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Pars defect repair

Started by RichardT on 04/25/2013 3:06am

This website helped me to find a surgeon to do direct repair of pars defect. Search for the blog by Scott Hews on this website. I have just had a direct Buck repair of bilateral pars defect and grade 1 L5/S1 spondylolisthesis.
Some specialists don't believe that you can get pain from a cold pars defect but I had tremendous relief from direct pars injection even though the fractures looked cold on CT PECT with bone scan. The injection wore off after three months so I have now had the repair surgery. ( days post op I am walking up and down stairs. I will post more as I progress.

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Hi Richard,

How did you get on? I have just been to see a surgeon (here in the UK, are you UK based?) about a direct repair. I have the exact same condition as you (bilateral pars defect and grade 1 spondylolisthesis). I have had it for nearly 10 years now (i am 29). It was missed, and i only received a diagnosis 18 months ago. The surgeon thinks i should have a direct repair as soon as possible (using screws but no bone graft).

How are you feeling a few months on? I hope it has helped you. It would be great to hear how it went, how old you are, the exact technique etc.

Many thanks!

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I would also like to know how you are doing.

I have bilateral pars defect and grade 1 spondylothingy. Always in mild pain, gets worse with certain activities. How old are you and where did you have the surgery (geographic location).

Thanks

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Please reply and update as I'm currently seeking ideal surgical repair for my 17 year old son/athlete. Bilateral L5 pars fracture. Pain for 10+ months. Tried everything He is miserable and desiring surgical intervention at this point. I am an RN. I have been researching direct pars repair. Seeing a surgeon for evaluation and discussion in February. This will be first ever consult and I anticipate many more with various professionals before we proceed with surgical interventions. We would go almost anywhere in the universe for a specialist in the exact procedure my son needs.

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Richard,

How are you doing post repair and who is your surgeon? Thanks in advance for your reply.

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Sorry for delay replying. In short I have had an excellent result for the surgery. I saw Prof John Dowell who is based at Springfield Hospital in Essex in the UK. He is one of the few UK surgeons to offer direct Buck repair. Post surgery I spent about a month mostly resting at home then gradually returned to driving and work at weeks 6 to 8. Stopped all analgesia within four weeks of surgery and haven't touched painkillers since. Back was a bit stiff and sore for a few months and needed hot baths at end of day but no meds. Able to cycle after 3 months and able to go skiing 9 months post op. Have returned to cycling up to one hour 2 x daily and feel fine but still avoid heavy lifting or twisting. I recommend direct Buck repair especially if young and/or wish to remain physically active.

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Thank you, RichardT! So glad to hear you are doing better. We saw our first surgeon today. He wants us to try injections again and possibly radio frequency as more conservative approaches before we go ahead with surgery. My son is 17. He is very determined to return to a very athletically active lifestyle. We are on a quest to do the best thing for him and obtain the best possible outcome. Thank you so much for sharing the name of your doctor and the location as this helps immensely. Thank you again and I look forward to more updates as you progressively improve.

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Hello Richard T,
I had exactly the same symptoms as you did and was giving the same diagnosis but the surgeons I was seeing were all telling me I had only one option which was to have my L5 S1 fused which I refused to have done, I was competing at a high level in Brazilian jui jitzu and was lifting heavy weights as well , I done a lot of research about my condition then came across this forum which was like finding gold for me, not only did you list the hospital were you had it done you named the surgeon, which made it very easy for me to make contact with the right people, anyway spent a long time on the phone to his secretary who was so helpful I couldn't put into words, went to Essex for a meeting with prof. Bucks and the rest is history. I had the Bucks Repair done 5 days ago and I feel instant relief , my legs are no longer tight, I can already squat to the floor with zero pain, am sleeping like I did before the injury, would like to thank you for writing this post as it's helped me find comfort again. Thank you

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Best wishes Lennox. I assume you are home now.
Just remember take it really easy for 4 to 6 weeks No lifting more than a flimsy Tesco bag of shopping and no twisting
Start off with gentle pool sessions just walking in deep water, get a flotation belt via James Davis physio also in Chelmsford. I continued walking in water with belt for over a year. Really good for reliving stiffness.

