Recent Diagnosed Bilateral Pars Fracture with Pain

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salve97
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April 5, 2012 at 6:06 am

Post count: 32

#5958

Well I just received the diagnostic injection. At the l3 pars level I had no relief AT All!! It seems my pain is actually lower than the injection sites. I’m completely at a loss now. May e the pain is not from the para defect. And it’s from the DDD on the lower levels. Now what!

Donald Corenman, MD, DC
Moderator

April 5, 2012 at 12:47 pm

Post count: 8660

#5961

Don’t forget that pars blocks can be non-effective even if the pars is the pain generator (a false negative test). The next step could be discograms if your physician agrees.

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 5, 2012 at 1:38 pm

Post count: 32

#5963

Now that I know whT the l3 pain feels like , the pain seems Lower. When they injected it they used a dye and the pars was completely filled in from it? it fell right into the cracks??? Mean anything? As I suspected the left side was much more defined by the dye than the right. But as I said the pain seems now compared to l3 around Si or l5. Funny to is that yesterday my pain was the lowest in months I’d say just below a one. But I did still had some calf pain to be noted. Maybe some nerve damage from different injury or circumstance. Neuropathy. So i did allot of yard work to bring on the pain so i could feel if shot worked. Maybe im just sore from latic acid. But as you mentioned the emg just show a little pinch bilaterally. I sent all docs and test to you already.

Donald Corenman, MD, DC
Moderator

April 5, 2012 at 8:22 pm

Post count: 8660

#5964

You would not expect the dye to “fill in the cracks” if the pannus was intact. If the dye fully surrounded the pannus and you had no diagnostic relief, this may not be the pain generator. You may need a discogram from a meticulous and experienced injectionist.

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 7, 2012 at 10:06 am

Post count: 32

#5973

Hello Dr. Corenman, Thank you for your time today. Giving all the info and the conversation we had to recoop my protocol should be as follows:

Continue conservative treatment (PT and Maybe another injections)
When I feel that I’m go to go back to work have my PT person put a heavy load in my session to see if I can take it. If so then just take it day by day until I have another episode and then:
Go get a Discogram:
Then send it to you …. for review?

You said you think that the L5 looks fine? Its just the L3 /L4 disc?? Should my next injection be in that area?

As for my Calfs and feet having the pins and needles what do you think can be causing that and could that just be aa temporary thing. I thought about the alchohal neorpathy but my liver functions are fine and I just got my yearly physical and did some blood test and those were fine. I’m a social drinker but drank alot in my past so Im stumped with that. This has to be related or just a big coincidence they are seperate. Per our conversation what are your thoughts?

Donald Corenman, MD, DC
Moderator

April 7, 2012 at 9:44 pm

Post count: 8660

#5976

You have to remember that these are just suggestions and that you have to gain the support of your treating physician to carry these suggestions through. I have never examined you so there are no specific recommendations that I can make.

You have indicated that your symptoms have improved in the last couple of weeks and that your benefits will run out soon. You are thinking of returning to your occupation. The question then is- can you go back to being a firefighter with the all of the required lifting and spinal loading? The only way to test the possibility of return is to recreate the typical loads on the spine that will be seen as a firefighter. This can be accomplished by a good therapist simulating the expected load on the spine in a controlled environment.

This testing can however cause a substantial flair-up so you have to be prepared for an exacerbation of your back pain and again, this has to be ordered by your physician. I am only giving you suggestions.

If you cannot load your spine without pain, you have a choice. You can live with the restrictions and get a sedentary job. You have seen that with restrictions, the spine pain becomes manageable. You may not be able to participate in the sports you want to but you may be able to avoid surgery.

If you want to see if surgery can reduce your spinal instability, you would need to undergo a work-up to determine the pain generator. You have already had numerous injections which were non-diagnostic. The next test could be a discogram. You have a relatively normal looking L5-S1 disc. The L3-4 disc is degenerative with the pars fractures and the L4-5 disc is mildly degenerative.

The discogram may indicate that you are a surgical candidate but you have to be prepared to also be ruled out for surgery too.

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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