In addition, the problem is not just the painful pannus but a global problem with the segment.

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

April 2, 2012 at 3:24 am

Post count: 32

#5938

As you can tell that I have a disease or a thing that makes me the best of what I do. I have OCD no diagnosed but that is the way I think or can’t stop thinking . We are going for a shot as discussed in we’d April 4th for the pars. But my leg pain is unbearable too . I’m wondering if my past alcohol abuse is contributing to my pain as alcohol neuropathy? I still drink alcohol but not to the extent of my early years . Or is this me over thinking because we all know both leg and back are on the same nerve paths? Just coincidental they are happening at same time. I really should get off the Internet !

Donald Corenman, MD, DC
Moderator

April 2, 2012 at 7:55 am

Post count: 8660

#5941

OCD is a good attribute on many occasions. Use it as a tool to improve yourself.

Alcohol abuse can cause peripheral neuropathy. If that is the case, an EMG test by a neurologist can help diagnose that. The pain of neuropathy tends to be of a “burning, gnawing” type and tends to be worse at night.

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

April 2, 2012 at 9:13 am

Post count: 32

#5943

You are right about the OCD because if I didn’t have it I’d still would be chasing a disc bulge instead of a pars defect . No pains at night any different than normal day to day calf pain. I’m just looking for other causes for this calf pain . I’m no drunk but I’m a typical guy who has a six pack watching football games etc. but early in life I would do a lot. Probably just my frustration and sort of depression because it’s been a long time since I’ve been pain free. My calf pain started in left calf on and off . Then the right started recently and now I’m getting the occasional throb in my left , hamstring. this I’m contributing to nerves and stress if this whole situation. But the leg pain is even worse than the back pain recently. Let’s keep our fingers crossed for the injection test Wednesday .
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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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