texasspondy

Dr. Corenman, is this a procedure that had to of been done overseas, Europe or something. I’m just curious as to my research or education on this is that in the U.S. it’s not approved except in the Neck or C area of the spine, and not the Lumbar, yes/no.
Appreciate the knowledge….

Dr. Corenman, I’m curious on something in this last post that kind of caught my eye. You have to be prepared to be ruled out for surgery…
My diagnosis is a little bit different than this gentleman, however we do have a common problem, a pars fracture. Mine is at the l5-s1 with some left formainal stenosis due to a slight bulge in l5 disk.

I’m curious becuase you made light of something that my doctor had brought up in that, if we were to have a sedentary type lifestyle we might, key word might be able to avoid surgery. If we choose to be active we might have no choice but to have surgery.

In my case, I have tried a somewhat sedentary route, meaning, I have not played golf, skiied, bowled, been back to the gym, and I’m sure there are other things. However my job is a mechanic, it’s what I’m trained to do, it’s what I know, and it pays my bills. I have had to lean on my buddy’s at work to do a few of the more heavier or awkward (pretzel) body position jobs, this has allowed me to reduce my pain level down to 2-4 instead of say 4-8.

I have tried and actually still trying to take steps to be in a more sedentary job atmosphere, however, it requires time, politics, additional training, credentials, so it’s not an automatic thing for me. I also can’t lean on my buddy’s forever, it’s not fair to them.

So where I’m going with this is, you mention surgery being ruled out, in your experience, I assume insurance co’s have the oh mighty say all, and what in a case like mine or this gentleman here would rule surgery out or I guess be denied? Because honestly, if myself or this gentleman were a new hire, and didn’t have our coworkers, friends support, we’d have to hit the ground running, and honestly, I’d be at home on fmla with no pay right now due to immense pain, so technically, you could say, I can’t perform my job, I can’t enjoy the activity’s I’d like to do, and truthfully, even if I was not 41 years old more like 65, I want to at least maybe golf in my retirement. Thank you sir for your time and experience for us to learn.

Dr. Corenman post=1670 wrote: You have to remember that these are just suggestions and that you have to gain the support of your treating physician to carry these suggestions through. I have never examined you so there are no specific recommendations that I can make.

You have indicated that your symptoms have improved in the last couple of weeks and that your benefits will run out soon. You are thinking of returning to your occupation. The question then is- can you go back to being a firefighter with the all of the required lifting and spinal loading? The only way to test the possibility of return is to recreate the typical loads on the spine that will be seen as a firefighter. This can be accomplished by a good therapist simulating the expected load on the spine in a controlled environment.

This testing can however cause a substantial flair-up so you have to be prepared for an exacerbation of your back pain and again, this has to be ordered by your physician. I am only giving you suggestions.

If you cannot load your spine without pain, you have a choice. You can live with the restrictions and get a sedentary job. You have seen that with restrictions, the spine pain becomes manageable. You may not be able to participate in the sports you want to but you may be able to avoid surgery.

If you want to see if surgery can reduce your spinal instability, you would need to undergo a work-up to determine the pain generator. You have already had numerous injections which were non-diagnostic. The next test could be a discogram. You have a relatively normal looking L5-S1 disc. The L3-4 disc is degenerative with the pars fractures and the L4-5 disc is mildly degenerative.

The discogram may indicate that you are a surgical candidate but you have to be prepared to also be ruled out for surgery too.

Dr. Corenman

Hello, I have been following your thread since it shares similiar diagnosis as my circumstances, l5-s1 pars defect with left foraminal stenosis.
I have had two ESI to date and the PMS injected the first bilaterally at the pars and the into the canal from the left side, the the second, at the pars bilaterally and then centrally in the canal. Both gave me about a day of relief. Between the cost of each, the day off work, being real sore for a week from the injection, scheduling of injections, getting a ride to the injection, and the lack of results, I chose not to do a third injection.
As of now, they have me going in next monday for a bone scan, something to do with seeing if the pars area is laying down new or old bone/scar tissue, and then discussing RFA depending on the bone scan results.

I think I’ve just concluded that I have tried all conservative measures, including PT, diet, vitamins, injections, bracing, time off work, light duty, good posture, heat, cold, chiropractic, etc and the true fix would seem a TLIF at l5-s1.

You know, I feel that even though the pars wasn’t broke necessarily from work itself, that the repetive nature of my career being a mechanic has thrust it into a state of being retorn or more damaged than if I had a sedentary job. I did not go workmans comp on this because of the nightmares I have had on other injuries wc and though costing me more, I don’t want a panel of folks deciding what and how I might get treated for something as serious as my back.
Best of luck and success with your back.