[Jinx]

#23183

Hi Dr Corenman,
I wonder if you could advise me of what to do next.
I saw an orthopaedic surgeon 2 years ago who told me there was nothing he could do to help me unless in an emergency (cauda equina symptoms) and that my condition would become disabling in time. I live with chronic pain from a fractured pars, moderate facet joint arthropathy, a transitional lumbosacral segment with lumbarised S1. I have good days and bad days. Standing for long periods and walking over a mile tends to aggravate my condition, as does bending and stretching and twisting or lifting heavy items. Sometimes I yelp in pain when i move my hips, sometimes it feels like my fracture might be moving and impinging the spinal cord because i get horrendous searing stabs that make me gasp out loud, other times i groan with pain when ive been active too long. I have sometimes suddenly lost the use if my leg for a split second, it can give way suddenly, but it is fleeting.
I have a mass of hypertrophic bone growth at the fracture site and an osteophyte in the foramen which i am assuming is affecting the nerves to my leg. I have regular hip and buttock pain and sometimes radiculopathy down to and around the front of the knee.

I am a 49 year old UK military veteran so have had a “heavy duty” career. I also have an aunt who was crippled in a wheelchair with spinal arthritis so there may be some hereditary stuff going on.

My question is this, should i accept theres nothing that a surgeon can do, or should i be looking at a second opinion. Is there something a surgeon could do to alleviate my pain? Or is it too difficult to operate on considering the bone growth?
Would a back brace be helpful or could it make things worse?
Anything you could suggest would be most appreciated.
Thank you for your time :)

Pictures of xray

[Donald Corenman, MD, DC]

#23186

You are finding put that there are “old style” physicians and “state of the art” physicians. The old training noted that the only spine surgery that needed to be considered is when there is risk of “life and limb” such as a cauda equina syndrome. The understanding of spinal disorders and the surgical potential has come a long way since then.

Your disorder “chronic pain from a fractured pars, moderate facet joint arthropathy” is most likely a condition that could respond to decompression and stabilization (fusion). I certainly would gain a second opinion from a capable spine surgeon as by face value, surgery should be able to help you.

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.

[Jinx]

#23191

Thank you for a speedy response. Which bones do you think might be fused? I have an LSTV with Lumbarised S1, so would it be S1, Transitional L5 and L4? What about the fractured pars pedicle would that be removed during fusion?
Thank you for your advice it is very much appreciated. I will start to do my homework and look for another surgeon. :)

[Donald Corenman, MD, DC]

#23195

The fractured pars level is most likely the slipped level (isthmic spondylolisthesis) and this is most likely the lowest movable level in the lower back. See the section under TLIF as this is more likely the surgery to repair this disorder.

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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