BlitzsweetloveMemberApril 18, 2013 at 3:36 amPost count: 6
I emailed the other day about my ice skater daughter. Found out today she has lumbarization at s1 with sclerosis. ( also has SBO, but we have known that). Would prolapse therapy possibly help her? She is in lots of pain. Her bone scan was also active. All other scans otherwise unremarkable.
Thank you so much for your time.Donald Corenman, MD, DCModeratorApril 20, 2013 at 9:17 pmPost count: 8459
I am not sure about the SBO as that means small bowel obstruction to me and I don’t think that is your daughter’s problem.
Lumbarization of S1 means that the first sacral segment became confused during maturation and did not join the other segments (S2-S5) in a solid union of the sacrum. This segment may or may not be movable but with a hot bone scan at this level, this means that the bone is seeing stress that it should not be seeing. More likely than not, this is one of the pain generators.
The way to prove this is to perform an injection of this region with a numbing medication (a block) and keep a pain diary (see website for this information). Temporary relief would indicate this is the pain generator. If steroid is also used in the block, longer term relief can be gained on occasion.
I think you mean prolotherapy regarding treatment. This is the injection of a damaging compound into the pain region to cause scar tissue to grow. I think there are indications for prolotherapy but since there are sensitive nerve roots around this region, the risk of damage to these roots outweighs the possible improvement from prolotherapy.
Dr. CorenmanBlitzsweetloveMemberApril 20, 2013 at 10:09 pmPost count: 6
Thanks so much. By SBO, I was referencing Spina bifida occulta.
If the injections( cortisone) do provide relief, do you ever do surgery at that point to fuse the vertebrae?
SharonDonald Corenman, MD, DCModeratorApril 21, 2013 at 12:17 amPost count: 8459
Surgery is commonly advocated when a positive block (good temporary relief) of a transverse-alar articulation is performed and the patient has failed good attempts at conservative care with continued disabling pain. The transverse/alar articulation by the way is the abnormal joint that is formed when the sacrum fails to fully fuse or the last lumbar vertebra tries to take on the sacral appearance incompletely. Spina bifida occulta is a common occurrence with this disorder and does not affect the biomechanics one way or the other.
The most common surgery is a fusion of the abnormal and painful segment. Consideration can be made to remove the abnormal articulation and not fuse the segment but in my experience, the success rate is only about 50%.
Dr. CorenmanBlitzsweetloveMemberApril 21, 2013 at 1:26 amPost count: 6
Thanks. I’m learning quite a bit. When its your 11 year old daughter you don’t want to leave any stone unturned.
One last question, assuming a successful fusion surgery, chances of her being able to go back to competitive skating? Hyperextention, load-bearing, repetitive sport. She is an elite athlete; just trying to help her be realistic about her future.
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