Spondylolysis pain for 5 years! Should I be worried?

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Kelly
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November 17, 2011 at 10:07 am

Post count: 2

#5118

Hello,

I am a university student majoring in a fine arts dance program. Five years ago I was diagnosed with unilateral spondylolysis on the right sides of my L4 and L5 vertebrae. When I was first diagnosed I was put in a back brace for 3 months and was in physiotherapy for 4 months. I was told that the healing process would take a long time and, because my pain had greatly reduced over the course of the 4 months I was in physio treatment, I was released to do home exercises on my own. I did exactly that and waited for the day I would be back to normal but that day never came. I have had chronic back pain in the same place (localized around the L4-L5 and S1 region) for the past 5 years with extension and even flexion!

Now that I have started dancing about 16 hours a week in school, my back pain has only increased. I am in physiotherapy once again and an MRI has been ordered for me. I was just wondering how it could be that I have never been pain-free for all these years! I am only 22 and on some days it feels like I have the back of a 70 year old. I will not get my MRI for another couple months, but in the mean time, should I be worried about my condition?

I have not been doing any back extension bends for the past three weeks and it looks like I will not be allowed to do any jumps either since my pain has increased. I have to take it day by day. Some days the pain is at a 1, 1 being only slightly painful, and other days it is at a 7. It seems I do not even have to do anything to set the pain off! What should I do because if I cannot participate in my dance classes my grades will go down? :(

Donald Corenman, MD, DC
Moderator

November 17, 2011 at 9:57 pm

Post count: 8660

#5119

You have been diagnosed with a unilateral spondylolysis at two levels when you were 17 years old and have lived with this for the last five years. You have had chronic back pain for the that five year period and brace treatment did not heal the pars defects. I assume you do not have any significant leg or buttock pain. True?

The first question I have is how were these pars defects diagnosed? Did you have a CT scan? Did the scan reveal unilateral defects of the pars or the facet? This is a significant difference as unilateral pars defects normally heal if braced (although at the age of 17, the healing potential is less). Facet fractures, which look like pars defects but the fracture line is a little lower, typically don’t heal and create a great deal of pain.

The MRI or a bone scan can determine if the opposite pars is under stress and potentially developing an impending fracture. The MRI can also determine the health of your discs. A new CT scan can determine if the opposite pars is intact or has fractured as a new development.

Pain can occur not just from the unilateral pars defect, but from the opposite pars which is under much greater stress and can have an impending fracture (although after five years, the opposite pars should have fractured by now if there was an impending fracture). Pain can also occur from degeneration of the disc which can result from pars defects but normally does not occur with a unilateral defect.

The pars fracture can cause bone spur formation which can compress the nerve and cause buttocks pain. This pain typically occurs with standing and walking and disappears with sitting but in the later stages can be present continuously.

I think you need a full work-up from a qualified spine surgeon to know what to do.

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.

Kelly
Member

November 18, 2011 at 4:40 am

Post count: 2

#5126

It is true that I do not have leg or buttock pain. As for the type of fracture, I am not actually sure if it was my pars or the facet that was fractured because I was just told it was spondylolysis which I assumed meant that it was the pars. I was never given specific details.

For the diagnosis, I first had an x-ray taken but they could not conclude anything from it so I had a bone scan done which is when they confirmed the stress fractures at my L4 and L5 levels. I have the most pain when doing back bends but I also have pain with forward bends and after sitting or standing for a prolonged period of time. The pain is the least when I am lying down.

Maybe my condition was not dealt with properly because I never had any follow-up scans or tests scheduled after my physio treatment to confirm whether that area was healing. At least now I will be having an MRI so I can get to the bottom of this mystery once and for all!

Thank you for your comments!

Donald Corenman, MD, DC
Moderator

November 18, 2011 at 9:46 pm

Post count: 8660

#5131

You report your diagnosis of spondylolysis was made with a bone scan as the fractures could not be seen by standard X-ray. You apparently never had a confirmation by a CT scan.

Bone scans are designed to light up where bone metabolic activity is very high such as in a pars fracture that “is attempting” to heal. Bone scans will not light up at a pars fracture that has no metabolic potential (no “attempt” to heal).

The problem with using a bone scan by itself to diagnose a pars fracture is that one side may be “quiet” or non-reactive as it has already fractured and now the opposite side is in the process of fracturing and “lighting up” or reactive. A CT scan is necessary or at the minimum, an MRI to actually visualize the area to determine the integrity of the pars.

Good Luck!

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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