RECENT DIAGNOSIS OF SPONDYLOLYSIS AND MINIMAL SPONDYLOLISTHESIS

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luckystar68
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September 13, 2012 at 5:06 am

Post count: 4

#6938

Hi Dr. Corenman,
I am re-posting under a new category to make sure I’m seen.I originally posted behind someone with 9 pages!
Thank you for taking the time out of your busy day to help us poor souls with spinal issues.

Hi Dr. Corenman:)
I’m a nurse(LVN) of 14yrs.and on 6/21/12,when repositioning a hospice 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 the bed pinned me between it and the wall at the waist level. Apparently 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.diagnosed 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 but that is not every day some days i have nerve pain at a level 2-3 pain level,several times a day.The pain has improved since the injury and comes and goes. I take Mobic, flexeril, and tylenol prn. My Dr. ordered me to return to work with no restrictions yesterday with the 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 re-injured, or hurting badly again. Is it safe for me to go back to work lifting and repositioning my pts with this condition?
With Much respect,
-luckystar68

Donald Corenman, MD, DC
Moderator

September 17, 2012 at 1:34 am

Post count: 8660

#6965

You have a recently diagnosed L5 spondylolysis. Is there a slip of L5 on S1? This may not be identified on an MRI (you are lying down when the test is performed) but should be identified on standing X-rays, especially with flexion and extension views.

More likely than not, this spondylolysis was present for years before the aggravating work comp event and this lift of the patient was in just the right angle, force and direction to tear the pannus (see description of “spondylolisthesis” and “pars fractures” on the website for pannus description).

The treatment hope is that the tear of the pannus (the scar tissue that holds this fracture together) can re-heal and you can become pain free again. If the pannus tear is causing the pain, healing of this tear in my experience takes about 8 to 12 weeks.

A back brace is helpful but should only be used for lifting and heavy activities.

You do have degenerative tears of the discs at L3-4 and L4-5 and the significance of these is unknown.

In Colorado, going back to work full time does not mean the case is closed unless the treating doctor closes the case. How else to test the patient but by going back to work full time to determine if the patient can tolerate the stress of work?

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.

luckystar68
Member

January 9, 2013 at 2:59 am

Post count: 4

#7699

Hi Dr Corenman,
I have been working my same job 1-2 nights a week on weekends. Usually my back hurts after I come home from work from a 6-8 level on a 10 scale. I then deal with the pain for a few days until it subsides to a very comfortable level of 3-4 and pain meds are usually effective.

So I just have a few new symptoms that are alarming me.

1.New Years Day (Happy New Year!)I had worked Sat, Sun and Monday then,extreme pain in the lower back, buttocks and thighs after waking up, so much I couldn’t move my legs to walk . I had to call for my hubby’s help to get to the bathroom. My buttocks legs and thighs were clenched very tight and the pain was excruciating. I was afraid to walk without hubby’s help. The pain subsided after about 20-30 minutes and I took my muscle relaxer and pain med. I havent had that type of
pain since then.

2. My back is staying swollen from the mid section, (where I’ve had scoliosis for years) to the sacrum. Bulges are seen visibly on each side of the spine at the middle but more on one side than the other. I noticed this on Sunday after working all night Saturday with a heavy pt over 200# in wt.
Also my lower back has a very visible hole (indention only-skin is intact)in it! about the size of my fist, where the spine goes inward, and I cant feel the spine here it just goes in and is very swollen. My back has never looked or felt this way before. I have had swelling and pain ,just never seen this hole in my back.
Do I need to be concerned? Has my listhesis worsened or slipped from stage I to stage 2?i never officially got my listhesis “staged” it was just termed mild slippage on my MRI in August 2012.
I had x-rays done of my lower back while bending foward, then straight at lower back, then hyper extending the back. I was never told what stage the listhesis is. My doctor whom looked at the x-rays said it doesn’t look like I need surgery but he does see the bilateral spondylolysis on the xray, but didn’t mention anything about the slippage.This was in October 2012 that he looked at the xrays.

The doctor I’ ve been seeing now is only a pain mgmt doctor and after i reported problem#1, his nurse called me back cancelled my appt and referred me to a spinal rehab clinic. He stated he has done everything he can.
I have the appt with Dallas Spinal Rehab on Tuesday.

What do you think this is the best course of action for these symptoms? I will at least go to the appt for an eval. but I really didn’t want Physical therapy. I tried that for 6 weeks back in August 2012 it only made my back hurt more.
They did find hyperlordosis on my MRI consistent with the listhesis.
Any words of advice would be helpful, thanks so much for your valuable time.
I am getting tired of the increasing and constant pain.
I also have some constipation but have a bm once every week or so, & bladder functions are normal.
Severe cramping in right leg at times sometimes while driving.
It seems like I’ve been riding the merry go round of Drs trying to treat these issues with my back, and because of the workers comp? I’ m not sure I’m receiving the correct treatment for my diagnosis. The pain is just becoming intolerable and unlivable most of the time and I don’t want to become a drug addict.
Thanks for any advice.
MK(aka worrywart)

Donald Corenman, MD, DC
Moderator

January 14, 2013 at 6:48 am

Post count: 8660

#7732

These symptoms are pretty significant. 6-8 level pain after a day of work is pretty high. Some occasions of inability to get out of bed and having to “crawl” up your legs with your hands to stand upright (gower’s maneuver) are both signs of significant spine dysfunction. It may be time to consider a surgical consultation. Bring all your films to the consultation and ask all these questions to the surgeon. You should have all these questions answered satisfactorily to understand what your options are.

You can still try epidural injections and pars blocks and these might relieve your pain enough to function without a surgical consultation. If your slip has progressed or is a grade II or greater, you probably will be happier with a surgical stabilization.

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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