madhavlParticipantJanuary 25, 2021 at 12:30 pmPost count: 1
Dearest Dr. Corenman,
I am a 19 y/o who has always led an extremely athletic life (junior pro tennis, soccer, basketball). I started having back pain 8 months ago. I got an X-Ray of LS-Spine in Flexion & Extension (Aug-20), an MRI of the LS Spine (Aug-20) and a CT Scan of the Lumbar spine (Dec-20). I have a bilateral pars defect at L5 and minimal Grade I Spondylolisthesis of L5/S1. We also found Spina Bifida Oculta.
I haven’t played sports for 8 months, let alone jog or run. I’ve been doing aggressive strengthening of the core and surrounding muscles in physiotherapy for the last 6 months. I hope to one day be able to get back to tennis and soccer. I have had to take a year off from college after high school because of my condition.
With the way conservative treatment has been going, I’m not confident I will be able to do that and get back to sports without fixing the defect. So I’m considering a direct pars repair surgery.
My questions are:
1. In your opinion, am I eligible for a direct pars repair? I really do not want to get a spinal fusion. The MRI shows healthy discs (only minimal disc height reduction and bulging), I have minimal Grade I slippage, my spine is stable, and I am 19 years old.
2. How long do you think recovery from a potential pars repair surgery would take? I have to attend college by August/September 2021, so when should I plan for an operation?
3. Since Pars Repairs are more likely to be successful in younger patients (adolescents), would it be better if I did it sooner than later? I am 19, would you suggest I wait longer to see if conservative treatment can get me back to sports or that I go ahead with a repair soon? For example, if I did the surgery between my Freshman and Sophomore year (May-August 2022), would that be worse/better/the same in terms of likely outcome?
Thank you very muchDonald Corenman, MD, DCModeratorJanuary 25, 2021 at 1:47 pmPost count: 8459
Pars repair success depends upon disc health (no tears or degeneration which precludes repair), age of patient (younger is much better due to healing potential), type of pars fracture (atrophic, hypertrophic), amount of gap of fracture (normally associated with type of fracture-atrophic, hypertrophic), amount of slip (greater slips associated with worse prognosis and patient body habitus (larger patients don’t do as well). Don’t be afraid of one level fusions as they can be highly effective and compatible with return to all sports.
You can wait as you already have a slip. If your symptoms have been present for greater than one year, it is unlikely to improve over time.
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