[Donald Corenman]

#4494

I have been active in competitive sports for my whole life. A year ago, I started to notice a sharp pain in my lower back. The pain gradually worsened and I saw my family physician who took and x-ray and assured me it was a muscular condition that would subside in a few weeks of rest. A number of weeks went by and the pain persisted, so I went to a pain specialist who took and MRI. He referred me to a spine doctor, who eventually sent me in for a CAT scan. I was diagnosed with Spondylolythesis, and they described to me that my pars interarticularis was partially fractured on the left side of the L5-S1 region and completely fractured on the right side. I was then put in a back brace and completed a month of physical therapy. I visited the same spine doctor just last week and was finally cleared to play sports with no restrictions. Unfortunately, I feel the same exact pain on the right side as before. I would describe it as just a sharp stabbing pain on the right side of my lower spine, which is aggravated by running, kicking, stretching my leg out, or bending backwards. Sometimes it will get to the point where I have severe muscle spasms, or it will start to hurt to even walk.

What are the chances the fracture never healed? I’m worried because if it didn’t heal in the 6 plus months of inactivity it probably never will. I doubt surgery is an option, but I am desperate to find something that will allow me to play sports without pain. Do you have any advice, tips, or suggestions regarding this condition?

[Donald Corenman, MD, DC]

#4501

You have been given a diagnosis of isthmic spondylolysthesis at L5 which is very common. This disorder is estimated to occur in one of every twenty individuals- especially ones involved in sports at a young age. Your report states that one side was “fully fractured” and one side “partially” fractured. I would have the radiologist and spine surgeon go back to that scan as most likely, both sides were fully fractured. Bone is generally brittle and partial fractures are very rare.

The chance of healing of those fractures depends upon the type of fractures and the reactivity of the bone fracture ends. Sometimes, the MRI can indicate how reactive the fracture ends are by using a skilled eye and the inversion recovery images (STIR images). This judgment would be beyond your ability to look at the scans yourself. The CT scan can indicate if the ends are atrophic (no reactive bone changes) which makes the healing of the fracture less likely. Trophic changes indicate a better chance of healing.

In general, when the patient is placed in a well made brace and with serious reduction of activity, about 50% of these fractures will heal. If the fracture doesn’t heal, then a decision needs to be made. I do believe that another limited CT study of your back would be helpful to your surgeon to determine if the fractures are healed (doubtful).

The fracture places more stress on the disc and the disc is not well equipped to handle this stress. If the disc develops a tear and then develops degenerative changes, then repair of the fractures will most likely not help to relieve back pain and a general physical therapy rehab program is appropriate. If the pain continues and interferes with daily life- a fusion of that level needs to be considered.

If however, the disc is still intact without tears, a surgical repair of the two pars fractures can eliminate instability and protect the disc.

Hope this helps.

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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