Build up back strength gradually and remember full fusion can continue to improve up to 18 months

All the best

Long term avoid heavy lifting !! and twisting. It is the bone graft that holds you not the screws !!

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Thanks RichardT

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We are looking for surgeon in US that is very experienced with direct pars repair. We see several papers on MIS techniques that are now being employed with some success. Have tried 7 mos of conservative treatment - now looking to at least discuss possible surgery, as our 20 year old son wants to be active - and potentially return to his sport. Not sure how this community works in terms of getting specific recommendations - can there be a recommendation of a hospital?

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It is important to distinguish between minimal access fusion surgery and direct screw fixation of pars defect. Unfortunately not many surgeons offer direct screw fixation of pars defect (Buck repair as it is technically difficult. In the UK there are only a handful such as Lester Wilson in London and John Dowell in Chelmsford

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Hi Richard,

At the moment I'm almost 11 weeks post op a Buck's repair done by Prof Dowell (thanks to your reference). However, I still have a tingling sensation in both my legs including twitching and spasms, especially after some exercise or early morning after waking up. Additionally, (and possibly due to the bad state of the disc at the L5-S1 level) I still feel my disc slipping thereby giving a sense of significant spinal instability. Furthermore whenever I arch my back whilst doing exercises I can still feel something pressing on the sciatica nerve. Not sure whether it's the significant disc bulge which I had before surgery, a bone spur or something else. Next to this, how did you bone graft site ache progress over time?

As you can see a number of questions as I am bit lost and searching for answers. Just very curious to what extent you have experienced anything similar to the above as well at this stage. More generically, how was your recovery from month to month? For my understanding did you have any other condition other than a pars fracture at L5-S1 as I went into surgery with severe DDD at L5-S1 and bilateral foraminal stenosis at L4-L5? I know every person and its recovery is unique. Yet, I'm looking for some anchor points and tapping into your experience would help a great deal in doing so!

Would you be so kind to shed some light on these questions?

Many thanks in advance!

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After my Buck repair I still had a lot of discomfort for about six months. I found swimming with flotation belt helpful and sessions with James Davis also helpful. From about 8 months post ~Buck things really settled down. Got back to cycling and skiing. Still very sensitive to any kind of heavy lifting- would cause irritation/ pain for a week or so after lifting a heavy bag or box so tried to avoid this. I guess this is because although the vertebra repaired I still had a degenerate disc underneath. Still would get occasional foot tingling and left with a feeling of slight fragility e.g. when I went to spin class i would avoid standing in pedals as my back felt vulnerable. As well as physio with James Davis which focuses on reducing tension through belly breathing etc I also benefitted from another physio who helped stretch hamstrings with lots of manual therapy etc.

Ultimately, in the long run if Bucks fails there is the option of a fusion but I recommend persevering with physio at your stage.

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You might consider a lumbar CT at three months to see if bone graft has taken over pars defect . Lateral X ray alone docent show clearly enough. If the bone graft has failed I have other suggestions.

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Many thanks RichardT for your quick and informative response! It is of great help to me to get an idea of what's up ahead which in turn helps me to deal with the issues I (still) have,. I might at a later stage like to tap into your experiences again but for now I really appreciate you sharing what you have gone through and make this forum so meaningful.

Best wishes!

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Hi Richard

I also have Pars fracture L5/S1, with prolapsed disc L4/L5 but OK disc l5-s1. I saw Dr Blagg last week and he has recommended this over fusion. I also have a sacralised L5 and a bit of extra bone which is currently somewhat stabilising the pars fracture. Surgeon is not sure if there is enough bone either end of the pars to fix as its currently fragmented. I wouldnt be considered for this surgery if my L5/S1 disc had degenerated and its unusual that its still intact which is can only put down to the other defect.

