suspected pars fracture, lumbarization? Athrosis? please help!

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besotted
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July 2, 2013 at 9:53 am

Post count: 1

#8983

Hello Dr,
I am hoping you can explain mri results to me? This is an old MRI from 2003. My doctor at the time never did explain it to me properly and I am having chronic/extreme pain again after years of stiffness and a tolerable, faint everlasting pain. (If that makes any sense?)

BACKROUND: I injured my back When I was 14 in the year 2000, ended up in the ER twice in one night because I was unable to move my lower body.
The ER could not/did not find anything wrong and did not diagnose me. (They sent me home with muscle relaxers and pain killers.) After about a week I was able to function normally again and did so until another spell would hit and I again would be laid up for up to a week.
I gave birth in 2002 and started seeing a pcp.
I explained my constant back problems to him and he sent me for an MRI. Shortly after I went for the MRI I lost my insurance and was not able to continue treatment.
Lived in MN

Anyhow, This is the information I have of the MRI:

Lumbar spine, 3 view
partial lumbarization of the S1 vertebrae. Arthrosis with suspected pars fracture of the L5-S1 facet level. Minimal anterolisthesis of L5

Impression: Suspected pars fracture L5 level with minimal anterolisthesis of L5
——————————————————————-
MRI of lumbar spine

History: Chronic back pain times 3-5 years? Pars fracture
Technique: Routine Lumbar Protocol

Compairison: None

Findings:
A transitional lumbosacral segment is present which most closely approximates S1 with a normally hydrated S1-2 disk

L1-2, 2-3, 3-4, all normal

L4-5 * normal disk morphology Mild facet arthrosis

L5-S1 normal disk height with mild desiccation and mild diffuse disk protrusion which extends dorsally 3mm. No central or lateral recess stenosis. Moderate facet arthrosis

Miscellaneous: Normal conus medullaris and cauda equina. Normal vertebrae and paraverleoral soft tissues. No pars defect or spondylolisthesis demonstrated.

Impression
1. The transitional lumbosacral is present labeled S1 with a normally hydrated S1-S2 disk
2. L5-S1 diffuse disk protrusion without stenosis. Moderate facet arthrosis.
———————————————————————

Basically what my PCP told me was that I had broken a vertebra and it healed wrong instead of healing like this (( it healed like this )(

I have no idea what any of it means!
All I know is that
I am in constant pain on a 6-8 pain scale with bouts free of extream but still steady in a manageable way and then sometimes pain so bad I can hardly move from my bed.
I am worried about trying to see a physician for this (I have insurance again) as I haven’t seen any physician except in an E.R. and the fact that I currently live in Florida and there are so many people faking injuries to receive medications they do not need that I fear I will be treated unfairly or as a drug seeker when all I want is to manage this pain to get back to work.

Could you possibly tell me what this MRI says and if I should still be suffering pain 13 years later? Could my back have gotten worse or could it have healed entirely and I have something else wrong?
Should I try finding a primary care physician or someone specialized?

PLEASE help as I am at my wits end and pain is becoming intolerable even for me!
Thank you

Donald Corenman, MD, DC
Moderator

July 3, 2013 at 7:41 pm

Post count: 8660

#8988

Your MRI findings are somewhat confusing. Did you have the old MRI in 2002 and then a new recent MRI? Do you have a slip at L5-S1 where the L5 vertebra has slipped forward on the S1 vertebra?

There are two reasons for a slip in your case. One is a degenerative spondylolisthesis and the other is an isthmic spondylolisthesis. See website for the differences.

The isthmic spondylolisthesis diagnosis is supported by the “first” MRI information “Arthrosis with suspected pars fracture of the L5-S1 facet level. Minimal anterolisthesis of L5”

The “second” MRI information of “L5-S1 normal disk height with mild desiccation and mild diffuse disk protrusion which extends dorsally 3mm. No central or lateral recess stenosis. Moderate facet arthrosis” does not report pars fractures but does report significant degenerative facets which supports the degenerative spondylolisthesis diagnosis.

You need to find a spine surgeon to give you the accurate information regarding your diagnosis and potential treatment.

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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