Recent Diagnosed Bilateral Pars Fracture with Pain

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salve97
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May 22, 2012 at 1:31 pm

Post count: 32

#6238

Hello Dr. It’s been about one month since my last post. Since then I recieved another injection at the l4-l5 Transforaminal. I can say it has helped a little but nothing significant. I go back to the pain clinic on june 5. My pain is really tricky. When I recieved the injection into the Pars Defect I felt no relief at all but im getting some relief with the epidural. I know those shots produce a false Negative because of the nerve placement. But now since the last injection I can really feel the pain at the level of the Pars L3. I’m going to suggest another at the l3 l4 area next time. But I have a feeling it will produce little results also. I really want to exaust all options before surgury. I’m really nervous about the surgury becuase my pain keeps on moving to all diferent levels. Is this typical of the Pars Injury? The neorosurgon is now suggesting fusion since it has been over or around 6 months since my injury. Is there anything else we can explore (shaving the discs since they have tears and have a slight bulde. This seems a little less invasive than fusion to test. Is there an exploratory procedure to see if the pars has healed or healing. This is all starting to get real to me. I just don’t want to jump into fusion but the pain has been somewhat consitant for 6 monts now. I still havent went for the discogram because the Rehab doctor says that is still more of a surgical test to do and not a dignostic test?? My pain is so tricky AGAIN. Im at the pioint you physicaly can’t tell im in pain but im just below showing it. So no one can tell my level. Any suggestions other than your previous of discogram>

Donald Corenman, MD, DC
Moderator

May 22, 2012 at 9:12 pm

Post count: 8660

#6239

Typically, isthmic spondylolisthesis pain is not migratory pain. The pain develops from the pannus at the pars defect, the torn disc or the nerve (or all three). Why your pain migrates could be from any of the three at the time of activity being aggravated but you cannot hang your hat on that.

Discal pain causes central lower back pain. “Trimming” the disc will reduce any existing compression of the nerves but only infrequently reduces lower back pain itself.

If you are going to consider surgery, the next test that I would do would be a discogram. Understand that there is a 90% chance that this will reveal the pain generator but there is a 10% chance that it would rule you out for surgery.

I have a new section on the website under “Treatment”; “When to have lower back surgery”. Read that to see if you if in any of the categories.

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

May 23, 2012 at 7:31 am

Post count: 32

#6244

NOW WHAT!! The Neorosureon sent me to Neuroligist for an exam because of other symptoms (perifial neuropathy) but as I assumed he does not think it anything to do with Periferal Neoropathy since symptoms started right after my injury and all blood test came back EXECELENT!!. Ever since my injury I been seeing the same rehab Dr. who has done 3 emg’s on me. All came back with nothing significant. The MRI as you have seen really does not show anything either other than the PARS DEFECT. Well this DR. does his physical exam and looks at MRI report and says he does not see anything either that is out of ordinary until he does HIS emg. He says he sees a ton of issues from l4 up to L2 and signs of serious impingement. He said that all my test have been focasing on lower back not up in the area his test is showing (which is my gut feeling all along also. My first Shot was at L5-S1, 2nd was in the Pars Defect and Last one was on L4-L5. As I have mentioned before I’m getting real nervous about this surgury as I feel that it just doesnt feel right. Could I have been getting the wrong diagnosis from the Rehab Dr. all along and not focasing on the upper lumbar region. ??? The neorologist didn’t tell me what to do except talk to the neorosurgon who is refering me for his eval. This throws a wrench in the whole thing. I just don’t know what to do anymore?? Now Im thinking the fusion at the pars might not be what is causing my pain. As I stated the pain seems to be moving but now I have evidence there is something wrong other than what I feel. Sorry for the horrible grammer, as I just input this on my Iphone.

Donald Corenman, MD, DC
Moderator

May 24, 2012 at 8:09 am

Post count: 8660

#6250

It is difficult to understand that this new neurologist finds significant changes in L2-4 and none of the other neurologists found anything.

Surgery typically should not be contemplated unless a pain generator is found. Your tests have not yet found the pain source as per our conversations. I think that if you are contemplating surgery, a discogram would be the next test if you were in my office.

