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in reply to: Questions About The Mechanics of Pars Fracture #7657
I understand that the forces were great in your accident deceleration but still not great enough or angular enough (your body was captured by the seat and restraint mechanisms) to fracture a normal pars.
Acute lower back pain should normally be apparent within 1-3 days after the accident but with the “shock” of the situation and medications or change in habits immediately after the accident, I could see ignoring this new pain as one of the “general aches and pains” that occur after any accident.
You are asking two different questions to note timing in changes within the disc in MRI after accident. The three to six months time is the time from a new annular tear to the noting of degenerative changes of a disc on an MRI. The 10-15 years is the time it takes normally to see significant changes in disc degeneration from the initial pars fracture. The name of the cascade from pars fracture to degenerative changes of that level is the “degenerative cascade”.
The tear of the pannus is the “straw that broke the camel’s back”. You had preexisting degenerative changes but these were all asymptomatic. It took the tear in the pannus to trigger all the symptoms that have subsequently occurred.
There is not a beginning of enough education and training in regular schools (let alone medical schools) to allow people to understand the mechanics of the lumbar spine.
It is unlikely that at the time of the accident that your pars could have been repaired to prevent progressive degenerative changes from taking place.
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.in reply to: Facet Joint Disorders #7652In general, tinnitus does not originate from the cervical spine. The acoustic cranial nerve does not exit the skull. There may be some feedback that can occur from other tracts that drop down below the base of the skull (foramen magnum).
Base of skull neck pain and back of the head headaches commonly do originate from the facets at C1-2, C2-3 and C3-4. Your CT report does note arthropathy (arthritis) of the C2-3 joint and this can cause some of your symptoms. You have a fusion of C3-4, so we can rule out that level as a cause of pain.
Since you have had diagnostic blocks of C2-3 that relieved your pain, the rhizolysis of the facets you have planned is a good next step. That is if you had a good 2-3 hour window of relief immediately after the facet injections (see pain diary).
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.in reply to: Lumbar 3 scyatica #7650Your age is about the average for symptoms from a degenerative scoliosis with resulting compression of a nerve root.
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.in reply to: Questions About The Mechanics of Pars Fracture #7647Question one-“Can a motor vehicle accident cause pars fractures?” Answer-yes but only very rarely and under dire circumstances-ejection from vehicle (no seat belts) or severe impact with body encroachment. The disc will not show signs of degeneration for at least three months and more likely six months or more. The typical mechanism is an extension moment (severe bend backwards).
Question two-“How immediate would be the onset of symptoms?” Answer-immediate. This would be an acute fracture with the subsequent inability to stand upright without significant pain and muscle spasm. No matter what medications you were on, you would notice the pain and dysfunction.
Question three-“How likely is it that the degenerative process could occur and be asymptomatic (painless)? Answer-This is the most common scenario. Most individuals develop this stress fracture when young and don’t develop symptoms until a relatively minor injury causes a tear of the fibrous pannus. You symptoms that have developed after a motor vehicle accident are typical. This does not mean that this preexisting condition precludes you from causation.
Forth question-“How long does it take from pars fracture to degenerative disc disease?” Answer-many years. I am currently researching this and anecdotally, it appears to take at least 10-15 years with some exceptions.
Last question-“If bilateral pars fractures are noted without a slip and with a normal disc, is it recommended to repair the pars fractures?” The answer is still under investigation. If the gap between fragments is large, I don’t think a repair can be effective. Also, the older the patient, the less natural healing response is possible, even with BMP. I can also argue the opposite side. I have repaired multiple adults under this condition successfully. Only time will tell if repair will be effective to prevent degenerative disc changes and what the fracture separation distance is for a successful repair. I have turned down patients for repair with a 5mm fracture separation (they need a fusion) and successfully repaired 3mm separations.
Will repair prevent the degenerative process? Logic and reasoning says it will but only the test of time will answer this question.
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.in reply to: Lumbar 3 scyatica #7646It appears you have a significant degenerative scoliosis of your lumbar spine. I have to ask how old you are as these changes take many years to occur.
The degenerative changes have created what sounds to be lateral recess stenosis and foraminal stenosis on the left at minimum of L5-S1 (see website for all these conditions). I would assume that the leg pain is much worse with standing and walking and improved with sitting and bending forward. This is called stenotic leg pain.
You could have some benefit from epidural steroids and traction but these might be temporizing measures. There are times that surgery might be the only long term solution for this condition but I do have some patients that can manage with this condition without surgery.
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.in reply to: Lumbar 3 scyatica #7644Please see the section under “Conditions” regarding “How to describe symptoms” so that you can convey what symptoms you are having specifically, the history of the symptoms and what work-up you have undergone.
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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