How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Dr. Mark Your Own Question

Dr. Mark
Dr. Mark, Physician / Surgeon
Category: Medical
Satisfied Customers: 11946
Experience:  U.S. Surgeon / Neurological Surgery
Type Your Medical Question Here...
Dr. Mark is online now
A new question is answered every 9 seconds

I have been diagnosed with bilateral pars defect of the L5

Resolved Question:

I have been diagnosed with bilateral pars defect of the L5 vertebrae. I have been to at least 6 different doctors and all point to a lumbar spinal fusion as my best bet for pain relief as many conservative treatments have not been successful. My medical insurance has denied the request for surgery twice saying there is no proof of spondylolisthesis. What do I do now? I have been off work due to the pain since January. Do I file for SSD???
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. Mark replied 3 years ago.
It seems that if all of your doctors have evaluated you and determined that you have instability in your spine (from the pars defect) -- that a fusion surgery would help you.

Unfortunately, it seems that your insurance company does not agree (a nurse reviewer is seeing if your doctor's notes have the key words necessary for approval).

So -- you should discuss this with your surgeon, to see if they can do further studies (such as flexion and extension views) to determine if you have instability in your spine, or to see if your pars defect does cause a listhesis in certain positions.

Of course - a fusion surgery does not guarantee pain relief, so that is why your insurance company wants further proof that a surgery could help. A surgeon could file an appeal with your insurance company asking for a physician reviewer to see if your surgery can be approved.
Customer: replied 3 years ago.

Are the flexion and extension views done by xray? To positively diagnose the pars defect, they did a CT scan and xrays where i had to bend forward and then bend backward (or try to). I have also had an MRI which showed nothing. I also have numbness & tingling down one leg - if i touch my outer thigh, i can feel it in my inner calf. The first denial said that I didn't have enough nerve damage to warrant surgery, but they did no nerve conductivity tests. This new denial basically denied the surgery because there was no proof of spondylolisthesis, but from everything I have read there have been cases of fusion done for the spondylolysis by itself...is it possible that even tho I am in constant pain that I have to wait for something more severe to happen for them to approve surgery???

 

 

Expert:  Dr. Mark replied 3 years ago.
OK.

The bending forward and backward are the flex-ex films.

Right now, you have to understand it from the insurance company's point of view. If you have no spondylolisthesis -- right now, on the MRI, your spinal cord looks essentially normal. The nerves are wide open, and there isn't anything that is putting pressure on your nerves.

So, in their eyes -- there isn't much that can be done for you.

Spondylolysis though, can cause back pain with the instability in the lower back, and often times this is tough to show. But generally many people do have your condition, but without any pain -- and eventually you can develop the spondylolisthesis.

Perhaps you can get an EMG test, which can show if there is any nerve issues This is performed by a neurologist.

Customer: replied 3 years ago.

Outside of surgery, can you suggest any other treatment options? I feel like I need to do something more than just sit around and wait for my condition to progress to a point where I either have more nerve damage or it develops into spondylolisthesis.

Expert:  Dr. Mark replied 3 years ago.
Well, really the only permanent thing you can do is to aggressively strengthen your core back muscles.

Strengthening your back muscles helps to "stabilize" your lower back, and lessens the pain from a spondylolysis.

This is called core muscle strengthening -- and you really have to get these muscles stronger for any benefit. Physical therapy to show you these exercises would be helpful.

The other things -- steroid injections, pain medications, a brace - only help to "mask" the true issue, and really would be only temporary fixes to your issue.
Dr. Mark, Physician / Surgeon
Category: Medical
Satisfied Customers: 11946
Experience: U.S. Surgeon / Neurological Surgery
Dr. Mark and 6 other Medical Specialists are ready to help you

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
< Last | Next >
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
 
 
 

Meet The Experts:

 
 
 
  • Dr. Thomas, MD

    Board Certified Physician

    Satisfied Customers:

    46349
    Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
< Last | Next >
  • http://ww2.justanswer.com/uploads/DR/DrThomasMd/2012-7-25_134438_Imagess1.64x64.jpg Dr. Thomas, MD's Avatar

    Dr. Thomas, MD

    Board Certified Physician

    Satisfied Customers:

    46349
    Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
  • http://ww2.justanswer.com/uploads/MY/mysticdoc/2012-6-8_15615_mysticdoc3.64x64.jpg Dr. D.J.'s Avatar

    Dr. D.J.

    Board Certified Physician

    Satisfied Customers:

    14679
    MD
  • http://ww2.justanswer.com/uploads/agketch/2008-7-14_184046_drketchresized.jpg Dr. Ketch's Avatar

    Dr. Ketch

    Board Certified Physician

    Satisfied Customers:

    76
    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • http://ww2.justanswer.com/uploads/FA/FamilyPhysician/2013-8-31_191624_JA550x500Photo.64x64.jpg Family Physician's Avatar

    Family Physician

    Doctor

    Satisfied Customers:

    2562
    Emergency Medicine and Family Practice for over 26 years
  • http://ww2.justanswer.com/uploads/DR/drappapo/2013-8-16_22576_drdavid.64x64.jpg Dr. David's Avatar

    Dr. David

    Board Certified Physician

    Satisfied Customers:

    224
    Treat children/young adults, former chief resident, multiple publications
  • http://ww2.justanswer.com/uploads/DrDLove/2009-08-12_141522_DrDLove.jpg Dr. D. Love's Avatar

    Dr. D. Love

    Doctor

    Satisfied Customers:

    11961
    Family Physician for 10 years; Hospital Medical Director for 10 years.
  • http://ww2.justanswer.com/uploads/CO/commissure/2011-4-15_192514_REISD20080926JR1090.64x64.jpg Dr. David's Avatar

    Dr. David

    Board Certified Physician

    Satisfied Customers:

    10667
    Experienced Physician trained in New York City. I'm ready to help.