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

July 24, 2012 at 3:05 pm

Post count: 32

#6580

Hello Dr. Its been a while since my last posts and here is where im at now. i’m still in pain all the time but the pain has decreased alot. it is not going from a 2 to a 3 most of the time. I have discontinued pain meds and muscle relaxers as they were becomming a nusense for me. I’m still out of work (firefighter) and I’m getting real anxios about getting back. I feel some days I’m able to function at a reasonable pace but I feel that at any moment I will be were I was with a bad movement. As for treatments they gave me a l3-l4 transformaminal injection with little results and a week later did a diagnostic l2 tru l5 bilateral facet injection which did seem to give SOME relief an hour or so after the proceeure. Then after a week of soreness subsided my pain level seemed to decresses substantuately for about 2 weeks then brought me to where I am right now. Strange???? Was it the Epidural that took 3 weeks to kick in or the facet injections to break the pain cycle to bring me where I’m in now. Well we are talking about the nerve ablation now but i’m coming into some resistance with wormans comp with this procedure??? why i don’t know. At mass general the ortho spine doc ruled me out for surgury (not sure if that is a good thing or bad) and the nearosurgon in providence said that he wants to fuse the Pars (he is the guy in which im under care now and keeping me out of work) I’m going to fight to get the Nerve ablaition with work comp before any talks of surgury but 1 out of 2 surgeons saying to fuse me is not comforting. What are your thoughts? Im now 8 months out since my initial injury and seem to be healing naturally. Is it possible at this pioint to make a full recover without surgury. And no nobody will entertain the option of a discogram????

luckystar68
Member

September 12, 2012 at 12:05 pm

Post count: 4

#6935

Hi Dr. Corenman:)
Wow! you’ve done such a great job of answering all these questions,
you’ve inspired me to ask one about my own condition which is almost identical to the man’s above. I’m a nurse(LVN) of 14yrs.and on 6/21/12,when repositioning a pt upward,I was pulling the large pt(about 150-200#)upward in an electric bed on wheels.The pt was coughing/having trouble breathing and had slid downward towards the foot of the bed and i was pulling pt up to the top of bed so i could then elevate the HOB and help her breathe easier. I do repostion all my pts primarily on my own while families sleep during night hours, every 2-3hrs x 13hrs. This was 4am.
The bed rolled over the carpeted floor abruptly as I tugged my pt upward in bed(i am standing at the head of bed doing this) and the bed pinned me between it and the wall at the waist level. When I had pulled the pt up- the bed was unlocked so it rolled. Then my back started to pain, but not unbearably just pangs in my lower back. later that day after my “nap” at home,I could not get up out of bed because my back hurt in the worst way, my husband had to help me out of bed. I took tylenol and it helped with the pain but on my next night’s assignment i kept having nerve pain in both sides of my lower back that radiated down my legs that would come and go. I had dull achy nerve pain also seated in my car on the drive home and when I bent to pick up my son’s toothbrush at home, I had a shooting pain at the bottom of my back . I called company nurse and I’ve been on disabilty since then and have nerve pain every day.
The work comp Dr.labeled it a lumbar sprain.
I went to 3 weeks of therapy to strengthen my core, the pain worsened with a machine that would slide upward with your pushing against gravity with your legs and body weight.I hurt worse after each therapy. On my last week of therapy, 3rd week@ 3X a week I had the constant nerve pain at my back and after that the therapist tried to straighten and push on my scoliosis I had sharp knife like stabbing pain at the center of back after.Also, On the drive to therapy I started having leg pain in right leg from behind the knee to my great toe and across the top of my foot. I immediatly told the work comp Dr. of my s/s and he ordered an MRI(i was taken off the weight machine that day, but did core exercises).
Finally on 8/26/12 my MRI was done and showed the following:
(I bet you get these a lot):)
At least a left L5-S1 spondylolysis, possibly bilateral spondylolysis, with minimal spondylolisthesis. Broad based disc protrusion noted without attenuation of thecal sac or neural impingement.At T12-L1, a broad based right posterior central disc protrusion mildly attenuates the right half of the thecal sac. Upper sacrum in near horizontal plane and exaggerated lumbar lordosis contribute to unusal mechanical stresses and low back pain.I also have L3-4 bulging,L4-5 bulging and intraosseous hemangioma within T12 on the right.
I am currently having pain levels (while Typing) at level 5 on 1-10 scale.The pain has improved since the injury and comes and goes as I take mobic and flexeril prn. My Dr, ordered my return to work with no restrictions yesterday, but I am still getting frequent nerve and lower back pain.He also ordered a referral to see a specialist of my choice for continued back pain.I am brave and need to work. I have ordered a lumbar back support. should I go for it and get back to work using a brace, turning and lifting heavy patients for 13 hour shifts, or should I insist on seeing a specialist first( This is third specialist the 1st two didnt bother reading my MRI & didnt care how much pain I was in. Once I start working at my job they close my case until I am reinjured again. Thanks! for your time, Dr.Corenman.
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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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