The surgeon has never done this operation on someone my age and is taking my case to a board of specialists. How would i get myself referred to your specialist considering i dont life in essex? I am in buckinghamshire, UK

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My 16 year old son suffers daily from bilateral l5 fractures.
Can anyone recommend a surgeon in the NY/NJ area that has performed a direct pars repair with great success? I'm looking for a surgeon that has performed many , as I understand this type of surgery requires a very " practiced" and skilled hand.
Thank you

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Hi Richard,

Last eek on the 13th Sept, I had my bilateral pars defect repair by Prof. Dowell using his Buck repair along with a discectomy. Aside, from a lot of bruising I am up and about walking everywhere. The tingling sensation that I had in my legs has completely gone and for the first time in a very long time I have had a decent nights sleep.

I am due to see Prof. Dowell for a following in two weeks time but so far all good.

Your posts really did help me decide to contact Prof. Dowell and do something about my back. Now I just need to have physio slowly and then start exercising to get back into shape.

Thank you for sharing your story in the first place .

Adnaan

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Hi everyone!

First of all thank you for this post Richard, it's been great to read about your progress.
I have a bilateral pars defect (L5) and am in constant pain (I'm preaching to the choir here, haha!)
I have a quick question - I am based in Devon - how did anyone outside of Essex get referred to Prof Dowell? Do I need to go through my GP or do I contact him directly?

Thank you so much in advance, want to get the ball rolling as soon as possible.
Kathryn

Edit - upon searching, it seems like Prof Dowell is a private surgeon, my mistake. does anybody have any recommendations for NHS surgeons? TIA

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How old are you.
Have you had CT SPECT scan.
What are you being offered locally. by NHS spinal surgeon?
If NHS only you might consider asking your GP for a referral to see
Mr Lester Wilson at Royal national orthopaedic hospital
Email: karen.archer@rnoh.nhs.uk Telephone:+44 (0)20 8909 5840

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Following on from Richard's posts, I thought I would share my condition, 6-years after having the Bucks Repair by Prof John Dowell. I receive a lot of emails from people asking about my experience and wanting to see how I have got on following the surgery, so I thought it may be good to idea to post an update.

It took me probably 6-months following the surgery to really feel as though it had been a success and now 6-years (at 50), I can still do all the activities I wanted to get back to with no issue related to the original defect. I go to the gym most days and I can run and lift weights, albeit at 50, not as well as I could at 25. I play golf reasonably regularly and can carry when necessary and I still snowboard every year. These are all the things that I had to either give up beforehand or took a cocktail of pain-killers to get through. Don't recall the last time I took a pain-killer.....

Having said all of this, I do get the occasional back-ache, if I've been digging the garden or over done it lifting things, but that's common probably for every 50-year old. Due to the defect I carried for approximately 25-years, I did do an enormous amount of damage to my discs around the area of the defect but these did settle down and stopped giving me pain around 6-months after the surgery. What I have noticed is that if I do have any period where I do not keep on top of my fitness, the discs do start to flare up and give me some discomfort. I found the answer to this is to simply keep active and fit.

In my personal opinion, the bucks repair was a better option for me than the spinal fusion. I wanted to return to normal activities without the loss of any spinal movement and that's the point of the bucks repair. Having said that, all conditions are different and therefore it not necessarily applicable to all. The other point I would personally make to everyone considering this surgery is that this surgery is probably 75% of the solution. Keeping fit, healthy and trim will account for the other 25%. Pretty much all health issues in life are worsened if you are unfit or overweight. I say this as I am someone who very easily puts on weight if I don't keep active as I have a very sedentary job. As soon as a few pounds pile on, my discs flare up. By keeping my core strength up, my fitness levels good and therefore my weight down, I live a relatively pain free life and able to do all the things I want.

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Hi, I'm trying to find a Dr. who can do this surgery for my 16 year old daughter. she's a top-notch tennis player and is in pain with a 7mm pars defect on the right, spina bifida occulta, and edema on the left pars. She has to have orthognathic surgery in September and I'm wondering if we should do this surgery first? She loves tennis but is in so much pain when trying to play. We live in Florida. Any advice would be so appreciated.

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I'm new to this forum, but I'm suffering from a unilateral (left side) pars fracture at the L5 level. My surgeon is in St Louis Missouri and he has proposed the direct pars repair surgery for me using the pedical screw and hook system. I'm scheduled for surgery July 19th. I have read mainly about the bucks technique. But have agreed to this technique, my surgeon said success rate should be about 90%

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