Recent Diagnosed Bilateral Pars Fracture with Pain

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salve97
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April 11, 2012 at 5:07 am

Post count: 32

#5999

Dr. Corenman, I have another question. I know im not your patient and you can only give recomendations: I noticed on your resume you have done some work with work comp. what is your opion on what I should do. As I mentioned I have 18 months to heal before I have to retire, so i have plenty of time to have surgury and heal if needed. But i recieved a call from personell today stating that the city doc wants to see me. Being that I have yet to have and adedquate diagnosis of what my pain is being generated from Pars… Disc.. whatever. Can they force me to return to work even though im in extreme pain? As you say all my MRI’s show somewhat normal discs,etc… except for the Pars. But my pain is getting worse (numbness in weakness in calfs and now feet) Its only been 4 months since I last worked and I can’t believe they could force me to work in the pain im in. Im just scared that the lack of a difinative diagnosses is really giong to hurt me. Any thoughts?

Donald Corenman, MD, DC
Moderator

April 11, 2012 at 11:47 am

Post count: 8660

#6001

I would assume the “City Doc” would have both your interest and the City’s at heart. If they sent you back to work as a firefighter and you developed severe incapacitating back spasms while trying to save someone’s life causing both you and the rescued individual to succumb, it might be at the very least embarrassing to the city.

You have not had enough testing to secure a diagnosis and I would hope the city could recognize this and remedy it.

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 21, 2012 at 2:17 am

Post count: 32

#6052

Dr. I managed to put off the city doc till mid May. My pain is about the same as it has been . I gave Had 2 days last week in which the pain was somewhat less than usual . But after a day of light yard work it came back . As noted earlier my pain is in the center and radiated to the hips. I think it is l5 area. The emg said l5 . My first epidural was l5 s1.facets 456, and shots to the l 3 pars. All did nothing exept the l5 S1 epidural. We never discussed the l5 l4 area with pain docs. Would it be wise to try shot in that area instead of going to discogram. A few weeks ago I sent my MRI to one of those laser spine clinics and they just called me. He said that my pain is from the central disc bulde and annualar tears at that l45 level and eventually will go to the l34. The way I’m getting the “electrical shocks in my spine when I lay on my back it defenitally feels like something is pressing on my cord. Maybe the pars is dormant and the discs are the real problem. What is the down side of those laser procedures? And how can an ortho doc remedy the disc problem?

Donald Corenman, MD, DC
Moderator

April 21, 2012 at 10:42 pm

Post count: 8660

#6058

Do not allow the diagnosis from one of the laser spine clinics influence you. They are simply reading the MRI and proposing what could be causing pain without a proper workup. The EMG in your case looks to be unhelpful as most of your pain is in the lower back and not the legs. EMGs are only helpful if there is motor weakness and that is easy to identify on a physical examination.

Nothing is pressing on your cord as the cord disappears below the L1 level. The “electrical shocks” more likely than not are from the discs or the facets.

A laser procedure is really just the cutting of some tissue using light to cook the tissue and in my opinion is a procedure that has little place in the spine.

Your problem is most likely pain originating from the discs. You can try to live with it or to find the source using discograms. The answer to that discover would most likely be a fusion.

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 22, 2012 at 4:37 am

Post count: 32

#6069

Yes I’m very sceptable about those laser centers. Thank you. Well I actually have some good news for a change. Today I was feeling really in the dumps so I decided to do something differnet for a change instead of the regular PT exercises. If I havent mentioned in one of my past posts im a very avid Road Cycleist. It was a prett nice day in the low 70’s so I decided just to go on the local bike path to get some excercise and get my muscles moving. Well this was the first time in almost 6 months I was almost completely pain free. “Almost” my calfs were really tight and hurt but that sort of went away after few miles. Well I managed to do 19 miles today and it felt great while riding. I ride with my saddle about 3 inces above my handle bars. I wonder it this sort of flexaation is allowing the discs to breathe and losed up the nerves? After the ride i got my pain back but at least I got some releif today. I just hope someone from workmans comp werent hiding in the trees taking pictures. (LOL). But in all seriousness I wonder if this will help with some sort of accurate diagnossis. On another note. As it was been six months and conservative treatment is fading. What is the protocol for visitiing your facility from across the country. If I go will there be a rapid serious of test so I can get an accurate diagnoss in one trip?? or will I have to make a serious of tripps or do some of the testings here? Please advise.

Donald Corenman, MD, DC
Moderator

April 22, 2012 at 4:56 am

Post count: 8660

#6071

Again, if you can function with minimal pain to your acceptance, you need not consider a surgical option. Road biking is normally one of the activities that can be performed with aggravated back pain although there are exceptions to this rule.

If you call the office and identify yourself as an out of town patient, my nurses do everything they can to get the entire diagnostic regime completed upon one visit to Vail. On occasion, this might take as much as 2-3 days. We have accommodations available close to the hospital and a company “Here To Help” if you need further assistance.

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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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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