Donald Corenman, MD, DC
Post count: 8427

Let us discuss what causes facet or pars fractures. If there was a decompression that thinned the pars or facet down beyond the point of structural integrity, the pars or the facet can be broken, especially with an extension moment. As I noted earlier that I have only seen this 3 or 4 times in the higher levels but today was very different.

This very day I took care of a patient that had two “minimally invasive” prior decompressions at the L4-5 level at another institution. She was undergoing a TLIF fusion of L4-5 by me. At the level of the prior decompression, she had an L4 inferior facet fracture due to the thinned pars, the first facet fracture that I have seen at this level.

I would assume that most surgeons measure the width of the pars when doing surgery to determine how “thin” the pars can be made while performing the appropriate surgery. I also assume there are some surgeons who find circumstances that dictate the thinning to the pars to a point that it might be structurally unsound. I do not think the original surgeon knew that the pars was thinned too much and most likely, the fracture did not occur on the operating room table.

Your friend’s experience was obviously not good. He underwent a microdiscectomy and was discharged from the surgical center in severe pain with no increase in medications from prior to surgery. The question to ask is why his pain was greater than prior to surgery as with a microdiscectomy, normally the pain improves substantially postoperatively. The lack of ability to communicate with the surgeon is something I also cannot explain.

The second surgeon reports an iatrogenic pars fracture (fracture caused by physician intervention) and fused the segments involved. I assume the fusion was for instability of the segment secondary to the pars fracture.

Two months after the second surgery, your friend bent down, felt a “pop” and developed pain greater than necessitated the first surgery. He now has had back and right leg pain for three years and his life is substantially changed.

I would hope he had a new work-up after that episode to determine the origin of the new pain and had it addressed.

I can understand your reluctance to have back surgery after the experience of your friend but I assure you that his experience is not universal. We have some of the best spine surgeons in the world here in the USA.

Dr. Corenman